Jaehyun Jeong, Henry M. Gunn High School, Palo Alto, California, USA
In 2015, Bill Gates predicted that the next global disaster would not be a war, but a disease. And over the past year, that unimaginable scenario has become a dreadful reality as we all grapple with the effects that the COVID-19 pandemic has had on our lives. However, some countries have had notable success controlling the pandemic where others have failed. Why is it that countries had such disparate outcomes with the pandemic?
The key barrier that countries such as New Zealand and South Korea had against the virus that others, like the U.S. and Italy, did not is robust health security. When implemented around the globe, these systems combine to form global public health security, defined by the World Health Organization (WHO) as “the activities required, both proactive and reactive, to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries” (WHO, 2007). So what are these activities? The U.S. Centers for Disease Control and Prevention (CDC) divides global health security into three main areas: prevention, detection, and response, (CDC, 2021).
Prevention is the lock. It guards the door and is the first line of defense. It consists of everything that the global population can do before an outbreak may occur in order to minimize any effects. The most obvious step is funding. Public health systems, not just general hospitals and welfare, but also institutions specialised for infectious diseases, need to be in place to contain an early outbreak, along with supply stockpiles (Chen & Assefa, 2021). Another area in which funding is helpful is vaccine prototyping. Vaccine prototypes can be made for dangerous families of viruses, then tweaked later on to match specific diseases. In fact, one COVID-19 vaccine was developed using an altered version of an mRNA vaccine that changes the Betacoronavirus spike proteins, which allow the virus to enter cells (Corbett et al., 2020). The most dangerous families of viruses consist of those that spread via respiratory pathways and are transmitted before symptoms appear in the patient (Adalja et al., 2018). Third, officials need to demonstrate unity and cultivate trust. A failure in this category was most clearly seen in the U.S., where politicians chose to deny science and divide the country along partisan lines, rather than listen to public health experts. Finally, low-income areas need to receive additional assistance as factors such as cramped housing combined with a higher probability of exposure mean that those living in poverty are more likely to contract and spread disease. Universal health coverage can improve pre-pandemic health conditions and allow for equal access to important medical treatments (Chen & Assefa, 2021).
Figure 1. Image of SARS-CoV-2 virus (Quapan, 2020).
Even with all the safety protocols in place, it is inevitable that a virus will slip through the cracks. When this occurs, the next step is to detect the virus. Tests likely will not be available in the early days of an outbreak, further emphasizing the need to isolate people with atypical symptoms or severe cases of common syndromes. Rapidly fluctuating guidelines need to be communicated quickly and effectively, which is why trust and unity among public officials must be emphasized (Hassan et al., 2021).
Finally, a quick and decisive response is necessary to put an end to an outbreak. As soon as testing is available, local and federal agencies should communicate to make sure locations have enough tests available and to track those who may have spread the virus (Hassan et al., 2021). Once vaccines become available, similar steps should be taken to get the population vaccinated quickly and equitably.
Figure 2. Coordinated testing location in Michigan, USA (Michigan National Guard, 2020).
Just like no one part of a security system is complete in and of itself, no one part of the global health security infrastructure is complete alone. All three parts must be well developed in order for the world to be ready for the next outbreak.
References
Adalja, A., Toner, E., & Watson, M. (2018, May). A Framework to Analyze the Pandemic Potential of Pathogens. Johns Hopkins Center for Health Security. https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2018/180510-pandemic-pathogens-report.pdf
Chen, Y.-Y., & Assefa, Y. (2021). The heterogeneity of the COVID-19 pandemic and national responses: An explanatory mixed-methods study. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10885-8
Corbett, K. S., Edwards, D. K., Leist, S. R., Abiona, O. M., Boyoglu-Barnum, S., Gillespie, R. A., Himansu, S., Schäfer, A., Ziwawo, C. T., DiPiazza, A. T., Dinnon, K. H., Elbashir, S. M., Shaw, C. A., Woods, A., Fritch, E. J., Martinez, D. R., Bock, K. W., Minai, M., Nagata, B. M., . . . Graham, B. S. (2020). SARS-CoV-2 mRNA vaccine design enabled by prototype pathogen preparedness. Nature, 586(7830), 567-571. https://doi.org/10.1038/s41586-020-2622-0
Global Health - CDC and the Global Health Security Agenda [Fact sheet]. (2021, January 8). CDC. Retrieved June 18, 2021, from https://www.cdc.gov/globalhealth/security/index.htm
Hassan, I., Mukaigawara, M., King, L., Fernandes, G., & Sridhar, D. (2021). Hindsight is 2020? Lessons in global health governance one year into the pandemic. Nature Medicine, 27(3), 396-400. https://doi.org/10.1038/s41591-021-01272-2
Michigan National Guard. (2020, June 6). Michigan Guard conducts COVID testing in Sturgis & Battle Creek, MI [Photograph; JPEG]. https://www.flickr.com/photos/71241705@N07/49986755102
Quapan. (2020, May 21). SARS-CoV-2 (µ-IMAGE) vaccines: mRNA-1273 (moderna), Ad5 (CanSinoBio, NantKwest/ImmunityBio), ChAdOx1 nCoV-19 (Oxford university). - Other remedies: S309 (antibody), hydroxychloroquin (Malaria-medicament), fluvoxamin (Antidepressivum), famotidine(heartburn [Image; JPEG]. https://www.flickr.com/photos/9361468@N05/49920420853
The world health report, 2007: A safer future : global public health security in the 21st century. (2007). World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/43713/9789241563444_eng.pdf
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