After every major disease outbreak, the World Health Organization (WHO) convenes a body of public health experts to provide feedback on the response effort — looking at what worked and what didn’t. These experts then make recommendations to world leaders meant to strengthen their countries' ability to tackle the next epidemic.
Unfortunately, these recommendations are often ignored or else their implementation is delayed, and the world ends up jumping from one health crisis to the next, experiencing death tolls and economic shocks that far exceed what they would have been had precautionary measures been taken.
That’s what happened with the H1N1 outbreak in 2009, and then the Ebola crisis in 2014-2016. The WHO had urged countries to coordinate on public health measures and make significant international investments to ensure future infectious diseases could be swiftly identified and contained.
In both cases, however, countries around the world were underprepared.
"Many of the recommendations [of past reports] were poorly implemented, or not implemented at all, and serious gaps persist," the Global Preparedness Monitoring Board (GPMB) wrote in "A World At Risk," a report released just months before the appearance of COVID-19. "For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act."
The GPMB was convened in 2018 by the WHO as a way to help course correct and encourage preventative action, instead of reactionary efforts. The body is independent from the WHO and will produce annual reports that both amplify many of the past recommendations of the WHO and analyze how the WHO can better address the next pandemic. Ultimately, it aims to reduce the health and economic impact of health crises by building stronger and more resilient health care systems.
In its 2019 report, the GPMB’s public health experts loudly and clearly pleaded with world leaders to implement measures to stop the next outbreak. Epidemics were becoming increasingly common, they argued, as climate change, urbanization, the wildlife trade, and other factors made it more likely for deadly pathogens to emerge. Between 2011 and 2018, the WHO tracked 1,483 epidemic events in 172 countries.
The GPMB warned that "there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 to 80 million people and wiping out nearly 5% of the world’s economy."
Reading the report now, it seems like it was foreshadowing the COVID-19 coronavirus pandemic.
The board said the global economy would be heavily disrupted by a pandemic of this nature because of how supply chains span countries and tourism employs millions worldwide, knowing that lockdown measures might be necessary. The International Monetary Fund recently said that COVID-19 will cause the global economy to shrink by 3%, the sharpest decline since the Great Depression.
The report also said a pandemic relief effort would be complicated by growing distrust in multilateral institutions. Since COVID-19 emerged, myths seeking to discredit health organizations have proliferated.
The board ultimately made seven recommendations at the time that they felt would help avert the next outbreak. It’s likely that many countries would currently be in a better place amid the COVID-19 pandemic had these suggestions been put into effect.
For example, the GPMB urged countries to develop "surge manufacturing capacity" for medical supplies. Many countries have struggled to test and diagnose people with coronavirus due to a chronic shortage of supplies. As a result, the virus has been able to spread undetected throughout many communities. Had manufacturing capacity been shifted toward tests and treatments when the virus was first detected in December, it would have been contained faster.
The report also noted that the vast majority of countries wouldn’t have the hospital capacity to treat patients during the outbreak of a highly infectious respiratory pathogen.
"Planning for emergencies creates a virtuous cycle, whereby preparedness enables a successful response and from which built capacities and knowledge gained during an outbreak become the foundation to prepare for the next threat," the GPMB wrote. "Setting up these arrangements will require prioritizing systems-building across the whole society, in a variety of contexts, testing different models, and creating environments and mechanisms for sharing best practices, among countries at all economic levels."
The board said it was critical to create funds for low-income countries with weak health care systems and social safety nets. Funding for this sort of international development faces continuous shortfalls. The United Nations is currently working to close these gaps, but the international nonprofit Oxfam warns that millions of people could die from COVID-19 in developing countries because of weak health care systems.
Still, some recommendations have successfully been implemented.
For instance, the GPMB said countries had to collaborate on the development of vaccines and treatments. Multilateral organizations like the Coalition for Epidemic Preparedness Innovations (CEPI) are supporting dozens of vaccine efforts worldwide. Many countries, with the exception of the US and Russia, among others, recently came together to pledge $8 billion to the global vaccine search.
The report authors also said that countries have gotten better at detecting outbreaks and declaring emergencies. In 2016, for example, the rapid response to the Zika virus helped to minimize lives lost. And the WHO began warning about COVID-19 in December.
Perhaps most urgently, the report said that the world was missing crucial leadership on the issue of pandemic preparedness — world leaders simply didn’t seem to take the threat seriously. But the authors wrote that these leaders still had time to boldly commit to defending against future outbreaks.
"The world is at risk," the authors wrote. "But, collectively, we already have the tools to save ourselves and our economies. What we need is leadership and the willingness to act forcefully and effectively."