COVID-19: Make It the Last Pandemic

"A groundswell of opinion is determined to address inequality so that we can come out of the pandemic looking forward to a better world, sustaining and expanding responses where they have shown a better path..."

Recognising that the COVID-19 pandemic has a disproportionately heavy impact on the economically poor and the most vulnerable, with repercussions for health and development goals, in May 2020, the World Health Assembly called for an independent, impartial, and comprehensive review of experiences gained and lessons to be learned. In response, the World Health Organization (WHO) Director-General appointed the Independent Panel for Pandemic Preparedness and Response, which in this report and associated documents shares its analysis and provides recommendations to improve capacity for global pandemic prevention, preparedness, and response.

The Independent Panel is concerned about inequality and marginalisation, noting that the burden of COVID-19 is being unevenly shared. Up to 125 million more people are estimated to have been pushed into extreme poverty, while 72 million more primary school-age children are at risk of being unable to read or understand a simple text because of school closures. Gender-based violence (GBV) is at record levels, and child marriages have increased.

In this context, the Panel sought to listen to and learn from a wide range of interlocutors in undertaking its work. Beginning in mid-September 2020, the Panel reviewed existing literature, conducted original research, heard the testimony of people working on the frontlines of the pandemic in town-hall-style meetings, welcomed submissions from its open invitation to contribute, and heard from experts in interviews and 15 roundtable discussions and in interviews. For example, on March 21 2021, a group of 24 experts in the field of communication for social change and behaviour change participated online in a roundtable on communication and community engagement. (Please see Related Summaries, below, for more information and for access to their paper.) Accordingly, the present summary of the Independent Panel's report highlights its communication and community engagement aspects.

In contrast to their own focus on inclusion in developing this report, the Panel notes that "the potential for communities to shape the response at the decision-making table has been severely neglected." For instance, while women constitute almost 60% of the health workforce and frontline workers, "they were not included in most of the COVID-19 response structures, thus increasing the equity gap for an effective response." Where the response did succeed, it incorporated local engagement, the Panel's analysis found: "Where community structures, such as cadres of community health workers, have been mobilized, they have made a critical difference in establishing trust in government instructions, extending services, and in relaying scientific information."

In brief, the report demonstrates that the current system - at both national and international levels - fell far short in protecting people from COVID-19. For starters, the time it took from the reporting of a cluster of cases of pneumonia of unknown origin in mid-late December 2019 to the declaration of a Public Health Emergency of International Concern was too long; information was not flowing as it should have. On the other hand, where the response was effective, open data and open science collaboration were incorporated into alert and response systems. For example, sharing the genome sequence of the novel coronavirus on an open platform led to what is described here as the rapid creation of diagnostic tests. Also, national responses that went smoothly built on lessons from previous outbreaks and/or were based on adaptable response plans. These responses "listened to the science, changed course where necessary, engaged communities, and communicated transparently and consistently."

In light of its diagnosis of what went awry and what worked well, the Panel calls for various immediate actions to end the COVID-19 pandemic. For example, high-income countries "with a vaccine pipeline for adequate coverage should, alongside their own scale up, commit to provide to the 92 low- and middle-income countries of the COVAX Gavi Advance Market Commitment at least one billion vaccine doses no later than 1 September 2021 and more than two billion doses by mid-2022." However, the Panel observes that "Vaccination alone will not end this pandemic. It must be combined with testing, contact-tracing, isolation, quarantine, masking, physical distancing, hand hygiene, and effective communication with the public."

To help the world prepare to prevent a future outbreak from becoming a pandemic, the Panel calls for the engagement of heads of state and government to lead on efforts to transform the existing system. Specific forward-looking recommendations for reforms, include, for example:

• Establish a Global Health Threats Council that will maintain political commitment to pandemic preparedness and response and hold actors accountable, including through peer recognition and scrutiny.
• Establish a new global system for surveillance based on full transparency. This system would provide the WHO with the authority to publish information about outbreaks with pandemic potential on an immediate basis.
• Invest in national preparedness now: All governments should review their preparedness plans and allocate the necessary funds and people required.
• Transform the Access to COVID-19 Tools (ACT) Accelerator (ACT-A) into a truly global platform aimed at delivering global public goods (i.e., vaccines, diagnostics, therapeutics, and supplies) swiftly and equitably worldwide.
• Focus and strengthen the authority and financing of the WHO, and create an International Pandemic Financing Facility with "the capacity to mobilize long-term (10-15 year) contributions of approximately US$ 5-10 billion annually to finance ongoing preparedness functions."

The report also shares recommendations for individual countries, including that heads of state and government should appoint national pandemic coordinators who are accountable to them and who have a mandate to drive whole-of-government coordination for pandemic preparedness and response. Also on a more local level, the Panel recommends the following:

• "Strengthen the engagement of local communities as key actors in pandemic preparedness and response and as active promoters of pandemic literacy, through the ability of people to identify, understand, analyse, interpret, and communicate about pandemics"; and
• "Invest in and co-ordinate risk communication policies and strategies that ensure timeliness, transparency, and accountability, and work with marginalized communities, including those who are digitally excluded, to build trust and resilience, in the co-creation of plans that promote health and wellbeing at all times, and build enduring trust."

Editor's note: The members of the Independent Panel are: Co-Chair HE Ellen JohnsonSirleaf, Co-Chair the Rt Hon. Helen Clark, Mauricio Cárdenas, Aya Chebbi, Mark Dybul, Michel Kazatchkine, Joanne Liu, Precious Matsoso, David Miliband, Thoraya Obaid, Preeti Sudan, Zhong Nanshan, and Ernesto Zedillo. The Panelists have a mix of skills and expertise in infectious disease, global and national health policy and financing, outbreaks and emergencies, economics, youth advocacy, and the well-being of women and girls.