The COVID-19 Pandemic: What have the experts learned?

What has COVID-19 taught you about disease and how do you think the world needs to prepare for pandemics in the future?

We need to look to having a better, safer, and fairer world post COVID. We need to be better prepared, we need to ensure every person has genuine access to health care, we need to structure our societies so we reduce the things that increase the likelihood and severity of pandemics, e.g. overcrowding, marginalisation, inequity and last but not least we have to look after the health of our planet- climate change, the animal world, our forests.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

Right from the start the scientific community came together- heeded the call WHO made when we activated the R&D Blueprint in the first week of January 2020- and worked tirelessly, together sharing ideas, discoveries and information- in true solidarity. The fruit of this solidarity is now evident- good diagnostic tests, we know about which treatments work and of course we now have vaccines. Vaccines are giving us a second window of opportunity to bring the pandemic under control. We must not squander it.

If we truly work together- build on the solidarity so many have shown, we will beat this together. But we are at a critical juncture, much depends on staying the course and working together- and continuing to apply the traditional public health measures while rolling out the vaccines, fairly, and appropriately to the highest risk groups first, in every country on the planet.

What has COVID-19 taught you / your industry about disease and how do you think the world needs to prepare for pandemics in the future?

BMJ’s vision is to help achieve a healthier world. We do this through publishing research, providing medical education and clinical decision support, and driving quality improvement in healthcare. COVID-19 has affected all of these activities. It has taught us the importance of publishing research quickly in a fast changing scientific environment. But we know we must also ensure that the research is of high quality and reliable. Our medical education and decision support tools have always been continually updated, but the COVID pandemic has reinforced the importance of having updating processes that take into account new evidence on a daily basis. Lastly the COVID pandemic has shown us once again that our users expect our content to be practical and to help answer their patients’ questions and solve their problems. This is challenging as the volume of scientific research is very great and there are ongoing questions about diagnosis, investigation, management, and prevention. However we remain committed to ensuring that our resources answer questions that will enable continuous clinical quality improvement.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

The COVID pandemic has shown the importance of collaboration to achieve the goals of effective diagnosis, treatment, and prevention of disease. This has required collaboration between primary care and secondary care; between doctors, nurses, and allied healthcare practitioners; and between the scientific community and clinicians on the frontline. Many patients with COVID-19 also have comorbidities and it is these patients who are often the most seriously ill. The management of patients with comorbidities requires a collaborative and team-based approach to achieve the holistic care that patients need. We have recently launched a new tool – BMJ Best Practice Comorbidities – to help interdisciplinary teams of healthcare professionals treat a patient’s infection with COVID-19 and associated comorbidities. This has proved vital during the pandemic - and will continue to be used into the future to help the growing number of patients with multiple communicable and non-communicable diseases.

What has COVID-19 taught you/your industry about disease and how do you think the world needs to prepare for pandemics in the future?

One key lesson that we’ve learned from this pandemic is that nobody is safe until everyone is safe because infectious diseases do not respect borders. Therefore, global equitable access to vaccines, particularly protecting health care workers and those most-at-risk – wherever they are, and whatever their income level – is the only way to lessen the public health and economic impact of the pandemic on individuals, communities, and nations.

This is why the COVAX Facility was set up. COVAX is a global collaboration co-led by Gavi, the Centre for Epidemic Preparedness Innovations (CEPI) and WHO – working in partnership with participating countries governments, vaccine manufacturers, UNICEF, the World Bank, and others.

This unprecedented international collaboration in terms of technological innovation, funding for vaccines and new models of public-private cooperation to enable rapid roll-out of vaccines once doses are delivered is going to be a valuable learning for future pandemics.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

Ensuring access to vaccines during a global pandemic is different to at any other because the vaccine is needed everywhere on a similar timescale. Rich and poor countries are affected and therefore questions around pricing, manufacturing and overall supply become much more complex.

While we have started delivering the first doses and this is already faster than when compared to the H1N1 last pandemic experience, our work is not done yet and the world must continue to work together if we are to successfully deliver on our mission.

COVID-19 has taught us that to address the complexities that lie ahead – from regulatory approvals to readiness and capacity, supply fluctuations to delivery and logistics or funding – the scientific and medical community must all work together if we are to successfully deliver on the largest global vaccine rollout in history.

