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COMMENTARY
Year : 2022  |  Volume : 66  |  Issue : 1  |  Page : 77-79  

Managing the next pandemic: Lessons for policy makers from COVID-19


CEO, Health Systems Transformation Platform, New Delhi, India

Date of Submission25-Aug-2021
Date of Decision09-Nov-2021
Date of Acceptance14-Nov-2021
Date of Web Publication5-Apr-2022

Correspondence Address:
Rajeev Sadanandan
Health Systems Transformation Platform, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1699_21

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   Abstract 


Managing a pandemic offers lessons for preparing for similar episodes in future. The importance of surveillance in One World–One Health mode and the need to share information expeditiously to mobilize national and international resources has been evident. Pandemics cause disruption to normal social and economic activity, which would be tolerated better if there is trust in authorities. Governments need to guard against over centralization in a health crisis as it discourages community involvement and willing compliance with pandemic-related restrictions. Health emergencies can be managed effectively if health systems have been strengthened during normal times. Financial flexibility needs to be built into the public financial management systems to fund the unanticipated expenditure. The pandemic has underscored the global interdependence and the need to have systems for a global response to health emergencies. Health systems have to be reengineered to better deal with future pandemics.

Keywords: COVID-19, health policy, health systems, pandemic, preparedness


How to cite this article:
Sadanandan R. Managing the next pandemic: Lessons for policy makers from COVID-19. Indian J Public Health 2022;66:77-9

How to cite this URL:
Sadanandan R. Managing the next pandemic: Lessons for policy makers from COVID-19. Indian J Public Health [serial online] 2022 [cited 2022 May 24];66:77-9. Available from: https://www.ijph.in/text.asp?2022/66/1/77/342594



While no government was prepared for the COVID-19 pandemic some countries successfully leveraged their experience of dealing with potential pandemics such as SARS and MERS to deal with COVID-19.[1] Therefore, lessons learnt from this pandemic can prepare government and communities to handle future pandemics better. This paper examines how the building blocks of health system including information, human resources, infrastructure and materials, organization and financing as well as soft components such as governance and trust influenced response to the pandemic and how they can be improved to manage future pandemics better.[2]


   Information Top


In an unfamiliar epidemic, credible and speedy information is crucial. Since early detection of the pathogen helps preventive action, surveillance and prompt reporting to the WHO under the International Health Regulations is essential for preventing conversion of an outbreak into a pandemic.[3] Since a pathogen could emerge anywhere in the world and from animals or wildlife, One World–One Health approach to surveillance is necessary.[4] During the outbreak, information is needed for planning nonpharmacological and medical interventions. For instance, social and epidemiological data can help nuance social restrictions instead of adopting blanket lockdowns. Therefore, systems need to be strengthened to collect and analyze information for decision making.


   Health Care Systems Top


In a health emergency, health sector is the key responder and takes the maximum impact. Since capacity of the health system to manage an emergency cannot be built during the emergency, all governments, especially those who have underspent on health, will need to strengthen the health system in normal times if they are to deal better with future pandemics.

Organization

During the current pandemic, focus was initially on tertiary hospitals. But when number of cases went up home management became the norm. Patients would choose to remain in home quarantine only if they had access to trusted primary care providers (PCPs). PCPs are best placed to guide patients on personal protection, infection control, monitor their symptoms and provide post COVID support. In partnership with the community, they can also support surveillance, tracking and quarantining of infected persons and their contacts.[5] But to do this, primary care teams must be adequately resourced, capacitated, and integrated with secondary and tertiary hospitals during normal times. Nonclinical services, including public health, epidemiology, and microbiology, have been the Cinderella of health systems. COVID-19 has raised their profile. The need for services that support health care delivery such as supply chains, procurement and information systems has also been evident. Technology, including remote consultations, has emerged as an alternative to in person interaction. If supplemented by point of care diagnostics, electronic health records and artificial intelligence, this has the potential to emerge as a cheaper and potentially disruptive channel of health care provision.

Health workforce

The key factor in providing health services is adequate number of qualified and competent human resources. While it may not be possible to recruit personnel adequate to handle all health emergencies, systems can be created to build capacity to enable task shifting among hospital staff, to engage qualified persons available in the community and rapidly train lay persons to take over some functions. The experience with technology for rapid capacity building has created models which can be refined and strengthened for future use.

While health workers were celebrated as heroes in many countries, in some the impact of stigma, violence, lack of protective equipment, and nonpayment of compensation forced many health workers to quit. Unless systems for facilitative and supportive supervision and resolution of grievances are instituted, health workers may be wary of being on the front lines in future pandemics.

Infrastructure and medical supplies

The sudden spike in the number of patients who needed to be isolated, needed oxygen or intensive care created urgent demand for infrastructure and equipment. Buildings were converted to makeshift hospitals. In future, town planning should consider designing buildings for alternate use as isolation centers or hospitals. Supply chain, procurement, and inventory management systems which were put under pressure, need to be strengthened to respond to rapidly escalating demand for materials. International supply chains failed when countries started competing for medical products. Nations will need to weigh supply chain security against economic considerations.

Health system resilience

Health systems are designed to carry spare capacity for surges. However, this may not exceed 20%–30% even in generously funded health systems.[6] It is not practical to carry more than that capacity in normal times anticipating an emergency. Instead, upgrading health systems to meet increased demand when the need arises, should be factored in at the planning stage itself.

