Learning the lessons of the pandemic

A little more than two years ago, NUS Press took on a real stretch project, and I'm pleased to share the fruits of that now, through our open access website, Infectious Disease Emergencies: Preparedness and Response.

It is an extraordinary compilation of the cumulative wisdom of the global community of disease outbreak responders, and of lessons learned from the COVID-19 pandemic. The project brings together more than 100 contributors, with first hand field experience, from organisations like the US, European, Africa and China Centers for Disease Control, the Robert Koch Institute in Germany, WHO, UNICEF, Médécins Sans Frontières, International Federation of Red Cross and Red Crescent Societies, more specialist groups like ALIMA - The Alliance for International Medical Action , Epicentre , CAPRISA in South Africa and Icddr Bangladesh , and or from universities like NUS, London School of Hygiene & Tropical Medicine, Oxford, etc. See our list of contributors! Along the way we incorporated the learnings from the 2022 mpox outbreak as well. NUS Press pitched to work with Chief Editor, NUS Medical School Prof Dale Fisher who marshalled this extraordinary team of collaborators. We are very pleased to have won out over much bigger publishers in this space.

The project was a real stretch for NUS Press, digital first, a new subject area and an order of magnitude larger in the scale and complexity than anything we had done in our long history.

But I wanted to take a moment here to reflect on what I learned about the thinkers and do-ers who make up the outbreak response community.

1. Everyone is equally important to responders, in a way that goes beyond the fact that medical practitioners owe a duty of care to patients. No one can be ignored in an outbreak.
2. Responders routinely must demand the impossible. Among the key lessons learned from COVID-19 pandemic was the importance of ensuring that social, health and critical care services are maintained even when systems are stretched to the breaking point by the emergency. See chapters on Maintaining essential health and social services, Clinical care in challenging settings, and Mental health and psychosocial support.
3. Thinking about ethics is very important in an outbreak, but judging patients and communities is not. When people engage in medically risky behaviour, responders intervene to alert them to these risks, to try and change the behaviour through different interventions and communications. But they do not hold back care or outreach because they personally disapprove of the risky behaviour. This has been a hard lesson to socialise to other authorities. How many lives were lost to AIDS in Southeast Asia because this approach was not taken? How difficult must it be for responders who are risking their health to communicate with folks who reject medical expertise? See chapters on What causes outbreaks, and Infodemics and information management.
4. Outbreak professionals understand that outbreaks are social phenomena. Inequality, discrimination and humanitarian crises add to the risk of the spread of disease. It is not ideology but straight up science for outbreak professionals to worry first about disadvantaged groups. See chapters on Protecting the vulnerable and Complicating humanitarian emergencies.
5. Outbreak responders have real experience of seeking input from multiple perspectives, whether from frontline healthcare workers or religious leaders. They understand that true teamwork is needed to solve the wicked social problems that outbreaks can be. See the chapters on Teamwork and decision-making, Successful risk communication and community engagement, and Working with communities and volunteers.
6. In the COVID-19 pandemic, it was clear that social trust was a key differentiating factor in the effectiveness of pandemic response in different settings. And it was clear that trust is fragile and needs to be nurtured and developed at all times, especially before and after crises. See reflections in chapters on National preparedness and Moving forward globally to improve health outcomes.
7. Responders are always learning, researching, and teaching and training, even in the heat of an emergency response. They lay the ground work for this in advance. See chapters on Research to inform practice, Evaluating and implementing new diagnostics, Enabling research for therapeutics, and Pandemic vaccine development.

Above all, the responder community values action over contemplation, and pragmatism over fixed ideas. With responders, problems are explored and solved, and revisited if necessary, together, with speed and without angst. This made them a great group to work a project with!

I've focused above on the overlaps with the concerns of NUS Press' core constituencies, social scientists and humanities scholars. But there is fascinating detail here too on the more core scientific and medical concerns of the outbreak community, Pathogen genomics for surveillance and outbreak investigations, One Health: the animal-human interface, and so on.

Thanks again to this group of authors and experts, and the talented group of young medical students (now doctors and researchers) that Dale marshalled for this project, particularly Joycelyn S. who first broached the idea of the project. Please do check out the website, (or pre-order the print book). Keep an eye on the new Centre for Infectious Disease Emergency Response (CIDER) at NUS Yong Loo Lin School of Medicine where these insights will be put to work teaching new generations of responders. Alas the risk of new outbreaks is ever present, and is not going away any time soon. The insights you will find will be useful in thinking about social resilience along many dimensions.