A Wakeup Call to the Global Health Community

The COVID-19 outbreak is only the latest in a long series of wakeup calls over the past few decades for the global health community. Infectious diseases can quickly overwhelm the health systems of countries that have made enormous strides in economic development and health preparedness. As we are witnessing, this epidemic is even overwhelming the health systems of most advanced economies as well.

 Dramatic growth in travel and unpreparedness of most healthcare systems around the world to cope with such crises makes it increasingly easy for local outbreaks to develop into epidemics and epidemics into pandemics.

 Better management of contagions will require planning, collaboration, and a comprehensive, systemic approach. A truly effective health-emergency response system will demand continuous vigilance and improvement in the capacity to rapidly identify and understand novel pathogens; develop diagnostics, vaccines, and other countermeasures; and distribute necessary medicines, medical supplies, health professionals, and timely public information. More importantly, individuals' behaviors can be a major factor in controlling such outbreaks and limiting their toll on both human lives and economic development.

 Accelerate Detection and Understanding of the Virus

 Improved digital tools and more timely sharing of standardized data can help authorities detect outbreaks more quickly. Sudden increases in internet searches for flu symptoms, select medications or equipment, and antibiotic purchases, and social media posts about illnesses, for example, could be early warnings of potential local outbreaks if used in an integrated way.

 Health agencies could partner with telecom and online media companies, pharmacies, and other sources to aggregate data and detect potential emergencies through predictive analysis—and then alert healthcare providers and supplies of drugs, diagnostic kits, and other supplies to gear up. National pharmacy systems (marketplace between suppliers and retail pharmacies) can immediately detect specific surges and help authorities locate a possible outbreak very rapidly as well as help identify the location of required drugs or medical supplies.

 Singapore launched the TraceTogether app that can identify people who have been within 2m of coronavirus patients for at least 30 minutes, using wireless Bluetooth technology, while other countries trial AI to identify, track and forecast outbreaks.

Transparency and extensive sharing of data—not just within countries but globally—is also critical. Understanding a novel pathogen is an iterative process. Every day, experts in different locations are learning new things about the coronavirus—how it spreads, its mortality, which containment measures seem to be working, and potential treatment. Governments need to create and foster data-sharing strategies in standard formats so that the data is interoperable.

Rapidly Develop Countermeasures to Build Resiliency

The more scientists learn about a novel pathogen, the faster they will be able to develop vaccines and other effective countermeasures to contain an outbreak.

Given the anticipation of emerging pathogens, the global health community should forge public-private partnerships and enhance financial incentives for drug developers. This will ensure that new antimicrobials are always under development and that drugs that may have been ineffective against previous pathogens are maintained so that they can be tested against novel pathogens that are resistant to those currently on the market. Health organizations should also bolster partnerships with drug companies to ensure that R&D, clinical trial networks, and manufacturing capacity can be mobilized more quickly and scaled up to fight a new outbreak.

Governments should quickly address the social and economic implications of a major infectious disease outbreak, which are often overlooked until substantial damage has been done. For example, as a result of COVID-19, students are learning from home on a profound scale. As of this month, UNESCO estimates 124 countries have implemented nationwide closures, impacting over 1 billion children. The extended and uncertain time frame of reopening schools poses particular challenges for supporting students. Many schools shifting to online learning models will be trying to establish basic online programming for the first time, and many teachers will be adapting to remote instruction with minimal training in online delivery. Online learning for primary and secondary education has never occurred at even a fraction of this scale, and the degree of effectiveness of many aspects is unknown.

Governments should also anticipate the potential economic hardships on workers and families. Singapore is using a number of innovative approaches to mitigate some of these problems during the current coronavirus outbreak, including a COVID-19 Resilience budget.

Improve Global Health Infrastructure

Governments should develop advanced strategies that will ensure strategic reserves are in place for essential drugs and medical supplies that might be needed in such events. Moreover, governments should consider localizing the production of such drugs and medical supplies wherever possible.

The availability and delivery of critical drugs, diagnostic kits, protective clothing, treatment facilities, and health personnel during an emergency can be greatly enhanced through advanced contingency planning and by ensuring that supply chains are agile, resilient, and geographically distributed. Global electronic marketplaces that link manufacturers with distributors can allow the dynamic reconfiguration of supply chains to locate essential supplies and ensure their availability in locations where they are needed.

One key lesson that has emerged from recent infectious-disease crises is that the supply network of masks, gowns, and other personal protective equipment must be geographically distributed. Medtech industry executives estimate that Asia produces up to 50% of N95 masks, including raw materials and fabrics for N95 masks manufactured elsewhere, as well as a large majority of isolation gowns. These supply chains are at risk. Several Asian and European countries have placed export controls on "protective apparel." Another risk of concentrating too much production or storage of critical drugs or medical supplies in one area is that transportation or manufacturing facilities could be locked down if a disease outbreak strikes that location itself.

The enormous stresses on the health care system around the world also illustrate the urgency of assuring that medical care can be delivered to large numbers of patients on short notice. Health systems must think about all available spaces and how they can be best used, including routine clinics, ambulatory care centers, and urgent care facilities. Underused hotels, which may be available due to lower travel, can present an option for extra capacity, especially for patients with noncritical conditions. The ability of governments to manage the capacity of their healthcare systems on short notice will depend on the availability of tools that bring together supply data (beds, specialists, equipment) with demand data (volume per disease code, demographics, location of service provision). With such health system capacity planning tools, governments can rapidly designate specific procedures in specific locations as "non-urgent" and be able to determine the freed up bed capacity that can be used.

And lastly, when a new vaccine or other effective treatments are found, there needs to be the ability to rapidly scale in time of need, and ensure that the infrastructure is in place to deliver supplies to populations—including people living in remote villages or highly impacted neighborhoods.

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Once the coronavirus outbreak subsides, there should be a period of reflection on the lessons learned—and how those lessons can be incorporated into future preparedness plans. Responding quickly to a fast-moving outbreak would be hard for any country, especially in a highly connected world. Through integrated strategies, agile approaches, use of digital tools, and improved planning and collaboration, outbreaks can be managed more effectively. Beyond preparing for the next outbreak, the COVID-19 crisis offers healthcare systems across the world an opportunity to further adopt new models of care (telemedicine, remote monitoring, home care), increase the resilience of the system (sharing equipment, optimally distributing loads on caregivers), and improve the financial sustainability of the system (low value-adding activities, unnecessary procedures/activities).