In order to free up resources to meet the surge in demand, some services will have to be curtailed. An explicit policy on prioritization will ensure that services, which are not emergent but have long term consequences, such as child immunization and DOTS for TB, are not reduced in favor of services for which there is an explicit demand. Protection of the interests of patients from low social and economic groups, with less information and power to demand access, who may disproportionately bear the brunt of reduction in services, also needs to be part of policy.

Response, ramped up during a crisis, is often not sustained in the post pandemic period. Additional investment in health systems is needed not only to build capacity to handle future pandemics, but also to manage the sequelae of COVID-19. Mental health issues and the long-term health complications of COVID-19 will persist, creating increased load on health systems. Health policy makers and system managers are being challenged to understand and respond to the transformation that the shock of the pandemic has brought to the health system. Like other shocks this is a threat and an opportunity to redesign health systems.[7]


   Governance Top


The speed, unfamiliarity, and scale of devastation of COVID-19 forced most governments to a crisis mode which often led to centralization and militarization of governance. Response to COVID-19 was often characterized as a war.[8] Consultation, transparency and participation that characterize democracy was often dispensed with. Community engagement, which can play a major role in risk communication, social and behavior change communication, surveillance and contact tracing, designing and planning interventions was ignored.[9] Engagement with communities should begin by trying to understand their context, lead to two-way communication based on that understanding and progress to co-opting them in the decision-making process. Marginalized communities have little chance to be involved or even consulted on the decisions that affect them. If their voices are not heard and concerns addressed, prevention measures may be worse than infection for such groups.


   Trust Top


Ability of societies to make the needed response depends, to a large extent, on the level of trust enjoyed by authorities. Trust has long been recognized as a key element in responding to health emergencies.[10] It is built over time, based on past experience of the community with actions of persons in authority. Governments that are transparent, explicit about parameters governing restrictions on individual freedom and acknowledges and tries to mitigate hardships caused by the pandemic elicits cooperation from the community.


   Financing Prevention and Care Top


Financing of unanticipated health emergencies need flexible fiscal policies and agile re deployment of resources. During this pandemic, much of the response was financed from public revenue, mostly through emergency decrees. To deal with future pandemics, systems for public financial management will need to have inbuilt shortcuts and flexibility.[11] Clarity is needed on how the cost overruns over insured amounts will be managed for public good.

The pandemic demonstrated that how health of countries is linked to each other in today's globalized world. The next pathogen might emerge anywhere and, if not controlled at the source, spread through the entire world. Transparency is necessary not only for the country of origin but for the entire world. The unwillingness of rich, vaccine producing nations to help poor countries shows that there is yet no unified defense against a more virulent pathogen that may emerge in future. Economic impact of the pandemic provides ample justification for increased investments to strengthen health systems to handle future pandemics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Han E, Tan MM, Turk E, Sridhar D, Leung GM, Shibuya K, et al. Lessons learnt from easing COVID-19 restrictions: An analysis of countries and regions in Asia Pacific and Europe. Lancet 2020;396:1525-34.  Back to cited text no. 1
    
2.
Osterholm MT. Preparing for the next pandemic. N Engl J Med 2005;352:1839-42.  Back to cited text no. 2
    
3.
Arthur RR, LeDuc JW, Hughes JM. Global surveillance for emerging infectious diseases. Tropical Infectious Diseases: Principles, Pathogens and Practice Elsevier Inc.; 2011. p. 105-109. Published online https://doi.org/10.1016, B978-0-7020-3935-5.00014-8, [Last accessed on 2021 Jul 23].  Back to cited text no. 3
    
4.
Mackenzie JS, Jeggo M. The one health approach – Why is it so important? Trop Med Infect Dis 2019;4:88.  Back to cited text no. 4
    
5.
Kearon J, Risdon C. The role of primary care in a pandemic: Reflections during the COVID-19 pandemic in Canada. Journal of Primary Care & Community Health 2020;11:1-4.  Back to cited text no. 5
    
6.
Hick JL, Hanfling D, Burstein JL, DeAtley C, Barbisch D, Bogdan GM, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med 2004;44:253-61.  Back to cited text no. 6
    
7.
Sacco PL, De Domenico M. Public health challenges and opportunities after COVID-19. Bull World Health Organ 2021;99:529-35.  Back to cited text no. 7
    
8.
Kalkman JP. Military crisis responses to COVID-19. J Contingencies Crisis Manag 2021;29:99-103.  Back to cited text no. 8
    
9.
Gilmore B, Ndejjo R, Tchetchia A, de Claro V, Mago E, Diallo AA, et al. Community engagement for COVID-19 prevention and control: A rapid evidence synthesis. BMJ Glob Health 2020;5:e003188.  Back to cited text no. 9
    
10.
Scott V, Crawford-Browne S, Sanders D. Critiquing the response to the Ebola epidemic through a primary health care approach. BMC Public Health 2016;16:410.  Back to cited text no. 10
    
11.
Asian Development Bank. Addressing the COVID-19 crisis: Lessons from support for public financial management. Synthesis Note No. 6 (COVID Series-2) February 2021, P. 3-6.  Back to cited text no. 11
    




 

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