WHS panel calls for more solidarity, intensified coordination and political leadership
COVID-19 has exposed the gaps in pandemic preparedness from the local to global level, and delivered a potent reminder of the high cost of complacence. At a panel discussion organised by the German Federal Ministry for Economic Cooperation and Development (BMZ) and Charité, experts weighed in on lessons from the current response and identified steps that can be taken to break ‘the cycle of neglect and panic.’
COVID-19 has subjected the world’s pandemic preparedness and response systems to a massive stress test over the past 10 months. What has been learned? And how can these lessons be applied to pandemic threats in the future? These questions were at the heart of the second part of a high-level event on ‘Developing Strategies for Fighting COVID-19,’ organised by Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) and Charité at the World Health Summit on October 27. Moderated by Dr Birgit Pickel, head of the BMZ’s Directorate Global Health, Pandemic Preparedness and One Health, the session brought together experts from international and regional health organisations, academics and development practitioners.
‘Our worst fears have materialised’
One of the cross-cutting observations was how unprepared we turned out to be for a threat that we knew was not only possible, but likely to emerge. Despite knowing that human encroachment into intact natural areas is intensifying the likelihood of previously unknown pathogens crossing from animals to humans, ‘we still find ourselves totally surprised’ by the devastating impact of the novel coronavirus, observed Dr Maria Flachsbarth, the Parliamentary State Secretary at BMZ.
And despite knowing what it takes to prepare for and respond effectively in the event of outbreaks, ‘our worst fears have materialised,’ in the words of Mr Elhadj As Sy. Along with Gro Harlem Brundtland, Mr Sy chairs the Global Preparedness Monitoring Board, whose September 2019 report The World At Risk was a clarion call for political leadership, global solidarity and investment in pandemic preparedness. ‘We knew at the time that political will matters, engaged citizenship matters, global solidarity matters, keeping supply chains going matters,’ said Mr Sy. ‘Only a year later we were confronted with COVID.’
Early public sharing of genetic sequence data allowed rapid scientific advances
Without downplaying the challenges facing communities, countries and regions around the world which are struggling to control the spread of the virus, the panelists also reflected on positive developments. Many of these can be traced back to changes introduced after the Ebola Virus Disease outbreak in West Africa in 2014-2016.
Dr Soumya Swaminathan, the Chief Scientist at WHO, described the unprecedented scientific advances in the development of diagnostics, treatments and vaccines for COVID-19. The early sharing of genetic sequence data on a public platform and the rapid development of the first testing protocol by the Charité Universitätsmedizin ‘played a huge role in the subsequent response,’ according to Dr Swaminathan. By January 13, 2020, just two weeks after the first reports of an atypical pneumonia, a publicly available diagnostic protocol was available for countries to use. Laboratories could start preparing for testing. Charité then worked with the WHO to develop reagents which could be shipped worldwide and to support training.
Ensuring adequate laboratory capacity to test for COVID-19 was a top priority in the early weeks of the pandemic. At first, Senegal and South Africa were the only African countries with the capacity to do molecular testing for COVID-19. By the end of February 2020, every country in Africa had at least one laboratory that could do testing, explained Dr Swaminathan.
Quick, flexible, demand-driven support for laboratories
The provision of rapid, tailored assistance to laboratories in partner countries is the core mission of the German Epidemic Preparedness Team (SEEG), an initiative of BMZ and the Federal Ministry of Health (BMG) implemented through a partnership between the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Charité Universitätsmedizin, the Robert Koch Institute and the Bernhard-Nocht-Institute for Tropical Medicine. According to Dr Michael Nagel, the head of operations for SEEG, German expert teams have carried out 32 missions since 2015 in response to specific requests from partners to develop capacity to test for a wide range of pathogens, from plague to Zika to COVID. ‘No two labs are alike,’ he explains. ‘We work with partners to come up with the best possible solution’ for their context. Since the start of the pandemic, SEEG teams have supported laboratories in Benin and Namibia to set up COVID testing; another team is presently working in Guatemala.
