Several initiatives to prepare the world for the next pandemic were put in place in the past two years. But many of them remain a work in progress, leaving the world unprepared for another global health threat in 2023, according to several health workers and experts.
“The short answer is no,” Helen Clark, former co-chair of the Independent Panel for Pandemic Preparedness and Response, told Devex in response to a question on whether the world is ready to tackle another pandemic in 2023.
It’s a statement echoed by others Devex spoke to. While there’s been notable progress, through initiatives such as the South Africa-based mRNA vaccine technology transfer hub and the Pandemic Fund, these initiatives are not yet fully functioning or are yet to reach their full potential.
Additionally, it’s still unclear where surge funding of up to $100 billion — as recommended by the Independent Panel for Pandemic Preparedness and Response — would come from when a pandemic threat emerges. The United Nations General Assembly also has yet to put in place a Global Health Threats Council that the Independent Panel recommended in 2021 to ensure high-level political leadership and attention to pandemic prevention, preparedness and response, although they’ve agreed to hold a high-level meeting in September 2023.
There are also no concrete mechanisms in place not to repeat the vaccine hoarding that the world witnessed for COVID-19.
And while COVID-19 continues to kill thousands, various countries have disinvested in activities such as surveillance that are helpful in tracking the evolution of the virus and detecting new ones — signaling that in many parts of the world, the pandemic is not being treated as an emergency anymore. Similarly, many have also dropped health measures meant to lower people’s risk of infection.
“We now don't wear masks, don't wash hands as often, and don't worry about falling sick like we used to,” Mumtaz Mohammed Hussain, a field health officer who works for an international organization in Bangladesh, told Devex.
One of the measures taken to prepare the world for the next health threat was setting up the mRNA vaccine technology transfer hub in South Africa. The aim was to expand the manufacturing of vaccines for COVID-19 and other diseases using mRNA technology, and build that capacity in more regions of the world benefitting low- and middle-income countries.
The hub has made significant progress since its inception. It had a formula ready for a COVID-19 vaccine in February, and has already started sharing the mRNA vaccine process knowledge with some of its partner facilities in other countries, called “spokes”. However, its vaccine still needs to undergo clinical trials, and its facility still needs to be GMP-licensed — meaning the vaccine is produced according to international quality standards.
The hub targets to do this by the second quarter of 2023 and conduct the clinical trials after. But that means the facility isn’t ready yet to contribute vaccine supplies in the case of another COVID-19 surge, or if a new pandemic emerges.
“In the event of a surge in Covid 19 vaccine requirements or a next pandemic our vaccine candidate will not be able to contribute to vaccine supply in the short term,” Petro Terblanche, managing director of Afrigen, which leads the hub, wrote to Devex via email.
She is hopeful that the capacities and capabilities created by the hub will allow them to be in a position to contribute to “rapid response vaccine development,” and the production of mRNA vaccines for clinical trials six to eight months from now. But she also expressed concerns that vaccine production and capabilities remain concentrated in a few regions.
Meanwhile, the Pandemic Fund, which is meant to finance activities in countries to strengthen pandemic prevention, preparedness, and response, remains underfunded. To date, it has received pledges amounting to $1.6 billion, of which only over $420 million has been handed over — far from the $10.5 billion that World Health Organization and the World Bank say is needed on an annual basis for pandemic preparedness and response.
“In the event that the worst happens, and a new pathogen erupts, the world is not better prepared in terms of systems and rules to coordinate a response to it than it was in 2019.”
— Helen Clark, former co-chair, Independent Panel for Pandemic Preparedness and Response“In 2023, G7 and G20 leaders must get serious about investing in pandemic preparedness – commit the resources to close this funding gap for year one and agree to a sustainable financing plan for the coming years,” said Carolyn Reynolds, co-founder of the Pandemic Action Network.
The fund plans to have its first call for proposals by the end of January 2023.
Beyond these initiatives however, health experts and workers spoke of alarming trends that could affect future pandemic responses.
Health workers are considered the backbone of health systems. But the COVID-19 pandemic has seen staffing shortages in hospitals due to the huge numbers of health workers — particularly in the public health system — having left the profession, many due to burnout.
Hussain, the field health officer from Bangladesh who works with Rohingya refugees, said she cannot forget feeling fear and helplessness during the height of the COVID-19 emergency.
“Psychologically, I have only started to get my life back on track and am not prepared to be derailed again. So, I do not think the world can ever be ready for another pandemic so soon,” she said.
Meanwhile, Naomi Wanjiru, a nurse working on TB and HIV in Kenya, said health infrastructure and personnel are still insufficient to accommodate a potential surge in patients during a pandemic. Personal protective equipment is also in limited supply.
Disinformation, distrust of public health authorities, and vaccine hesitancy “are at an all-time high,” Reynolds said. And there’s COVID-19 “fatigue”, with many people now unwilling to adhere to health measures such as voluntary masking or quarantines.
The world isn’t prepared to tackle the next pandemic, but Clark said the first aim must be to prevent an outbreak from becoming one.
“To do that, there must be an improved system to detect [a] new disease very rapidly and minimize its spread,” she said.
That requires “laser-focused” surveillance systems as well as governments that immediately report threats to WHO and allow WHO-designated experts immediate access to an outbreak site for investigations. Additionally, the U.N. health aid agency must be able to “report those threats to the world without delay, using the precautionary principle,” and the WHO director-general should be able to declare a public health emergency of international concern that is “unhindered by politics,” Clark said.
There are hopes these will be addressed through IHR reforms. However, Clark said such amendments will only be considered by the World Health Assembly — the decision-making body of WHO made up of its member states — in May 2024, and it will take some time after that for new amendments to come into force.
“In the event that the worst happens, and a new pathogen erupts, the world is not better prepared in terms of systems and rules to coordinate a response to it than it was in 2019,” she said.
While reforms to improve the system are underway, “there is too much tinkering with the system, and not enough transformation,” Clark said.
Most countries are also in debt, and the war in Ukraine continues to have spillover impacts globally. The rapid rise of COVID-19 cases in China has implications globally, including on supply chains.
But one of the big reasons why many think the world isn’t prepared for the next pandemic is because of persisting inequalities.
“The global inequalities that we experienced during this particular COVID emergency have never been resolved,” Dr. Githinji Gitahi, CEO of Amref Health Africa, told Devex.
As an example, he said conversations on intellectual property have been going on for more than two years at the World Trade Organization. While some progress has been made on vaccines, WTO member states have to date not agreed on whether to extend that to tests and treatments.
“If that is not resolved for COVID, which was such an emergency, why would we expect that intellectual property will be available for distributed global manufacturing if we have another emergency tomorrow?” he said.
A zero draft of a potential pandemic accord — which many hope would address the inequities seen in the distribution of lifesaving health products such as COVID-19 vaccines — will also only be discussed in February 2023.
“If there was another respiratory emergency in January, Africa would still wait for months or years to get its people vaccinated. That one, I have no doubt about,” he said.