November 28, 2022
By Nellie Bristol
COVID GAP
The West African Ebola outbreak of 2014-2016 brought a surge of national and international attention to epidemic and pandemic preparedness including revamped or new country level capacity assessment tools. The assessments, including the voluntary Joint External Evaluation (JEE), State Parties Self-Assessment Annual Reporting (SPAR), and the Global Health Security Index, measure health emergency preparedness and response capacities, including those required by the International Health Regulations (IHR). The thinking was that if countries knew where their capacities were weak, they could develop National Action Plans for Health Security and devote funding toward strengthening them.
But even with this renewed attention, country capacities continued to lag. Many countries struggled to translate the knowledge gained from the assessments into the competencies required to stifle emerging outbreaks. Sixteen years after the current version of the IHR was adopted by the World Health Assembly, the average self-reported global score for capacity implementation was 64%.
Although still falling far short of its $10.5 billion yearly funding goal, the newly launched Pandemic Fund housed at the World Bank is intended to ease the situation. Its goals are to help fill country and regional capacity gaps in disease surveillance, laboratory systems, emergency communication, coordination and management, health workforce, and community engagement, especially in low- and middle-income countries. In the longer term, it aims to invest in health systems at the community and primary health care levels to provide overall health system strengthening.
The additional resources available under the fund, which plans to issue calls for proposals by early next year, could be a boon to countries that are well aware of their preparedness shortcomings, but lack the cash to do anything about them. But many countries lack not only funding, but technical and management tools to address the deficits. Organizations working with countries on the issue have found that capacity building is a multilayered, complex undertaking that in addition to funding, requires focused attention to building enabling environments, multi sectoral networks, and developing tools that teach both the public and public health technical staff how to advocate for better preparedness from their leaders.
Health ministers in the World Health Organization’s Africa region, for example, noting that no country in the epidemic-prone region has achieved all the required IHR capacities, adopted a new strategy for health security for 2022-2030. Its three pillars focus on emergency response, surveillance, and health system resilience. As explained by Ambrose Otau Talisuna, WHO regional advisor for IHR and Global Health Security, in addition to considering traditional capacity assessments, WHO examined after and intra action reviews that considered countries’ COVID responses. Using this information, WHO and partners including the Africa Centres for Disease Control and Prevention, are working with countries to develop specific 24-month road maps to fill priority preparedness gaps. Catalytic funding would be provided by international partners, but countries are expected to develop their own financial mobilization strategies to support road map implementation. To ensure oversight and accountability, WHO is asking countries to identify a specific organization, such as a relevant ministry of health department or national public health institute, to take charge of the program and identify technical working groups to help with coordination. WHO embeds staff in the Ministry of Health for three months to help get the program off the ground. Road maps should be aligned with boarder national action plans for health to ensure overall health system enhancements, Talisuna said.
Talisuna holds out hope that this more focused approach will provide countries the support they need to develop better protections. “The assessment is the easiest thing to do,” he said. “We have driven all these countries to do these assessments and they have embraced them. And then the countries identify the gaps then we can’t fill in those gaps and they get an outbreak and then we begin running, firefighting. So really it gives us who have been working in this space nightmares. We hope the road maps this time will be funded, otherwise it will be the same scenario.... where we plan and we don’t implement anything. I hope that this time will be different.”
Resolve to Save Lives is another organization with a long track record in this area hoping the Pandemic Fund will boost capacity building, but it also notes that preparedness requires more than just additional funding. “National Action Plans for Health Security are among the most complex planning processes in public health, with multisectoral interdependencies across 19 different technical areas,” Resolve to Save Lives argues. “Countries face big challenges in prioritizing and sequencing activities...the first 100 Joint External Evaluations identified more than 7,000 gaps in preparedness capacity. Without rigorous approaches to ensure prioritization, plans tend to be unwieldy and difficult to execute.”
In gathering lessons from five years of working in this area, Resolve to Save Lives recommends: effective, committed, consistent political leadership and multisectoral coordination; establishment of dedicated teams to accelerate pandemic preparedness; development of accountability systems that track implementation of capacities against preparedness plans; better coordinated partner contributions at the country level, and; instituting timeliness metrics to drive performance improvement. Specific to the last recommendation, Resolve to Save Lives suggests a 7-1-7 target: 7 days to detect a potential outbreak, 1 day to report it to public health authorities, and 7 days to mount an initial effective response. “7-1-7 has been an effective communications tool to really crystallize where there are gaps in detection, notification, and response. In addition, it has been a very useful approach to identify the bottlenecks or barriers to epidemic response and leads to direct measures to effect performance improvement,” said Christopher Lee, Resolve to Save Lives director of global preparedness and response.
Resolve to Save Lives also works with countries to generate sustained domestic financial support for capacity building. Lee notes that donors prefer funding capital expenses such as equipment or laboratories centers, but much of the investment required for preparedness is recurrent costs including mundane items such as fuel for transporting response teams but also salaries for epidemiologists, veterinarians, laboratorians, and front-line health workers who are the most likely to identify and report potential outbreaks. Working with local and international civil society groups, Resolve to Save Lives aims to build the capacity of technical staff to understanding budgeting processes and local political economy so that they can make a case for including preparedness funds in national budgets. Lee said the approach was particularly effective in Nigeria where technical leads were able to unlock $3 million of domestic financing for preparedness activities. Resolve to Save Lives is working with the Global Health Advocacy Incubator and its Budget Advocacy Toolkit for Epidemic Preparedness to help more countries find ways to increase domestic resources.
As the specter looms of more and perhaps even more devastating epidemics and pandemics, experts in the field are hopeful that the availability of new resources along with innovative approaches to help countries take advantage of them will edge the world closer to better health emergency preparedness. “I really think this is the right timing because countries really need to do this when the COVID-19 memory is very, very fresh,” Talisuna said.
