Primer| Public Goods

Pandemic Preparedness: Is a plan enough?

The recent COVID-19 pandemic shook the world and raised questions on our global preparedness against a pandemic.

By Shalini Muniapan | 7 May 2020


What is a pandemic?

A pandemic is a global outbreak of a disease. It refers to the geographical spread of the disease, rather than a change in the characteristics of the disease itself. According to the World Health Organisation (WHO), a pandemic is only declared when there is a global spread of a new disease which people are not yet immune to. Pandemics are usually classified as epidemics first.

Figure 1: The Spread of a disease and the different terminologies.

During Malaysia’s first wave of the Covid-19 pandemic, 22 cases were reported, related to people who traveled to infected regions and those who were in close contact with infected persons. The second wave of COVID-19 started on February 27, 11 days after no cases were recorded in Malaysia.

Overview on the current pandemic, COVID-19.

COVID-19 was first detected in Wuhan, China in late 2019 and spread globally at a rapid rate. The virus has a high reproduction rate (what scientists refer to as R0), which has led to many countries around the world to enforce varying levels of lockdown measures. These measures largely involve social distancing and isolation, aimed at breaking the chain of transmission (although Sweden opted for a rather different approach). This interactive by New York Times (NYT) captures how the virus got out from Wuhan and spread to the rest of the world.

As of 5 May 2020, globally 3,580,247 persons have been tested positive for COVID-19, with 251,365 deaths and a reported 1,162,563 individuals have recovered. Since then, a number of countries in Europe and Asia have already started opening up their economies. The WHO has also released conditions that is advisable for countries to fulfill prior to lifting the movement restriction, on top of ensuring that the disease transmission is under control. These includes South Korea, Germany, New Zealand, Czech Republic, and Italy.

Is a pandemic something we can prepare for?

While many describe the economic fallout as a result of Covid-19 as ‘unprecedented’, the pandemic itself is not. Recent history is dotted with instances of pandemics surfacing, and being aware of this, many countries around the world have pandemic preparedness plans in place.

One cooperative mechanism that is in place is the International Health Regulations (IHR),  an agreement between 196 countries including all WHO Member States, first adopted in 1969. Through IHR, countries agreed to detect, assess and report public health events such as local outbreaks. After the SARS outbreak in China in 2005, IHR was revised to grant WHO exceptional powers to act. This included the authority to name and shame countries that do not comply with the IHR requirements on outbreak detection.

The WHO’s IHR Core Capacity Monitoring Framework (Self-Reported by Member States) and Joint External Evaluation (JEE) [External Peer Reviewed] are existing frameworks that measures preparedness of a country’s healthcare systems. These frameworks are important, because national governments are effectively the first point of contact with outbreaks. Failure to contain such outbreaks locally can lead to the spread of a virus across international borders.    

Malaysia’s Strategy for Emerging Diseases and Public Health Emergencies II (MySED II) is derived from the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies III (APSED III) by WHO. The regional goal is to strengthen public health emergency preparedness (PHEP) and response capacity by improving public health systems, and regional coordination.

Figure 2: APSED III focuses on the core components for public health emergency preparedness and response at all levels.

Source: Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III)

Figure Description: National Preparedness comes first, followed by Regional Preparedness, alert and responses. Finally, by virtue of all of the above, global preparedness, alert and response comes in. If countries are not prepared at national level, this risks putting a strain on global preparedness and can result in a collapse.

Global Health Security Index (GHSI) Ranking

While most countries have a plan to deal with pandemics, according to the Global Health Security Index (GHSI) 2019  [A project by Nuclear Threat Initiative (NTI) and John Hopkins Centre for Health Security (JHU) and developed by the Economist Intelligence Unit (EIU)no country is fully prepared. However, 13 countries were considered to be “most prepared” –  Malaysia, with  had an index score of 62.2, falls into  the ‘more prepared’ category. Globally, the United States of America (USA) was the most prepared with an index score of 83.5, followed by the United Kingdom at 77.9, Netherlands at 77.6 and Canada at 75.3.

The GHSI measures the state of health security around the world. The index evaluates a health system using six (6) categories: the prevention of the emergence of pathogens, detection and reporting mechanisms for epidemics, rapid response and mitigation to prevent spread of the epidemic.

Further, the index assesses the health system in itself, the country’s compliance with global norms and overall risk environment and vulnerability to biological threats.

Preparedness, however, does not necessarily translate into actual action. While most of the countries ranked as ‘most prepared’ are showing signs of being able to cope with the pandemic, the country that is deemed to be the most prepared for a pandemic by the GHSI, the USA, is struggling. The country now logs the highest infected cases and the highest death toll in the world. (The GHSI offers an explanation of the mismatch between the USA’s preparedness ranking and their current handling of the COVID-19 crisis).

According to this index New Zealand was classified as being more prepared, scoring 54 out of 100 on the GHSI scale (ranked at 35th place globally). However, the country has successfully managed to contain and eliminate the spread of the virus among their community (As of 8th June 2020, New Zealand has successfully eliminated the virus since it has recorded zero cases in 15 days).

Despite Spain scoring better than New Zealand on the index (the country scored 65.9/100 and came in 15th place globally), at the time of writing, Spain was second to USA globally in total numbers of confirmed cases (as of 8th May 2020). Countries that have managed reasonably well in handling the COVID-19 crisis and set to restart their economies gradually are Australia, New Zealand and South Korea. Out of the three, Australia and South Korea come in the Top 10 in the GHSI; Australia at 4th place and South Korea at 9th place.

Among the countries that effectively managed COVID-19 outbreak in their country without imposing an extensive movement restriction measures is Taiwan. Despite being the closest to China, by applying early intervention, extensive prevention strategy, flexibility in command structure, integration of big data and effective information disclosure, the country managed to contain the spread

Source: John Hopkins Corona Virus Resource Centre & Author’s own calculation. (As of 5 May 2020).

Note: In some countries the reported recovery rate might be lagging as compared to the actual on ground numbers, because patients go through 14-day incubation period upon recovery before going through a final COVID-19 test prior to discharge. In UK, the Government advisory still states if individuals suffering from mild symptoms to stay-home and self isolate. Hence, patients might have tested positive and recovered at home but might not have been recorded officially.

Conclusion

So, can countries really prepare for a pandemic? To a certain extent, yes. We can formulate plans to best prepare our healthcare systems and government machinery. However, there are still unforeseen circumstances that may not be captured by existing frameworks. For example, few predicted the extent of the shortage of face masks globally during COVID-19, which was driven by the fact that most of the world’s masks are manufactured in China and Taiwan, where lockdown measures were in place a lot earlier.

There is also the issue of strategies that different countries undertake in combating the spread of the virus, which may be a function political will, available resources and overall preparedness, among other things. Nonetheless, we need to reflect on the lessons we have learnt from the COVID-19 pandemic, and ensure ongoing awareness of the threat of pandemics and its potential impact on the healthcare system as well as the economy of a nation as a whole.