What has COVID-19 taught you / your industry about disease and how do you think the world needs to prepare for pandemics in the future?

COVID-19 is a reminder that swift, evidence-based decision making, and being prepared are important for managing health crises effectively. Early in the pandemic, when our collective understanding of the virus was limited, many African governments were quick to implement lockdowns, ban large gatherings and implement public health measures such as good hand hygiene, physical distancing and wearing masks. Though the strong measures hurt economies, implementing them bought time and showed African leaders were ready to make difficult decisions to safeguard the health of their citizens. What hurt the continent is that we lacked resources and countries found it difficult to access key tools like tests. COVID-19 has underlined that preparing for pandemics takes resources and resolve. African leaders demonstrated resolve but have often lacked resources. We need to ensure equal access to health across the globe.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

The rollout of several COVID-19 vaccines just over a year after the disease was discovered is an incredible feat that shows the strength of collaboration across the global scientific community. However, the quick development of vaccines is not enough. A vaccine must move from the laboratory to people’s arms. Vaccines must be distributed equitably. Unfortunately, less than 2% of the 690 million COVID-19 vaccine doses administered to date globally have been in Africa, where most countries received vaccines only five weeks ago and in small quantities. More than a billion Africans remain on the margins of this historic march to overcome the pandemic. I strongly encourage pharmaceutical companies to support wider manufacturing of the vaccines. I urge wealthy countries to move quickly from pledges to action in sharing surplus doses so that all at-risk populations can be protected globally.

What has COVID-19 taught you about disease and how do you think the world needs to prepare for pandemics in the future?

For many Americans, COVID-19 has taught them about the importance of public health measures, as well as the critical importance of lung health. COVID-19 has made it evident that every breath matters. So whether quitting smoking or seeking to better manage lung diseases, people are more aware of their lung health.

Moving forward, robust investments in public health infrastructure will be needed to prepare for the next pandemic. This will be critical to saving lives. And it’s especially important as we know that climate change can increase vector-borne diseases, so it’s not a matter of if, but when we’ll need to prepare for the next pandemic. The American Lung Association will be there to share trusted information and fund research to advance treatments.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

Collaboration is critical to advancing science and saving lives. The pandemic has brought many institutions together and forged unique partnerships, including through the Lung Association’s COVID-19 Action Initiative. We know that we’re stronger together, and we’ll get through this.

What has COVID-19 taught you/your industry about disease and how do you think the world needs to prepare for pandemics in the future?

I spent a year working on the West Africa Ebola outbreak in 2014-2015. I left that experience with a passion for ensuring the world didn’t face a crisis of that magnitude again. However, the world quickly moved on and few of the many recommendations that were made coming out of Ebola were acted on.

COVID-19 has shown the world how fragile and interconnected our public health system is, and how poorly equipped the world is to manage a crisis of this magnitude. We’ve seen price gouging of PPE, inequitable rollout of vaccines and the lack of basic supplies like oxygen in many parts of the world.

As we continue to battle this crisis into a second year, the world can’t afford excuses. That is why we created Pandemic Action Network, a coalition that insists that COVID-19 should leave a legacy of long-term preparedness. World leaders must take bold action to proactively prepare for and prevent pandemics just as they would any other national and global security threat to humanity.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

COVID-19 has shown the world the importance of investing in global health research and development (R&D). Many years ago when I worked in the Clinton administration, the budget for the National Institutes for Health was doubled, seeding much of the research (mRNA and coronavirus) that allows us to have a vaccine today. If scientists hadn’t been picking away at spike proteins “just in case,” we would not be where we are today. People question how fast the vaccine process has moved, but it is precisely a result of decades of research and global scientific cooperation. Next time there is an outbreak, we won’t be as lucky unless we invest in organizations like the Coalition for Epidemic Preparedness Innovations (CEPI) which envisions a world where we can effectively end pandemics by shortening the timeline of vaccine development to just 100 days.

What has COVID-19 taught you about disease?

COVID-19 has taught us how a disease can disrupt way of living. For example, in the fight against this pandemic, restrictive measures were adopted by countries to prevent the further spread of the virus. These restrictive measures include lockdown, social distancing, isolation and quarantine. All these have affected our daily activities in such a way that there is reduced face to face interactions. Further, lockdowns, isolation and quarantine have made us realise the importance of the relationships and the interactions that we have in our societies which we always take for granted. On the other hand, Africa Health Organization (AHO) has learnt the power of technology in bridging the gap between these restrictive measures and office operations. For example the use of Zoom Meetings, Google Meet, WhatsApp, Skype and Microsoft Teams have made office work quiet easy during these difficult times.

