No More Pandemics! Bearing Witness to COVID-19 and Committing to a More Secure Future

"The most successful national responses to COVID-19 have been those which have engaged with local communities to build resilient health systems and inform service delivery, decision-making and governance to meet the needs of communities."

Concerned about inequality and marginalisation in the context of the COVID-19 pandemic, 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 over an 8-month period consulted with hundreds of people at the centre of the response and heard their advice as to what needs to change to make sure such a catastrophe never happens again. This report shares some of these voices - exploring emerging themes of the need for change and resilience, and the importance of having a seat at the decision-making table. It also presents short video clips featuring stories from around the world. (For the main report ("COVID-19: Make It the Last Pandemic") and other Panel-produced or -related documents, see Related Summaries, below.)

Indeed, the need to overcome inequities in pandemic preparedness and response is central to the Panel's recommendations, based on the interactions the Panel had over the course of its investigations. The report shares many examples of ways in which factors like gender and age have been pivotal axes on which disadvantage has only deepened during the pandemic. For instance, maintenance of services for sexual and reproductive health and rights was not given priority in the early months of pandemic. Young people have been not only affected by such oversights but by labour market and educational disruptions; impacts on physical and mental health have been severe. Inequity has extended to geographic considerations, with the lack of internet access in remote areas leaving the digitally disconnected prey to misinformation and unable to benefit from any of the digitally-based mitigation measures in the pandemic such as remote work or telehealth.

While the pandemic has deepened various types of inequalities, it has also spurred efforts to combat them, with positive examples of multistakeholder, intersectional, and intergenerational approaches referenced here. For instance, the Panel's Exchange drew attention to the body of evidence supporting the central role of midwives and midwifery in upholding and protecting women's rights. Women's participation in peace movements and against violence have also been pivotal to COVID-19 response - notably, in the negotiation of ceasefires to facilitate distribution of supplies such as food packages.

All that said, "A repeated refrain in the testimony presented to the Panel was the failure of coordinating authorities to include those most affected and at the frontlines of the response." Going forward, the "humanitarian community should transfer power and resources to local actors, especially in humanitarian settings, so that these actors are able to respond more immediately and effectively....There is a clear need for pandemic preparedness and response decision-making bodies to include those closest to the response and those most affected - including those infected and directly affected." For that reason, The Communication Initiative, in its submission to the Panel (see "WITH PEOPLE" at Related Summaries, below) proposed that: "in any new national pandemic taskforces that are established or in existing national pandemic planning and coordination bodies, 25 per cent of the membership in the core policy and budgeting processes are people from local communities as well as communication and community engagement practitioners."

The Panel's comparative analysis of national responses found they were most effective where decision-making authority was clear, was coordinated across levels of government, and heeded timely scientific advice. High-performing countries communicated consistently and transparently and developed partnerships not only with sub-national levels of government but also with actors beyond government, engaging with community health workers and community leaders, as well as the private sector. For instance, partnerships with local leaders and work alongside community members have been critical to the tailoring of messages and campaigns during this public health emergency. Similarly, shared values and a sense of social responsibility within communities have emerged as fundamental to the successful deployment of non-pharmaceutical public health interventions in response to COVID-19, such as mask wearing and physical distancing.

In light of the extensive evidence that the impact of the pandemic has been uneven and that disadvantage has been exacerbated, the Panel stresses that preparedness planning needs to be more inclusive and incorporate whole-of-society responses. The Panel recommends that countries increase the health and social investments needed to build resilience. Participants in the Panel's youth Exchange advocated for systems approaches, recasting resilience not as an outcome but as an ability.

In conclusion: "The Independent Panel has been fortified in its determination to make bold, sweeping and urgent recommendations by the testimony it received from people in the frontlines of the response. The failures of the international system of pandemic preparedness and response are manifest, and the voices raised to say 'never again' are compelling....Never has the interconnectedness of the world been more evident, nor its fragilities."