Preventing Future Pandemics
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The world is paying a heavy price for not reacting timely and taking action to curb the spread of the Corona virus to various countries.
The slow reaction of the world to the initial Covid-19 epidemic in China can be attributed to either an intelligence failure on the World Health Organisation (WHO) or it lacked the mechanism and independence to effectively detect, assess and communicate timely without interference the potential of such an outbreak to snowball and spread to other regions and countries.
The World Health Organization timeline indicates that Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia in Wuhan, Hubei Province on the 31st of December 2019, of which a novel coronavirus was eventually identified as the culprit.
On receiving this information WHO established an IMST (Incident Management Support Team) on the 1st of January 2020 across the three levels of the organization: headquarters, regional headquarters and country level, putting the organization on an emergency footing for dealing with the outbreak.
On the 5th of January WHO informed the world through their new publication "Disease Outbreak News" on the new virus. This was a flagship technical publication to the scientific and public health community as well as global media. It contained a risk assessment and advice, also reported on what China had told the organization about the status of patients and the public health response on the cluster of pneumonia cases in Wuhan.
On the 10th of January WHO issued a comprehensive package of technical guidance online with advice to all countries on how to detect, test and manage potential cases, based on what was known about the virus at the time. This guidance was shared with WHO's regional emergency directors to share with WHO representatives in countries.
On 13th January 2020 officials confirm a case of COVID-19 in Thailand, the first recorded case outside of China.
WHO experts from its China and Western Pacific regional offices conducted a brief field visit to Wuhan between 20th and 21st January 2020 and subsequently issued a statement on the 22nd of January Confirming that there was evidence of human-to-human transmission in Wuhan but more investigation was needed to understand the full extent of transmission.
Following this visit the WHO Director-General convened an Emergency Committee (EC) meeting to assess whether the outbreak constituted a public health emergency of international concern. The independent members from around the world could not reach a consensus based on the evidence available at the time. They asked to be reconvened within 10 days after receiving more information.
The Director-General then led a delegation to China on the 28th of January to meet China’s leadership, learn more about China’s response, and to offer any technical assistance. The WHO DG, Dr. Tedros agreed with Chinese government leaders that an international team of leading scientists would travel to China on a mission to better understand the context, the overall response, and exchange information and experience.
After this visit the Director General on the 30th of January reconvened the Emergency Committee (EC). This time, the EC reached consensus and advised the Director-General that the outbreak constituted a Public Health Emergency of International Concern (PHEIC). The Director-General accepted the recommendation and declared the novel coronavirus outbreak (2019-nCoV) a Public Health Emergency of International Concern (PHEIC).
However WHO declared the coronavirus outbreak a pandemic on the 11th of March more than a month after it declared Covid-19 a PHEIC on the 30th of January. As at this time the disease had spread to more than 114 countries with 118,000 cases and 4291 deaths.
Going through the event time line most people will wonder why it took WHO so long to declare Covid-19 a pandemic seeing the magnitude of spread and deaths it has brought globally.
However it appears WHO got itself into this quagmire having no formal method to use since it discarded the 6 stage procedure for declaring a pandemic due to the negative publicity it received when it was applied to the H1N1 influenza outbreak, a pandemic which ended up not being as deadly and disruptive as feared and was harshly criticized by a lot of governments who were frustrated about buying vaccines that they ended up not using.
However WHO gave the reason for declaring Covid-19 a pandemic as follows;
“Deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction, WHO made the assessment that COVID-19 can be characterized as a pandemic.”
However the WHO Director General defended his action in making the late pronouncement thus;
“pandemic’ is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.”
Am not sure a lot of us will be convinced by this defense as there may have been other political considerations.
From the current experience, It will be expedient for countries to take immediate action to protect it’s citizens once a disease outbreak has been adjudged to be a PHEIC.
WHO officials were initially slow to act in getting to the root of the problem In Wuhan as it took 20 days after the Chinese authorities reported the outbreak before the WHO resident personnel’s made a visit to Wuhan the center of the outbreak. They relied more on the information coming from the Chinese authority without sending their foot soldiers to the sites for immediate verification and assessment of the situation on ground.
This calls for a proactive intelligence and monitoring unit in all member countries to monitor and report on disease outbreaks and it’s potential to become a pandemic. This unit should be independent from the countries agency for disease control but will collaborate and cooperate with them in order to achieve it's purpose.
Once a disease outbreak is detected, the risks and threats of the epidemic and it's potential of becoming a pandemic needs to be assessed. If the result of the evaluation is high, a red alert has to be issued to all member countries with recommendations on prevention and mitigation actions to be taken by each country.
The affected Country may have to be isolated once an epidemic is declared pending when a proper understanding of the disease mechanism of infection and spread is established. Such isolation may require the cessation of all forms of travel to the affected country and a mandatory quarantine of travelers from that country.