Dr Jan Felix Drexler, a professor at Charité Universitätsmedizin and head of the Virus Epidemiology group, praised the synergies between the government, the country’s public health institutions, GIZ and the university hospital which enable SEEG to respond effectively to diverse requests. ‘It’s a really unique cooperation,’ he said. ‘I can’t think of any other example where multi-sectoral assistance can be organised and delivered so quickly.’
Regional Centers for Disease Control have played a critical role
In 2015 African heads of state decided that the continent needed a public health agency to coordinate actions on pandemic preparedness and response. ‘This was a visionary move, and we can see the difference,’ said Dr Ahmed Ouma, the Deputy Director of the African Centers for Disease Control and Prevention.
Since the start of the pandemic, the Africa CDC has coordinated actors across the continent in their response activities, encouraged local production, and negotiated access to test kits, protective equipment and now vaccines. African heads of state have met an unprecedented eight times since February 2020 to discuss the COVID response, while ministers of health, foreign affairs, transportation and finance have met regularly under the auspices of the Africa CDC and African Union. According to Dr Ouma, this intensified coordination ‘has changed the way we’ve responded to COVID-19 on the continent and has kept the numbers low, despite bad predictions at the beginning.’
The European Centre for Disease Prevention and Control (ECDC), which was founded after the SARS epidemic of 2003, works closely with national public health bodies across Europe, as well as with those in neighbouring countries, particularly in the areas of surveillance, data and monitoring. According to Dr Andrea Ammon, the director of the ECDC, the reality of the current pandemic ‘exceeds all the measures of preparedness that we had put in place.’ Countries are facing difficulties in ensuring robust surveillance, sustainable testing and contract tracing, and effective risk communication and community engagement strategies to counter ‘pandemic fatigue’. Against a very dynamic backdrop, the ECDC gives guidance to member states and outlines options for response, taking particular care to align its advice with WHO Europe. The ECDC is in close contact with other CDCs worldwide, including with China CDC, and has recently signed a collaboration agreement with the Africa CDC: ‘We have over the last 10 months really nurtured these connections in order to share experience and also to try to align our views.’
Breaking ‘the cycle of neglect and panic’
In his comments Mr Elhadj As Sy, co-Chair of the Global Preparedness Monitoring Board and Chair of the Kofi Annan Foundation, made an impassioned case for breaking what he terms ‘the cycle of neglect and panic’ when it comes to pandemic preparedness. Rather than waiting for a catastrophe to arrive and then trying to respond, what’s needed is to work ‘in the spirit of a continuum’: early engagement, early alert, early warning, preparedness and response. This type of approach ‘strengthens capacities and infrastructure so that communities and institutions can withstand shocks,’ he explained.
Beyond investment in preparedness, Mr Sy went on to outline other elements of ‘the composite response we really need,’ starting with political leadership. He pointed out that the WHO is an intergovernmental body dependent upon member states to contribute financially, to strengthen the institution, to listen to its advice and to be led by science. ‘If the very member states that are supposed to obey these rules are the first ones to break them,’ he said, ‘then we have a leadership crisis.’ Solving this requires a commitment to make our existing institutions work – and specifically for member states to engage with and fully fund the WHO. He also called for a fresh look at the ‘nature of the obligation’ to implement the International Health Regulations, which at present is left up to the ‘good will’ of member states.
Germany is ready to lead
Mr Sy ended by commending Germany for the leadership role it has assumed, not only in terms of financing, but also in raising its voice in support of science and evidence-based action. At the political level and the international arena, this ‘thought leadership’ is needed more than ever.
In her closing remarks, Dr Flachsbarth reiterated Germany’s desire to see a strong, well-funded and flexible WHO, and indicated that the country is ready to take on responsibility in this regard. Among others, she emphasised the importance of investing in resilient health systems which are ready to respond in outbreak situations, and the urgent need to think and work within a One Health framework, particularly in relation to early warning systems.
Finally, she appealed for governments and private institutions to join Germany in providing financial support the Access to COVID-19 Tools Accelerator (ACTA), which has been established to accelerate development, production and equitable access to test, treatments and vaccines. ‘One thing is clear,’ she said. ‘COVID can only be beaten together, or not at all.’
Karen Birdsall, October 2020