Featured image: US Army personnel deployed at a Texas hospital check for updates. Photo: Reuters
It has become clear that by the time the world has dealt with COVID-19, a large chunk of 2020 will have passed and severe economic and healthcare costs will have been incurred globally whatever is the optimal choice made by countries between testing and social distancing.
The US has passed a $2.2 trillion relief package and the G-20 nations have pledged to inject $5 trillion.
Building on the current crisis and with global pandemics becoming increasingly more common, what are we learning structurally about global health response systems and how can we move forward to more effectively deal with future crises? The answer lies in a policy trifecta to transform global health:
1. Create resilient national public health agencies;
2. Devise structured approaches to deal with panic and misinformation during pandemics; and
3. Adopt a trusteeship orientation for bio-pharmaceutical solutions and innovations.
A key lesson in public health can be derived from the Canadian experience after SARS in 2003. The following year, Canada created the Public Health Agency of Canada (PHAC), a Public Health Network and Council (PHNC) as a forum for collaboration, coordination and governance, and created the position of Chief Public Health Officer (CPHO).
The Canadian effort to develop such institutional backbones may serve as an example for other countries to employ institutional mechanisms to contain pandemics.
As of yet, we do not have enough robust scientific data or evidence to determine how countries responded to previous viral challenges (for example, Ebola, Zika, etc.) or if they were able to proactively build more resilient public health systems. By having a national Public Health Agency (PHA), with a CPHO and a PHNC, countries can measure and monitor relevant metrics to create indices of a country’s specific resilience to pandemics. Perhaps they can even create and disseminate annual national pandemic preparedness reports.
PHAs can build and engage in national surveillance systems on disease outbreaks, play germ games like Bill Gates has prescribed to keep nations pandemic prepared and can also engage in structural solutions through coordination with related ministries.
They can also enhance cooperation with multilateral agencies like World Health Organization and bring about a long-run orientation to deal with global health crises coming from pandemics.
While many have pointed out that climate change has increased our vulnerability to pandemics, having such agencies will enable countries to measure and report relationships between the two, thereby enabling proactive (rather than reactive) steps to flatten the curve every time there is a pandemic. This should aid in better managing the lasting welfare consequences of pandemics on a population.
In 2005, Douglas Almond (Columbia University and National Bureau of Economic Research) conducted research examining the long-term effects of in-utero influenza exposure in the post-1940 US population. What he found was that the 1918 influenza pandemic did in fact have lasting consequences.
Cohorts in-utero during the 1918 pandemic displayed reduced educational attainment, increased rates of physical disability, lower income and socioeconomic status, and higher transfer payments compared with other birth cohorts.
While some have contested these findings, and though at present COVID-19 is not showing signs of in-utero transmission, general societal constraints under which babies are being born through all of 2020, may actually end up impacting their long-run human capital attainment 20 years down the line in comparison to earlier or later cohorts; catching and responding to such outbreaks with a PHA and PHNC effort led by a country level CPHO should thus pay dividends in the long run for nations.
The second element in the policy trifecta in global health remains the role of information asymmetry specifically related to the trust deficit between patients and providers, which as we already observe, is inducing panic and misinformation. This is even more of a pernicious issue in the world of social media.
Discrimination towards people of certain ethnic dispensations rise during these pandemics, similar to what we saw during the Ebola outbreak. Misinformation, including fake cures and risky rumours, compounds the adverse welfare consequences. We are also witnessing stigmatisation and violence against doctors and frontline healthcare workers.
Traditional medicines (like drinking cow urine, using local herbs, washing in salty water, etc.) are being suggested as treatments in countries like India, China and parts of Africa.
All of these claims have either zero or, at best, fragile scientific basis. One way to structurally deal with misinformation is to use a national PHA and a PHNC initiative systematically during a pandemic (as well as during non-pandemic times), to educate societies to stay vigilant and resist fake science and misinformation.
PHAs can also use celebrities to create public awareness campaigns that document evidence based on real (not voodoo) science during pandemic times. They could also be given the mandate to coordinate action with social media firms to systematically scrape out misinformation so as to contain panic from going viral during pandemics.
The third component of the trifecta is around bio-pharmaceutical solutions to treating pandemics should they still break out despite all structured institutional efforts. I have written elsewhere about this, so will not belabour but the basic principles here need to be trusteeship in research and development incentives, global cooperation both in innovation and innovation finances and finally an across the value chain implementation of an access and innovation philosophy, from testing, to diagnostic tools to devices and drugs or vaccines.
Science policy which has been influenced by the linear model of basic to applied research from the post-World War II Vannevar Bush paradigm probably also needs a revisiting to incorporate multiway feedback, dynamics and ability to update priors and posteriors learning from COVID-19.
Hopefully, by the end of 2020, COVID-19 will have subsided. But there is an expectation that the world learns and moves towards these trifecta of policy lessons in global health. Doing so should prepare nations to more effectively and efficiently deal with the pandemic outbreaks of tomorrow.
Chirantan Chatterjee is a Visiting Fellow at the Hoover Institution, Stanford University and ICICI Bank Chair Professor at IIM Ahmedabad, India where he is also the Chairperson of the Center for Management of Health Services. His research focuses on global health and pharmaceutical economics.