Could We Have Been More Prepared for the Coronavirus Pandemic?
By The Task Force for Global Health
Responding to the scale and impact of the coronavirus pandemic is a challenge the public health community has not faced in the modern era. While all countries are mounting various levels of response, it is the countries with weak health systems that will likely feel the greatest impact.
As this pandemic has reminded us, the world is more connected than ever. Limited response by one country because of a weak or over-burdened health system puts countries all over the world at risk which is why, for decades, health system strengthening has been at the core of The Task Force for Global Health’s work.
“Health system strengthening is a really broad term. It involves many components from the highest-level national health agencies down to local public health departments, healthcare clinics and even basic access to clean water, medicines and bandages in a community,” said The Task Force’s Head of Health System Strengthening, Patrick O’Carroll, MD, MPH.
“But there are fundamental pillars of a strong health system that are utterly essential for every country, including experienced field epidemiologists, laboratory capacity, information and communications systems, vaccine and drug storage and deployment capability, clinical care, and leadership and management. Collectively, these pillars support a nation’s capacity to protect the health of its population and deal with health threats like COVID-19,” he adds.
While the time for immediate response is now, it is important to also identify the challenges our health systems are facing in this pandemic and continue planning for public health investments in the immediate and long-term to solve those challenges before the next outbreak comes.
“When a country needs its health systems to effectively respond to an urgent threat, it is too late to suddenly build the needed response systems and workforce,” said O’Carroll. “It takes time and steady effort to build real public health capacity. Every time an outbreak like this happens, it is a wake-up call that we need continued investment in health system strengthening, at every level of our government; and we need to invest it wisely so that it will pay off in the long-term.”
With programs ranging from vaccine development, systems for vaccine deployment, surveillance, training of epidemiologists, and getting medical supplies and medicines where they are needed, The Task Force helps countries strengthen their health systems so that countries, especially low- and middle- income countries, can protect the health of their populations today and prepare for the epidemics and pandemics of the future.
Building Epidemiological Capacity to Slow the Spread of a Pandemic
Health system strengthening is often equated to having more doctors and nurses. While having a qualified healthcare workforce is certainly one critical element of a strong health system, health system strengthening is much more than that.
“Certainly, many countries need more nurses and doctors. But an effective public health response to something like COVID-19 ideally means that we prevent and slow the spread of the epidemic so that we don’t overwhelm the capacity of our healthcare system to provide needed care,” said The Task Force for Global Health’s Head of Health System Strengthening, Patrick O’Carroll, MD, MPH.
In order to do this, The Task Force’s Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) has worked with the Centers for Disease Control and Prevention for more than 20 years to build global outbreak response capacity by establishing and supporting Field Epidemiology (and Laboratory) Training Programs (FETPs/FELTPs) globally.
These FETPs and FELTPs – embedded within ministries of health, national public health institutes, universities, and other public health agencies – are currently on the frontlines in the fight to control the spread of coronavirus. Working with their respective health agencies, their ongoing activities include points of entry screening, disease surveillance, case investigation, contact tracing, assistance at quarantine centers, development of testing and treatment protocols, and providing epidemiologists to the World Health Organization’s (WHO) Global Outbreak Alert and Response Network (GOARN) for deployment to outbreak hot spots.
As the secretariat for this global network, TEPHINET is operating a virtual platform called TEPHIConnect for programs, globally, to connect and share strategies and challenges on coronavirus preparedness and response efforts.
In addition, TEPHINET is holding monthly global teleconferences for programs to share their experiences in these areas. TEPHINET has also created a Coronavirus Knowledge Hub on its website to share reputable learning and training resources on COVID-19.
“The current outbreak is a stark reminder of the need to invest more in field epidemiology capacity building at the country program level,” said TEPHINET’s Program Director, Carl Reddy, MB.BCh, FCPHM, M.Sc. “In order to develop the capacity to deal effectively with tomorrow’s outbreaks, we need to invest today in building field epidemiology capacity through established FETPs/FELTPs and new frontline trainings.”
Equipping Clinical Care Facilities
In clinical care settings, health facilities are running low on basic medical supplies and equipment for treating patients with COVID-19. The humanitarian response is often to send anything and everything but that strategy frequently puts a greater burden on health facilities because many donated supplies fail to be useful.
“A well-functioning health system ensures access to essential medical products, vaccines, and devices,” said Lori Warrens, Program Director of MedSurplus Alliance. “It takes established processes from donor to recipient health facilities to ensure that requested supplies make it to areas of need during emergencies like outbreaks.”
Through an accreditation program for medical surplus recovery organizations (MSROs) and other donors, The Task Force for Global Health’s MedSurplus Alliance (MSA) has helped develop this process so that countries receive the supplies and equipment they need quickly.
In response to the coronavirus pandemic, MSA-accredited MSROs are working with the most affected countries and community health providers in the United States to help combat the strain on health facilities by sending essential protective gear.
