Preparing for the next health pandemic
It has only been a few months since I vacated my post of the Cabinet Secretary for Health in my country, Kenya. I was appointed just when the world was gearing up to fight the novel disease, Coronavirus. I had barely gotten settled in my new job when the first case of the disease was reported in Kenya (March 2020).
Like a sudden storm, I found myself, learning the emergency drills to a health response while at the same time preparing the country against a disease we knew barely anything about. To our advantage though, the delayed arrival of the virus allowed us to observe how the rest of the world was managing, particularly those countries severely paralyzed by the contagion. It was my role to lead Kenya in developing our own appropriate emergency response to what was arguably the greatest health challenge of our generation.
Our strategy included the deliberate initiative to forge a unified Government approach under the leadership of President Uhuru Kenyatta which saw the formation of the National Emergency Response Committee on Coronavirus which I chaired. This committee brought together different Government departments and agencies with members drawn from the senior most levels in Government. It benefitted from advice of the National Taskforce on Covid 19 which, being an operational organ of the national response, was chaired by the Principal Secretary in the Ministry of Health.
This taskforce had several work streams amongst which was the critical one that assessed the preparedness of facilities at both national and sub-national levels led by the chairperson of the Kenya Medical Practitioners, Pharmacists and Dentists’ Council. It also benefited from recommendations of the modelling consortium which included senior medical workers and epidemiologists drawn from private and public medical institutions, medical schools and research institutions across the country.
It is worth noting that because our country is structured in two levels, the national and the county level formations, it was necessary to ensure coordination at both levels at the senior most level, a task undertaken by the president.
Following this multi-level and multi-agency approach, we developed a raft of responses, some that were uniquely Kenyan. Where for instance the rest of the world was locking in people in their areas of residence, we gave the most vulnerable members of the society, particularly those living in informal settlements an opportunity to work, cleaning and clearing bushes in what we called, kazi mitaani, or work in the villages. This way, we essentially ensured that people spent time in the outdoors, with less crowds in what would otherwise meant crowding in these spaces, thereby minimising infection while at the same time allowing people to get physically active as they earned their livelihoods.
When transatlantic countries were considering severe isolation from South Africa by restricting travel at the emergence of the Omicron variant; in Kenya, we decided to lobby the region and the rest of the world not to take the restrictive measures before understanding the findings of a robust scientific investigation were completed. As it turned out, the variant was not any more lethal than the initial Delta variant that was already prevalent across many countries.
As may be apparent by now, a lot of decisions were purely driven by science and prevailing local circumstances. But like in the case in many other countries, the measures included the closure of schools, the imposition of a dusk to dawn nationwide curfew, the requirement for regular washing of hands and the mandatory wearing of masks in public places.
In addition to these measures, we also promoted public awareness about the virus and encouraged Kenyans to get vaccinated when vaccinations became available.
We may have been lucky to get away with minimal damage as it were, thanks partly to our actions and the mercy of God, but we most certainly need to draw from the lessons learnt as a community of the world to prepare for the next pandemic for there will most definitely be another in the future and the world will be in a better place by planning for it. It’s a matter of when, not if.
First, let us address the globalisation of disease outbreaks with the rapid spread across borders due to increased travel and trade. The interconnectedness of the world through transportation networks, trade, and population migration have made it easier for diseases to spread rapidly around the globe.
The outbreak of COVID-19 is an example of how a disease can quickly spread around the world. To address the challenges of global disease outbreak, global cooperation and coordination among countries and international organisations is crucial. This includes sharing datasets, resources and expertise, as well as strengthening local health systems to deal with any incidences as soon as they emerge.
We also need a paradigm shift, adapting a more comprehensive, holistic, and proactive approach, rather than a reactive one. This would require a change in the way we think about and approach public health and global health issues.
One key aspect of this shift would be to prioritise prevention and preparedness. This would involve building capacity for surveillance, early warning and response, and investing in research and development of new tools, such as vaccines and therapeutics. We for instance saw the need for local capacity to produce and distribute basic commodities such as personal protective equipment and masks. And in this regard, no nation is an island, all countries must work together at both the global and regional levels, supporting each other to respond quickly to any threats that could potentially become regional or even global pandemics.
