We were fascinated by the recent event – ‘Covid-19 and development: implications for preparedness and response in future pandemics’. Our colleagues Hayley MacGregor and Sabina Rashid took stock of what the COVID-19 pandemic has taught us. Lynda Keeru reports back with this summary of their discussions.
The pandemic is not over – unfortunately, it is unfolding in dramatic ways in different parts of the world. What we have seen with the response to COVID-19 are some limitations in the utility of conventional approaches but also some bright spots for the future of things that have really worked well. Now is the time to ask what does this pandemic teach us about pandemic preparedness and response both now and in the future?
Over the past year, the unfolding of the COVID-19 pandemic has repeatedly shown that what we have witnessed is more than a health crisis. It has manifested itself as an intersecting crisis across multiple areas including education, the economy and social care. The impacts of the epidemic are diverse across contexts and predictability and uncertainty are ongoing as new variants emerge.
Snapshot from Africa and Bangladesh
In rural and urban Africa and in informal settlements in Bangladesh, there are people living with everyday uncertainties and threats of various kinds in circumstance characterized by precariousness and competing priorities such as climate, conflict, security and livelihoods. These are key threats that people have to navigate alongside COVID-19.
With emergence of corona virus, there were anxious predictions of the devastation that a pandemic could wreak in Africa. The World Health Organization joint evaluation exercise consistently assessed all African countries as unprepared despite the health systems investment post-Ebola and the establishment of African centers for disease control in 2017 to strengthen science networks.
Epidemiological methods predicted many deaths. African countries adopted border control methods early with swift responses whilst cases remained low. In some instances, very stringent lockdowns were implemented early. What followed was the heterogeneous unfolding of COVID-19 with peaks in a few countries, pockets of infection in others and some countries spared with very low mortality that seemed verifiable despite very limited levels of testing.
This unfolding picture challenged the notion of a linear temporality. The early African success has been linked to many factors like demography and cross-immunity. WHO and Africa CDC have credited this success to decisive action by African leadership, collaboration in joint platforms and to existing experiences of managing infectious diseases outbreaks.
The lack of recognition of African success and the predictable reluctance of countries in the global north to look to African experience has been seen as further evidence of the need to decolonize the days of global health. Since the last quarter of 2020, many countries in Africa started experiencing the second wave which is of course proving much more challenging.
In Bangladesh, between March 2020 and January 2021, the number of infected people stands at 531,799 and number of deaths at 8,023. A countrywide shutdown was implemented from 26 March to 31 May 2020 to contain the spread of the virus just as was the case in many African countries. The government enacted widespread surveillance to ensure home quarantine and social distancing and directed the law enforcement agencies to ensure that they were as strict as possible. Businesses, factories, shopping centres, mosques and all educational institutions were shut. This gave rise to mass confusion and mass migration from urban areas to rural villages.
Without a doubt this had a huge impact and economists predicted the loss of jobs for 20 million people especially in the informal sector; placing serious stress on the economy. In addition, with disrupted sources of income, food consumption reduced and people’s emotional and mental stress heightened. A lot of misinformation and fear was witnessed and people who contracted the virus experienced a lot of stigma.
The Bangladesh response has largely been reactive with very disjointed initiatives. A lot of indecisiveness and confusion was observed and the health systems was very unprepared.
New ways of viewing pandemic responses
Hayley reflected on the challenges these circumstances posed for conventional approaches to epidemic preparedness and response. In recent years, the idea of epidemic preparedness has come to the fore in global health discourse and practice and has been added in certain strategies and institutional architectures. A reorganization of the WHO strengthened the health emergencies programme and recommended a phased approach to epidemics. It set operational pillars and a cycle of action that inscribes an emergency temporality and one that would move from preparedness through to response recovery. These plans are situated within a global health security paradigm but with special focus on one pathogen and also privileged planning centrally and central control.
Preparedness relies on particular strategies, particularly for prediction, such as surveillance modelling. In the context of COVID-19 there has also been much discussion of the heavy reliance on certain kinds of evidence such as from epidemiology and there being cause for greater interdisciplinary but also for plurality of knowledge including experiential knowledge of outbreaks.
Sabina weighed in on the importance of reframing health beyond a biomedical (disease model) approach to health. The models need to be socially just that place the communities and people at the center. Responsive decisions and policies must be balanced with social and economic interventions with an awareness of the heterogeneous nature of communities. There continue to be concerns on how to foster institutional responses that are adaptive and support local mobilization. There’s need to think of governance and resourcing strategies that could enable a better balance with top down planning and strengthen forms of solidarity.
COVID-19 has made us consider the proportionality of public health measures. There have been questions about the balance of health, human rights and economic wellbeing. We need to account for livelihood realities and incorporate intersectoral thinking such as social protection as part of the response.
Fundamentally, we need clear recognition that pandemic preparedness and response are not only technical, they are also deeply social and political processes.