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Lessons We Learned from Previous Pandemics

March 20, 2020

For years infectious disease experts who specialize in pandemics, including some of my colleagues, have said the question isn’t if there would be another pandemic but rather when. In fact, in 2016, we held a Bold Thinkers Series event called “Global Health Security Threats: Are We Prepared?” COVID-19 is just the kind of event they predicted.

The understandable focus of the press has been that the U.S. did not devise COVID-19 testing fast enough and that most countries lack the surge capacity needed for hospital beds, ventilators, masks, personal protective equipment for healthcare providers, and other supplies. But there are two lessons we’ve learned from previous pandemics that have gotten less attention and that also are critical.

We learned one lesson when Abt executed the Zika awareness campaign in 2016. We discovered how important it is to adopt the fundamental components of effective social and behavior change communication (communications). They include:

  • Coordination at all levels—from international organizations to cities--to ensure collaboration, harmonization, and joint communications planning and implementation. This requires early establishment of multi-level working groups that preferably rely on existing organizational structures.
  • A quick determination of priority behaviors through a participatory process with all stakeholders, led by people with communications expertise.
  • Recognition of communications as a crosscutting line of work integrated into other technical areas.
  • Rapid formative research to make sure communications activities are contextually relevant.
  • Agreement on communications key indicators to enable rigorous comparisons.

What we have seen instead is a cacophony of advice from country to country and within countries with deadly consequences. Behavior didn’t change. People continued to go to bars and restaurants--until governments took the draconian step of shutting them down. And the number of cases and deaths continued to mount. More strategic communications could have made a difference.

The second lesson came in 2013 from our flu work for the Centers for Disease Control and Prevention (CDC) in the aftermath of the H1N1 pandemic. What has become clear is the need for a research strategy ready for launch immediately upon an outbreak--and funding for that research. Too many countries lack both the research strategy and funding.

Past pandemics highlighted the problem. It took six months to set up a research program for the 2009-2011 H1N1 pandemic. It missed the first wave of the outbreak. Zika and Ebola took a year. When the Ebola research plan was ready, the outbreak was over. And a vaccine for COVID-19 is expected to take even longer to develop: 12-18 months. The rapid rise of pandemic cases requires a fast, nimble, and flexible response.

The U.S took a step in the right direction in 2013 when the CDC awarded Abt a contract to establish an infrastructure of research hospitals and institutions to enable flu research to begin three days after an outbreak. The research platform, which CDC may use for COVID-19, identifies and enrolls patients with possible pandemic influenza infection and collects clinical specimens and medical information in a standardized way. The real-time data informs public health officials about testing and treatment practices, clinical characteristics, and outcomes of hospitalized pandemic patients. These findings help inform the response and rapidly adjust how we make decisions in emergencies.

Other nations must follow suit. What’s needed are:

  • Rigorous national research strategies.
  • International donor funding for such programs for developing countries and training in epidemiology and laboratory and data management.
  • International donor investments in projects that investigate vaccine effectiveness for vulnerable groups.
  • South-south assistance in which countries with data management systems share them with countries unable to develop their own.
  • A standing pool of funding, financed by international donors and national governments, to jump start pandemic research.

The private sector is not going to put money into such research efforts just in case a pandemic occurs. The return on investment is too uncertain. Government must do what the private sector can’t or won’t do. It is the role of government—not the private sector—to safeguard the public.

We must have research capacity available when we need it—and we will need it. If the number of COVID-19 cases and deaths is anything close to projections, this may be an agonizing lesson with huge costs. Maybe governments finally will learn it. In theory it didn’t have to be this way. Warnings from the experts abounded. But it’s human nature to ignore distant threats, which pandemics always seem to be. So human nature may have made this painful experience inevitable. We can only hope and pray that we won’t repeat it.

Learn more about Abt’s COVID-19 Insights.

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