March 2022 marks two years since the World Health Organization (WHO) declared the rapid and wide spread of COVID-19 to be a pandemic. It was – sadly – clear that the world wasn’t ready.
Two years and more than six million deaths later, and following scores of articles about how countries could have done better, what have we learnt? Are we ready for the next threat?
The Omicron variant has provided an unwanted but useful test, and the results do not bode well for the next pandemic. The response to Omicron has been fragmented, inconsistent and often evidence-free. But despite these problems, there are some examples emerging globally for how we can do better in future – and learning from these lessons will be crucial if we want to be better prepared for the epidemics and pandemics to come.
One ongoing problem for COVID-19 has been poor situational awareness and misguided overconfidence in where the infection really is. Early on, the US was looking at China while infections arrived from Europe and elsewhere. Omicron was identified in Botswana and South Africa, but soon cases were appearing everywhere, even arriving from countries that had not detected the new variant yet. If more countries had the capacity to generate genome sequence data locally and sustainably, and better incentives and structures for sharing data, health outcomes could have been different with alarms raised earlier. Instead, we’ve seen economy-damaging, scattergun travel bans that have had little or no effect.
The hugely valuable COVID-19 insights produced in countries like South Africa and Uganda reflect a vital new era that we should be accelerating for other pathogens too. We are already seeing valuable progress. Ten years ago, sequencing for Ebola outbreaks was typically done by reactive international teams. But during the recent Guinea outbreak, support instead came from regional expertise in our team in The Gambia. This meant that instead of having to wait for a long cycle of information to feed back to the source where people’s lives were on the line, the intelligence gathering could be done locally and much more quickly.
To tackle future COVID-19 variants and other pandemics, countries will also need to make better use of the tools that are available. Despite vaccines and rapid tests, several high-income countries introduced lockdowns in response to Omicron. This shows it is not just about having the tools available, it’s having the understanding of how to use them effectively. This means considering factors from the dynamics of vaccine confidence to the logistics of deployment and reaching hard to reach populations.
It’s about far more than the pathogen itself – it’s taking into account people’s behaviour, social sciences and breaking down barriers between different disciplines and countries to explore all the complexity that we know impacts on public health and whether interventions are successful or not. It means drawing on lessons from infections like measles, which several European countries have struggled to eliminate despite the availability of a highly effective vaccine.
Omicron has also raised the potential that vaccines may need to be updated in future. We therefore must learn from approaches for tracking evolving viruses like influenza, or the logistics of reactive vaccination campaigns for infections like meningitis. In essence we must open up our minds and draw on the expertise and knowledge that can be found on the ground in all communities impacted by outbreaks. Connecting the dots will make front-line responses much stronger.
Despite the tools now available for COVID-19, resources and expertise are typically concentrated in a relatively small number of countries. The result? A fragmented and introspective international response, one of reactive travel bans and struggling domestic policies.
We need a new approach for this era of pandemics. An approach that is decentralised: a global focus that benefits from local knowledge and expertise. At the London School of Hygiene & Tropical Medicine (LSHTM), we have staff deployed in multiple countries, with the aim of moving beyond reactive research to build longer-term programmes. We need a future where we transition away from a centralised, ad-hoc, fragmented approach to epidemic science to one where crucial methods and capacity are widely available.
To prepare for future pandemics, we will need to identify the best evidence and turn it into the best action. Omicron has revealed the huge gaps that remain within the global response. But globally it also provides an opportunity to learn before the next threat arrives. That means looking beyond Europe and the US, and bringing together the best global evidence on what a good response requires. That is at the heart of LSHTM’s new Centre for Epidemic Preparedness & Response.
That is why the Centre will create decentralised fellowships for early career researchers that can be embedded within the places that will have most impact. And that is why we will draw heavily on broader strategic perspectives and expertise from WHO AFRO and other partners at our upcoming launch.
By generating, aggregating and listening to evidence from dozens of countries we can move beyond outdated ways of tackling epidemics – strategies that have fallen tragically short over the last two years.
Tuesday 29 March 2022