The accredited-MSROs Hospital Sisters Mission Outreach, SOS, and Medshare partnered with UPS and The UPS Foundation to deliver over 4 million masks and other essential supplies to health providers in Shanghai at the beginning of the outbreak. Brother’s Brother Foundation shipped several 40 ft. containers of Personal Protective Equipment (PPE) and other supplies to hospitals in Honduras, Dominican Republic, and Puerto Rico.
Today, MSROs are prioritizing health providers serving vulnerable populations in low-resource settings located near their operations in Georgia, Texas, Kentucky, Illinois, Ohio, California, and New Jersey. In one instance, accredited-MSRO, Medical Bridges, supplied 6000 masks to 20 rural clinics and hospitals in Texas, and MSA is working with the Georgia Primary Care Association to meet local needs in Georgia.
To help prevent the donation of inappropriate medical supplies and equipment and appropriately allocate scarce supplies during this pandemic, MSA is also providing guidance and resources to donors on how to identify what specific supplies are needed and the best ways to maximize them.
Pandemic Preparedness: Building the Systems and Developing the Vaccines
While this pandemic is not an influenza pandemic, influenza systems are being utilized in COVID-19 response around the world.
Influenza systems are critical to public health and are uniquely positioned to help countries respond to pandemic or epidemic threats. For example, the capacities and mechanisms of the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS) are at work in more than 125 countries and are being used to detect and diagnose cases of the new virus. The WHO Global Initiative of Sharing All Influenza Data (GISAID) also enabled the rapid sharing of the first genetic sequence data for the novel coronavirus from China.
In addition to surveillance and data sharing, vaccines are a vital tool in public health response. The Task Force for Global Health’s Partnership for Influenza Vaccine Introduction (PIVI) builds and strengthens seasonal influenza vaccination programs in low- and middle-income countries, protecting them from the flu – which kills between 290,000-650,000 people annually – and creating capacities that can be used for other pandemic or epidemic threats. As a result, influenza vaccination programs are a key tool for general infectious disease preparedness.
Preparedness investments tend to increase during and immediately following outbreaks, while funding often decreases shortly afterward, leaving the world unprepared to face the next threat. Economies, population health, and global health security continue to be negatively impacted by these cycles of panic and neglect.
Building and strengthening seasonal influenza programs can help break this cycle by laying a critical foundation for overall readiness. An analysis of the 2009 pandemic found that countries with seasonal influenza vaccination programs were twice as likely to provide necessary documentation to receive donated influenza vaccine and were more likely to receive their shipment of vaccine during the active pandemic period than countries without such programs (1).
New epidemic and pandemic threats – like the coronavirus and Ebola – will continue to emerge, and vaccines have been, and will likely be, a piece of the public health response, making the establishment, testing, and readiness of vaccination programs in advance vital to countries’ capacity to respond and deliver vaccines; and PIVI is building those capacities today to be ready for tomorrow.
Without these systems, vaccines will not be deployed, but there also must first be an effective and safe vaccine developed.
Currently, vaccine experts in academic and industry labs are rapidly working to address the need for a coronavirus vaccine. The Task Force’s Brighton Collaboration is part of this urgent work by bringing together vaccine experts to advance the safety of vaccines through rigorous science.
Funded by the Coalition for Epidemic Preparedness Innovation (CEPI), the Brighton Collaboration helps guide vaccine developers on how they can maximize the value of safety data collected in their respective vaccine trials. As a first step, they brought together COVID-19 vaccine developers and other experts for a two-day web-conference to discuss and reach consensus on certain key safety aspects that should be evaluated pre-clinically, in clinical trials and after approval, and the Collaboration will continue to review the safety of the vaccine candidates as they advance through development.
Highlighting the importance of pandemic preparedness, The Task Force has also come together with governments, industry, academia, non-governmental organizations, and philanthropy to form the Alliance for Influenza Preparedness.
This global collaboration of individuals and organizations is committed to improving global health security through greater and more effective use of seasonal influenza vaccination programs in countries worldwide, with a focus on low- and middle- income countries.
As the Alliance secretariat, The Task Force supports the vision of this group to create a world that is better prepared to detect, prevent, and respond to epidemics and pandemics with a focus on influenza.
 Rachael Porter, Shoshanna Goldin, Kathryn La Fond, Lisa Hedman, Mellissa Ungkuldee, Jordan Kurzum, Eduardo Azziz-Baumgartner, Claudia Nannei, Joseph Bresee, Ann Moen. 2020. Does having a seasonal influenza program facilitate pandemic preparedness? An analysis of vaccine deployment during the 2009 pandemic. Vaccine 38. 1152-1159. https://www.ncbi.nlm.nih.gov/pubmed/31839465
O’Carroll provides a more in-depth perspective in our Public Health Informatics Institute’s “Inform Me, Informatics” podcast. Hear the full podcast here.