COVID-19 has also taught us how fast a disease can spread globally within a short period of time. For example, looking at how COVID-19 started in Wuhan in December, 2019 by 19th May, 2020 the global had already 4, 894 098 of coronavirus cases and 320, 180 deaths. As of 9th April, 2021 according to the Worldometer, the globe has 134, 641, 215 coronavirus cases and 2, 917, 995 related deaths. This shows how invasive is the COVID-19 and how it has impacted the whole world within a short space.

How do you think the world needs to prepare for pandemics in the future?

In preparation for pandemics in the future, the world needs to develop resilient health systems, especially to the developing world where the health systems are nearly collapsing yet there are only few cases as compared to the developed countries. For instance, according to Coronavirus in Africa tracker as of 9th April, 2021, Africa has 4, 318, 288 confirmed coronavirus cases from which 346, 085 are active confirmed cases and 114, 937 related deaths while in European countries according to European Centre for Disease Prevention and Control as of 9th April, 2021, Europe has 44, 882, 774 coronavirus cases and 971, 595 related deaths.

Learning from developing world’s experience with the pandemic, we have seen how their health care delivery systems are exhausted on which the developing countries health care delivery systems cannot withstand such pressure. There is need to have strong governance in health care, more funding allocation towards health which will increase the number of health workforce, expand infrastructures and improve availability of medications in health facilities. Additionally, the increased health financing will improve research which will help in identification of diseases, developing patterns of such diseases and developing medications/immunizations at an earlier stage before becoming pandemics.

Governance

We need strong-willed leaders in health sector at country level. The passion of these leaders will help to develop vibrant health care delivery systems. Well-built governance in the health sector is required in the areas of resource mobilisation, policy development, planning the needs of the population, needs priotisation and resource allocation which will eventually determine the country’s preparedness for the future pandemics. However, there is need to develop the capacity of the health sectors in developing countries. This is evidenced by poor management and planning of the health resources as well as lack of expertise on needs priotisation and policy development. Therefore, developing the lacking skills and expertise will determine the functionality of the health care delivery system.

Health financing

Improving funding allocation for health care services will strengthen the health care delivery system. This will in return improve availability of health workforce, the equipment and supplies, improve research and infrastructure which will help to develop a resilient health system in readiness to the future pandemics. In the developing countries most of their health financing comes from the domestic sources and others rely in donor funding. This is a challenge as these countries have limited resources that help to accumulate enough funding for health. Further, health financing is greatly affected by the high burden of mortality and morbidity of diseases that these developing countries suffer. For example, HIV/AIDS, cancers, tuberculosis, maternal deaths, neonatal deaths and under-5 deaths just to mention a few. There is need to help these countries build their capacity in mobilizing resources and advocate for increased financial aid in health sectors.

Health workforce

Health workforce is the backbone of every health care delivery system. However, the global suffers from critical shortage of the health workforce with a huge health workforce-patient ratio and the situation is worse in rural areas where more than half of the global population lives. The crisis has affected all countries despite the country’s level of development. However, the situation is more prominent in developing countries. Therefore, for the countries to be able to prepare for the future pandemics they need to invest resources in recruiting enough health professionals, developing new health cadres with short training duration period, improving the motivation strategies so that we are able to retain the ones already in the public health services. Further, there is also need to address the inequities that exists between the rural and urban population in terms of availability of health workforce. This can be achieved by creating robust research on the field so as to identify the demotivating factors and address them appropriately.

Essential medicines

Medications are the integral part of the health system. There is need for countries to have enough medications and supplies. For example, we have seen how lack of adequate protective equipment in hospitals has affected the lives of our health workforce. This is more experienced by the developing countries where the resources are already limited and they are unable to contain the pandemic.

Health information systems

There is need for countries to have robust research in the field of health. The research will help the countries to identify emerging health issues of public health significance at the early stage hence reducing the number of casualties. The up to date information of the population health will help the health planners and policy makers in coming up the policies/strategies that are responding to the changing needs of the population.

