What does pandemic preparedness mean In practice?

The Covid-19 Inquiry is currently investigating how prepared the United Kingdom was in the run-up to the last pandemic. Former prime ministers, ministers, and chancellors, and scientific and clinical experts, have been giving lengthy evidence about our country’s pandemic preparedness.

A lingering question many people in the wider public may have, however, is how feasible it is to prepare for a pandemic at all. Infectious diseases, as we have all experienced over the last few years, are unpredictable and fickle. So what can we do as individuals and as a nation to prepare for the next pandemic, be it a year, ten years, or a century away?

Resourcing the health service

Firstly, we must ensure that we have a robust healthcare system which is appropriately resourced and staffed. The NHS is an institution that we in Wales are justifiably proud of, despite many systemic issues. And as a nation, we can be especially proud of the role of Wales in the genesis of the health service.

At the height of the pandemic, many of those reading this were working in hospitals, surgeries, or pharmacies to heal the sick. Others would have shown their support for this by painting rainbows or clanging pots and pans. But what we’ve known for a while, and has since become more obvious with the recent healthcare strikes, is that resourcing of the service is inadequate. This problem ranges from staffing to the stocking of quality personal protective equipment (PPE).

Ensuring that the system is adequately resourced does not only mean we obtain sufficient and appropriate masks, diagnostic tests, clothing, gloves, medicines, and equipment to care for those who fall ill and protect those doing the work. We must also have the staffing capacity to cope with staff illness; properly staff shift rotas to prevent burnout among healthcare workers; and provide and support a generally excellent level of care.

One of my enduring memories of the early pandemic is the almost inexorable march of the Covid-19 virus from China to Italy and finally to our shores. One of the key advantages we can have over a pandemic is forewarning: seeing it coming and having the time to put plans in place to defend ourselves. Accurate and robust surveillance of emerging infectious disease is therefore essential, but how do we do this?

Pandemic preparedness within and across borders

International collaboration is key. There must be direct communications between countries, but also via transnational organisations such as the World Health Organisation. The open sharing of information is essential in identifying emerging threats. On a national level, investing in public health laboratories to ensure they have the resources to identify novel diseases is of vital importance. So too is their ability to conduct tracking and tracing, to quickly identify infections and those who have been in close contact with them.

This leads to the matter of research and development (R&D). We have all benefitted from the fruits of a robust R&D sector here in the UK. One of the early, major protections against Covid-19 was of course the Oxford AstraZeneca vaccine. This was developed by a team led by Dame Sarah Gilbert of the Jenner Institute at Oxford University in conjunction with several collaborators. Investment in biomedical research in the UK is funded in a variety of ways, including grants from charities or public bodies. The competition for limited research funds is intense and many promising projects are left by the wayside.

It was revealed that the government conducted some pandemic preparedness exercises in the years before the Covid-19 pandemic. These included exercise Cygnus and exercise Alice: two simulations conducted in 2016 to try and model and predict how a pandemic of flu or Middle Eastern Respiratory Syndrome (MERS) could impact the UK. The findings of these scenarios included the impact a pandemic could have on PPE stocks, and how timely restrictions on movement would be important in helping to slow down the spread of a pandemic.

One limitation of our pandemic preparation, however, seems to have been placing a lot of emphasis on preparing for a strain of flu which could be approached with pre-existing drugs and treatments. The government did not attempt to model a novel virus which could not be treated so quickly and easily.

Moving forward, governments must regularly review and update their pandemic response plans, incorporating lessons learned from previous outbreaks. These plans should include clear protocols for early detection, rapid response, risk communication, and coordination among different sectors and agencies. And this must include both known viruses and hypothetical examples of viruses which have pandemic potential.

Education, education, education

One of the major pillars of pandemic preparedness is education. Snappy three-word slogans can be effective to a point during a pandemic but messaging fatigue can lead to a loss of effectiveness. Significant emphasis is placed on public health education and infectious disease in secondary education for many science awards. This is excellent in providing a basic framework on which to build future public health campaigns.

Of course, not everyone is currently studying. So public health campaigns in the form of commercials, apps, and print materials can be incredibly effective in raising awareness of practices which can help prevent infectious diseases, such as hand-washing and respiratory etiquette.

Improving public awareness is also essential in combating another invidious “virus”, which we saw circulating alongside the Covid-19 pathogen. The name of this virus is misinformation. Ensuring the populace has the tools and ability to address misinformation is vital. This is not only for pandemic preparedness, but also because misinformation can lead to the spread of fear, panic, and confusion. In times of crisis, society needs accurate and reliable information to make informed decisions about health and safety. Misinformation amplifies anxiety and hinders effective public health measures, impeding overall crisis response.

Preparing for a future pandemic will cost money. Some will argue this does not need to be spent, as the next pandemic might not happen for a generation or more. Many, however, would say that we cannot afford not to invest in a robust, multi-layered defence which will have wider benefits for the country.

It is believed that the cost to the UK public purse of Covid-19 could be as high as £410bn. By regularly investing a fraction of this in pandemic preparedness, governments can save lives, mitigate economic impacts, and strengthen their ability to protect public health in the face of future outbreaks.