Further, in the global and regional response, the focus should extend to look at health as a threat to security, deserving of the world community’s urgent response with utmost sensitivity and alertness. This means recognizing that the health of populations in different countries get affected, and that an outbreak in one country can quickly become a global pandemic, one that not only compromises a country’s economic health but also threatens its security, perhaps even its very existence.
Additionally, a paradigm shift would require a focus on health equity in addressing social determinants of health. This would involve recognizing that the burden of disease is not evenly distributed, and that certain populations are more vulnerable to disease outbreaks due to factors such as poverty, lack of access to healthcare, and discrimination.
Finally, it would also involve incorporating a data and science driven ecosystem approach, which considers the interconnectedness of human, animal and environmental health, and how they influence each other.
All these solutions are important but perhaps the most important of them all is communication. Communication is not only about sharing information but also about building trust and understanding. Effective response to any pandemic must of necessity be premised on the ability of communities to take charge of their health solutions and this can best be achieved through community engagement, a factor that can best be fostered through communication. When communities develop trust in their Government’s response, and develop their own solutions based on the Government’s proposals, promoting a cooperative and collaborative approach, then it will be easier to arrest the spread of pandemics.
There are several ways to ensure faster communication during a global pandemic, they include the establishment of international networks of public health experts, epidemiologists, and other relevant professionals who can quickly share information effectively and collaborate on response efforts.
Other ways include the use of technology, particularly to share information, in a clear and consistent manner. In this regard, advancements in artificial intelligence may be leveraged.
Further, we saw how COVID-19 left economies in devastation. The big question now is, should the world have a standby pandemics funding mechanism? A standby or permanent funding mechanism would provide a dedicated source of funds that can be quickly mobilised in the event of a pandemic. This would ensure that resources are available to respond quickly and effectively to an outbreak, and can help to reduce the economic and social impacts of a pandemic. Existing mechanisms focus on specific health issues, there is a need to mobilise resources for the yet to be seen challenges. the future pandemic.
A mechanism could take several forms, such as a dedicated fund established by governments or international organisations, or a mechanism for reallocating funds from existing budgets. Additionally, it could be designed to be inclusive and equitable, ensuring that low-income countries and vulnerable populations have equal access to the funds.
We cannot talk about global pandemic response without acknowledging the role the World Health Organization (WHO) plays. Looking at the last pandemic, I believe there is a need to enhance the role of WHO in future pandemic management, particularly in view of the attacks on the organisation, particularly reputational attacks to the head of the organisation at the beginning of COVID-19, and also given the perceived failures of the WHO to rise to the occasion with urgency at the time.
This can be done in several ways; Investing in strengthening the organisation’s technical capabilities, enhancing its mandate to include more authority and resources to respond to global health emergencies, improving coordination with other international organisations, governments, and non-governmental organisations, building capacity in low- and middle-income countries to improve their ability to detect and respond to outbreaks and incorporating community engagement and participation in the response.
Leveraging the many lessons we learnt in responding to the Covid 19, and drawing from them in our immediate preparations for the next health attack, we can make sure we are not caught napping. Of importance is to ensure that the response is anchored in resilient institutions so that where we relied on adhoc committees, we can have more structured response mechanisms, where we had no capacity in our health systems we are better equipped from both a technological perspective as well as human resource and where we were struggling with funding, we are better organized to draw down resources at the global, regional and even national levels.
We must also realize that imperatives of the past such as national geographical boundaries and our obsession in defending them will no longer be relevant in the fight against a global health threat. We must appreciate that a global pandemic is no respecter of national boundaries and affects all countries indiscriminately. We cannot attack it piecemeal, country by country, in a manner akin to the use of guerilla tactics. The world must instead work as a single army, defending ourselves against a common enemy with each country being the other’s keeper. A silo mentality and knee jerk reactions will neither be sustainable nor effective.
Sen. Mutahi Kagwe is former Cabinet Minister for Information, Communication and Technology and Immediate former Cabinet Secretary for Health, Kenya