Such action will be necessary since it will be foolhardy to rely on the country to present a factual situation to the world as most countries will look at protecting it's own interests first even if it is at the expense of other member countries. A point in case is the accusations and counter accusations between China and US. China has been accused of not disclosing to the world the full extent of the epidemic in Wuhan which resulted in the late declaration of a pandemic by the World Health Organization and the resultant aftermath we are currently living with.
This wouldn’t be the case if WHO had the capability and authority to swiftly investigate, assess and report independently on the situation.
Isolating the affected country will no doubt have economic consequences on it's ability to transact with other countries while the isolation is in place .
The Country may have to go into dialogue with various trading partners in order to find a way to guarantee some movement of goods into the country as to forestall food shortages and ameliorate any hardship this will bring to its citizens while the epidemic persists.
The proposed intelligence and monitory unit should be vested with the independent authority of investigating and assessing any country disease out break and reporting it's findings directly to the headquarters in a timely fashion, since speed is of the essence in a potential pandemic if it is to be nipped in the bud. This mandate requires the corporation of all member countries of United Nations.
The WHO intelligence and monitoring officials shall enjoy such privileges and immunities as are necessary for the independent exercise of their functions in connection to the surveillance and monitoring function. There may be a need to enshrine the independence of these monitoring units to the host nation in the UN charter in order to ensure they are given unfetered access to the affected region as well as information required to make detailed assessment without undue interference from the host nation.
There will be lots of lessons to learn from the current pandemic which will enable us to be better prepare for any future pandemic if current proposed measures are unable to prevent another outbreak.
For instance we have seen that solutions needs to be tailored and adapted by countries because of there different peculiarities as regards social, cultural and economic consideration. There can be no one-size-fits all solution as we have seen from our current experience due to different levels of development of each country as well as their socio cultural and economic circumstances. The way forward is to release a master template that will be adapted by all regions based on their unique situation.
The world needs to act in unison in order to avert any future catastrophe that threatens our existence. No one nation should be allowed to put humanity in jeopardy no matter its might. A country can virtually be brought to it's knees with the cooperation of all or majority of member nations through effective sanctions and isolation if the country chooses to act in an unconventional way in defiance to acceptable norms governing nations. It's late to apportion blame on China for not being transparent on the situation in the country but we now need to device a mechanism that imposes this transparency, compliance and cooperation on member nations.
We have seen that the catastrophic effects of a pandemic can be in the same magnitude as that of a nuclear disaster or an intentionally released biological weapon and hence it should be accorded the same level of threat and attention. The threat must be taking very seriously by all nations.
The present modus operandi of WHO seems to be bugged down by bureaucratic bottle neck and hence may not be able to react swiftly and timely in preventing future pandemic. We may need a more robust agile organization strictly constituted for the sole purpose of preventing future pandemics, protected by a new charter with diplomatic immunity to be able to function and achieve it's purpose, that cannot be driven out at will by a host nation as currently meted out to WHO officials in some countries. A pandemic is a very serious event and should never be politicized or used as a political instrument to advance individual selfish ambitions.
President George Bush of the United States of America, in 2005 recognized the enormity and threat to our existence of a pandemic and developed a national strategy with the sole purpose of averting such event. This came under the ambit of The National Institute for Allergy and Infectious disease (NIAID) headed by Anthony Fauci. However this organization did not have the capability to prevent such event because it lacked the logistics and intelligence to swiftly detect and assess the potential of an outbreak to become a pandemic wherever it occurred in the world. It was an American organization not that of a world organization such as WHO.
A pandemic is a global event and requires global synergy and cooperation to avert an occurrence. Time is of the essence in an outbreak as succinctly captured by president Bush
"A pandemic is a lot like a forest fire. If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can spread quickly beyond our ability to control it."
Subsequent presidents also recognized this threat and ensured that the plan was well funded and the organisation continued with its research work to avert or ameliorate the effects of a pandemic.
However due to not having enough intelligence on the magnitude of the outbreak in China they were unable to act swiftly to put their plan into action in order to prevent what we are now witnessing. Over 100, 000 American deaths and over 5 million cases worldwide as a result of Covid-19 pandemic.
Having this timely intelligence of the potential of an outbreak to become a pandemic is very crucial to averting future occurrence. We need to device more effective and timely mechanism for obtaining such intelligence wherever we have an outbreak. Hence the proposal to either reform WHO to make it more agile and responsive to such threat or an alternative organization solely for the purpose of preventing future pandemics.
If we wait for another pandemic to take hold, it may be too late to act and many lives will be needlessly lost again because we failed to act together.
We need global cooperation and leadership in fighting and preventing future pandemics. That also means working together as one world. Failure to act in concert in order to prevent another catastrophic event such as this is at our peril
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