Health intelligence to deal with the pandemic

The danger of a deadly pandemic was feared by everyone working in pandemic preparedness but not fully realised by those leading the world. Some certainly understood the potential dangers of it to national security but not its full impact. Now we are concerned with just surviving, when more 1.5 million have died and 70 million are confirmed to have contracted Covid-19. These are heavily under-reported numbers and the actual figures are many times more. While we are occupied in ensuring the safety of our loved ones, the economic damage is only becoming visible now. The world economy has suffered heavily, millions have lost their jobs or are receiving reduced earnings and similar numbers have been pushed down the poverty line.

At last the vaccines are here, but anyone who has worked in vaccine deployment could tell that from the availability of a vaccine to its procurement, then supply and cold chains to the end user, people eventually agreeing to a new vaccine — it’s a tall order. Until we achieve herd immunity through vaccine, we are all vulnerable even if some get vaccinated.

Will this virus be the last one causing a pandemic? Certainly not. And with the population density increasing and people and goods mixing at an unprecedented scale we may have to face these threats regularly. The way out should not be like the cost of a single-use product. Instead, we need to invest in systems and processes which help us protect and control the current pandemic and act as a foundation for early detection and control for potential future ones. The resources mobilised for Covid-19 will not stay long. Old habits will come back with health going back to the lowest of priorities for financing in most countries.

Back in 2014, with a threat of the Ebola pandemic looming high, many countries woke up to the threat of a major pandemic. In a meeting, I requested that while setting up a defence system for Ebola, we should build systems which could stay and keep protecting us from other outbreaks. “Stay focused on Ebola,” I was reprimanded by a high-ranking official at the Ministry of Health. Soon, the money was spent and the systems set up for Ebola disintegrated after a few months. That year our health sector’s severe deficiencies of infection control practices became crystal clear to me. I was afraid even if one Ebola patient came to our hospitals, it would have been enough to start a major outbreak. Unfortunately, we did nothing except a lot of training, international tours, meetings, and publishing guidelines which no one reads.

To effectively utilise temporary decision-makers' attention, we need to set up effective systems of health intelligence, where potential health threats are identified early, and controlled locally. That means going beyond ordinary disease surveillance which just produces weekly, monthly, or yearly reports. This should be funded on a par with funding of countries for their other intelligence agencies. Health intelligence should be complemented with capacities and resources for early and effective controls. That is going to require different thought processes, new teams who could think beyond the horizon, have legal mandate to identify and eliminate potential national health threats free of political or any other influence. The end of Covid-19 may just be winning a battle in a long war with many unidentified microorganisms. They have lasted on this planet for billions of years. We are a new kid on the block and may have overestimated our strength to fight. Well now the bugs are fighting back so we should get ready!