The recent COVID 19 outbreak brings health security back to the top of the policy agenda.
The world is now responding to COVID 19 to prevent it from becoming a broader global crisis. As new infections and deaths mount every day, and the fear of global spread and pandemic is growing, how do governments organisations or communities manage?
A pandemic is the spread of an infectious disease in numerous countries or continents that affects an exceptionally high proportion of the world’s population.
Pandemics can endanger large numbers of people and are unpredictable. While we know there will be pandemics, we don’t know when. Until they happen, we won’t know how severe they will be, or who will be most affected.
How did we get here?
The origin of most infectious diseases in epidemics and pandemics are animals. The most significant pandemics are influenza based. They spread fast and occur every 10 to 50 years and are almost certain to continue to occur. The 1918 flu pandemic killed at least 50 million people while the AIDS pandemic, which began in the mid-1980s, evolved over 30 years and affected more than 80 million people (roughly 32 million people have died while 38 million people are living with the HIV virus).
Pandemics generate an unprecedent level of fear. Often people will get very ill, and many will likely die. As a result, healthcare services may have difficulties providing direct care. Also, a very high absence rate of employees due to sick leave can occur during some periods, disrupting societal infrastructures.
It is paramount for all levels of government to plan for these disruptions because of the certainty of pandemic occurrence, and their expected high socio-economic and political impacts, combined with the uncertainty they bring.
4 systematic responses to pandemics
Response to pandemics varies with the disease. Severity, availability of treatment or vaccines, force of transmission and, above all, route and duration of transmission (which are key to controlling the outbreak) shape the response.
Pandemic response is composed of four blocks:
- Coordination: Coordinate responders at the highest level of the state and at subnational levels. These include experts in charge of surveillance, laboratories, sanitation, vector control, logistics and healthcare services. They also include partners from other sectors such as education, military and police forces, communications, transport, animal health officials and community representatives. In order that these resources and partners work effectively, a dedicated physical space, such as an emergency operation centre with communication tools, is needed. Also essential is a plan of action, regularly updated as the situation evolves, describing interventions and distribution of roles and responsibilities. This plan should lay out how businesses and other organisations will continue to provide essential services through a sustained period of significant employee absenteeism.
- Health information: Implement surveillance of the disease to provide information about the number of cases and deaths by period and location as well as the coverage and impact of interventions being performed.
- Communication of risk: Initiate outbreak-risk communication by relaying information on the nature of the event and the protective measures that people can take, listening to those affected in order to understand their fears, concerns, perceptions and views, and managing rumours and hearsay. This will prevent the rapid spread of unreliable information that can generate fear and irrational actions.
- Health interventions: Each disease requires a different set of health interventions to be rolled out in order to reduce transmission, morbidity and mortality, and the impact on health systems and other sectors. Health interventions can include the interruption of environmental sources (e.g. provision of safe water, adequate sanitation and shelter, and establishment of standard infection control precautions in healthcare facilities); removal of people from exposure (e.g. initiation of social distancing measures); modification of host response (re-establishment or strengthening of vaccination, treatment of cases and provision of prophylactic chemotherapy); inactivation or neutralisation of the pathogen (e.g. water treatment measures); isolation of infected people to prevent spread and to optimize case management within adapted specialized health facilities (e.g. for diseases such as Ebola and cholera); reduction of vector transmission (e.g. elimination of breeding sites, larviciding, spraying of insecticide in health facilities and communities, distribution of long-lasting insecticide-treated nets and implementation of environmental hygiene, depending on local vector species); improvement of personal hygiene and food handling procedures (e.g. through health education, provision of detergents, including soap, and adequate access to safe water); removal of contamination source (in case of intoxication); behavioural and social interventions, including limitation of social or mass gatherings, control of funeral procedures (e.g. for cholera or haemorrhagic fevers), systematic cleaning and disinfection of market places, and forbidding small-scale improper water selling (cholera etc.).
For the successful implementation of health interventions there are also two essentials: community engagement and field responders gauging local perceptions of the disease and of the response measures, listening to communities’ fears and attitudes and supporting community participation.
It is of key importance that healthcare workers, who are regularly more affected than other occupations during epidemics or pandemics that involve touch or proximity, are protected to support and maintain health-system capacity. This is done through the reinforcement of infection-control precautions in healthcare facilities and provision of personal protective equipment.
Without an effective vaccination or medication, health interventions will focus on:
- Isolation of infected people and those they have encountered;
- Treatment of cases in specialised health facilities with reinforcement of standard infection control precautions;
- Removal of people from exposure through initiation of social distancing measures and cancellation of mass gathering events;
- Improvement of personal hygiene through health education and provision of detergents and soap.
While health services start to become overwhelmed in affected areas, fear, panic, stigmatisation, economic losses and social disruption challenge politicians, government officials, community leaders as well as professionals. It is urgent for all governments, organisations and communities to systematically address these four essential components. They must anticipate the impact of the epidemic.
This year, the GCSP is offering an executive-level course on “Addressing Challenges in Global Health Security” from 20-23 April. Is your government or organisation ready to deal with this challenge? How can we improve the prevention of outbreaks and our response to them? This executive course provides health and security specialists with answers, equipping them to better prevent, detect and combat health security emergencies.
Coronavirus: Everything you need to know in a visual explainer:
Novel Coronavirus - WHO
Is It a Pandemic Yet?