Service delivery

This entails that the health services that are provided in the health facilities are meeting the needs of the population. Further, the health services should be made accessible and affordable to all citizens as having access to the health services is a fundamental human right. This means all the financial burdens in accessing health care are removed considering that the majority of the global population lives in rural areas where people are living in extreme poverty.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

COVID-19 has taught the scientific community on the power of collaboration in achieving a common goal. We can see how quick they have come up with the COVD-19 immunization to save the globe from the pandemic. Learning from this experience, if such collaborations are nurtured hopefully the globe will be able to overcome future pandemics with minimal casualties. However, there is need to invest resources towards building the capacity of countries especially in the third world where countries are lagging behind in terms of scientific research. The main aim of the capacity building package would be to strengthen the expertise of the scientists, to provide adequate equipment and supplies and to improve their collaborative working skills.

Strengthen the expertise of the scientists

Inadequate expertise and scientists in developing countries is due to the brain drain. More scientists leave their countries looking for greener pasture. This is mainly because of poor working conditions including poor remuneration. Further, fewer people are recruited and trained. This also affects the numbers and availability of local scientists. Therefore, there is need for countries to revise their recruitment policies so that more people are trained. In addition, in order to build the capacity of the existing local scientist, countries need to retrain them through workshops or make partnership with other countries who are doing well in research. These countries will send their experts to the developing countries to mentor their scientists or by doing exchange visits.

Provision of adequate equipment and supplies

Most of the developing countries they lack equipment and supplies to support them to advance laboratory research. This is because they have inadequate funding for health which limit these countries to procure the required equipment. In most cases these equipment are expensive. Therefore, there is need for countries to have the capacity to develop their own equipment. Learning from COVID-19 pandemic, we have seen how the pandemic has brought together engineers in countries including the developing countries to come up with innovative ways of supporting the health care delivery systems. For example, countries developed their own oxygen concentrators, masks and hand sanitizers. Further, there is need for designing low-cost equipment form which these developing countries can be able to buy.

Improving collaborative skills

The collaborative working at international level will be achieved by attaching the local researchers from developing countries with the research institutions from the developed countries. This will not only improve their collaborative working skills but also sharpen their research skills. At national level, this can be attained by bringing together the research scientists from different fields in the country. Additionally, at national level, countries can train their research scientists on collaborative working to help them gain collaboration skills.

What has COVID-19 taught you / your industry about disease and how do you think the world needs to prepare for pandemics in the future?

Fortunately, pandemics occur relatively infrequently, so hopefully we won’t find ourselves in a similar position again where every person needs to be so focused on the same end goal. Nevertheless, there are still learnings from this that we can apply in the future.

The UK was the first country to grant temporary authorisation for the Pfizer/BioNTech COVID-19 vaccine. Normal timelines were set aside and processes evolved to reflect the global health crisis that we were confronted with. This willingness to adapt and focus on what’s most important is something that we should remember and reflect on.

Collaboration has also been a key element of the past year. It is proof of what the life sciences industry can achieve by working together on a common shared goal. By harnessing this moment, we can reposition the relationship between wellbeing, healthcare and the economy to recognise the pivotal role health plays to our society.

The pandemic has demonstrated what life is like when we don’t have access to vaccines or treatments. Vaccine research had always been considered as quite niche and somewhat taken for granted with routine flu and travel vaccinations. Now, there is a greater appreciation of the importance of life saving vaccines, as well as the work of scientists and the pharmaceutical industry, in ensuring a healthy world.

What has COVID-19 taught the scientific community about working together and collaborating to achieve goals?

From the beginning of the pandemic, it was clear that no one company or innovation would be able to bring an end to COVID-19. Strong partnerships across the research community have been crucial to the progress that we have been able to make and the reason we partnered with BioNTech to develop an mRNA-based COVID-19 vaccine.

We have a duty of care to people who are living with illness. So, it is incumbent on us to embrace that responsibility, interrogate what we have learned (both what worked and what didn’t), including what can be achieved through partnership and apply those learnings to our existing and pipeline treatments.

Right now, we are best known for our partnership with BioNTech and the successful development of an mRNA vaccine for COVID-19. But we haven’t slowed down or stopped any of our other research. We are also working on what we hope will be breakthrough treatments of the future in areas such as gene therapy, novel cancer treatments and other vaccine-preventable diseases.