International policymakers gathering in London today are braced for a tough task: two years after Covid-19 unleashed an enormous human and economic toll, they must step up preparations for the next pandemic.
And, despite a virus that has claimed millions of lives and cost billions of dollars since the start of 2020, leaders from around the world now face two problems in seeking to allocate resources. First, there is a temptation to shift focus elsewhere as the threat from Covid appears to be fading. Second, there are intensifying demands from other threats, most immediately the invasion of Ukraine.
Against a backdrop of slowing economic growth and spiralling debt, it is no easy time for the Coalition for Epidemic Preparedness Innovations (Cepi) to convene a replenishment conference this week. Cepi, a foundation, wants up to $3.5bn to help develop new vaccines and systems to tackle “disease X” — the next, but as-yet-unknown, pandemic.
In the case of Covid-19, it took 326 days to progress from virus identification to emergency authorisation of vaccines — a feat never before achieved so quickly. But Cepi wants to reduce this time further, to 100 days, through strengthened disease surveillance and data sharing, accelerated regulatory approval, enhanced manufacturing capacity, and prototype vaccines that are ready to be adapted and quickly tested.
“We can’t let ourselves be completely distracted,” says Richard Hatchett, Cepi’s director. “Covid is the seventh global infectious disease crisis since the start of this century.”
He is referring to what are seen as the ‘near-misses’, of Sars, Mers, Ebola, Zika, and two particularly dangerous influenza strains, before the advent of Covid-19. “This class of threat reflects the way modern life functions. We’ll see a continued frequency of emergencies and vulnerabilities.”
Cepi is not alone in its efforts to demand additional funding and innovative approaches to prepare for future health threats. Many national and international groups have been set up to reflect on the gaps and errors in the response to the current pandemic, and multiple organisations are already formulating responses.
The Global Fund to fight HIV, TB and Malaria, which tackles the “big three” infectious diseases in lower and middle income countries, recently launched its own replenishment fundraising campaign for $18bn. That includes $6bn for health-system resilience and pandemic preparedness.
But, as the organisation’s director Peter Sands warns, policymakers’ responses swing between “cycles of panic and neglect”. Funding is drying up for the current pandemic response, even as poorer countries continue their struggle to gain access to vaccines and build systems to deliver them, and richer countries remain vigilant over new variants of Covid-19 against which existing defences may prove less effective.
David Heymann, a professor at the London School of Hygiene and Tropical Medicine and a former top official at the World Health Organization, says that while Singapore and Hong Kong learnt from their experiences of the early 2000s Sars outbreak, other jurisdictions failed to learn the lessons.
“You need surge capacity and continuing access to healthcare,” he points out. “You have to hook up preparedness, from basic public health capacity to resilient health systems and population health. The problem in public health is it’s a long-term benefit while political leaders are looking for short-term gains.”
Heymann underlines the importance of broader initiatives to mitigate both the emergence of new diseases and other public health challenges — such as climate change, the interaction of human and animal health, and the need for more primary care and preventive services to limit “underlying conditions”, such as diabetes and obesity.
In a report for the Global Challenges Foundation think-tank, Heymann and other authors stress the importance of reinforcing existing multilateral institutions, rather than creating new ones, and shifting decision-making from a “colonial” global level to national and local organisations.
This mirrors a study last month led by the Institute for Health Metrics and Evaluation, which highlighted how higher pandemic mortality and reduced vaccination rates were correlated with higher levels of corruption and lower levels of trust in government.
As the Global Health Security Index concluded late last year in an assessment of readiness for future pandemics: “No country is fully prepared . . . [leaving] a world acutely vulnerable to future health emergencies, including those potentially more devastating than Covid-19.”
While it ranked the US as the best prepared nation in theory, it stressed that the country’s response in practice to the pandemic had been “extremely poor” — marred by politicians’ questioning of health officials, the weaknesses of its fragmented medical system, and inadequate numbers of staff and hospital capacity.
The Global Health Security Index pointed to the need for greater accountability on the part of economic actors — a demand echoed in rising calls for an international pandemic preparedness treaty and a mechanism that finance ministers, central banks and investors can use to assess the strength of health systems.
As Heymann says: “If the economic sector does not hold public health accountable, we will end up with the same damage in the future. It’s not for health to look out for the economy, but for the economy to make sure it gets what it needs from health.”