www.jogh.org • 2 1 Rakesh Vadakkethil Radhakrishnan Alwin Issac for futurepandemics? How thenationsshouldgearup JOGH ©2021ISGH © 2021THEAUTHOR(S) The onlineversionofthisarticlecontainssupplementarymaterial. Electronic material: supplementary National InstituteofNursingEducation,PostGraduateMedical EducationandResearch(PGIMER),Chandigarh, India College ofNursing,AllIndiaInstituteMedicalSciences(AIIMS),Bhubaneswar, India health coverage. the fundamentalsofuniversal ience, nationsmustadhereto To increasepandemicresil doi: 10.7189/jogh.11.03075 1 of theirhealthcaresystem,technology,communication,evidence basedpractice,andplanofaction. This article examines the strategies that stood apart in curbing the COVID-19 among certain countries in terms stated theeruptionasapandemiconMarch11,2020[ international concern.Withthesteep rise innumberofpeopleinfectedwiththevirusoutsideChina, WHO virulence anditscontagiousnature,WHO declared novelcoronavirusoutbreakapublichealthemergency of named “2019-nCoV”, which was later renamed as coronavirus disease 2019 (COVID-19). Owing to the virus H , VRVijay − − − − detected novel coronavirus as the causative agent for the pneumonia cases and the virus was initially detected novelcoronavirusasthecausativeagentforpneumoniacasesandviruswasinitially an increaseinpneumoniacasesofunknownoriginonDecember31,2019.HealthauthoritiesChina ealth authoritiesfromthecityofWuhan,China,informedWorldHealthOrganization (WHO)about to ensureoptimum cost-effectivenessforthe public. demic byestablishingprotocols formonitoring,diagnosis,treatment,andvaccineproduction essary foraneffectiveresponse. ing, reduceduncertainty,and promoted theefficientuseofresources,allwhichwerenec sharing, whichenabledthepublic toadoptprotectivebehavior, enhanceddiseasemonitor advanced technologies. care systems. launching their anti-epidemic action plans at the grassroots level by expanding primary health EBP, inconjunctionwithcutting-edgetechnology,played acriticalroleincontainingthepan The mostimportanttoolinriskmanagementwasproactive communicationandknowledge testing,contacttracking,andvigilantquarantinewereallmadeeasier,Surveillance, thanksto Universal Health Coverage (UHC) assisted nations which had them well placed, in quickly
1 , NadiyaKrishnan
- lance systemandaccesstohealthcareforall. of infectionfromanimalstohumansmightgounnoticedwithoutarobustsurveil Africa andpartsofAsiaaremorevulnerableforzoonoticdiseases[ for an outbreaktoprogress a pandemic. A recentstudyreiterates thatregionsin tion fortrade,commerce,andtourismacrossthenationalbordershasmadeiteasy and endanger humanity. The ever-rising trend of globalization and human migra COVID-19 wouldn’t be the lasttimeaviruswouldjumpfromanimalintohumans Owing totheplightofwildlifehabitat,poorhealthsystem,andglobalconnectivity, 1 , ManjuDhandapani 1 , JaisonJacob 1
1 ]. 2021;11:03075. dapani M.Howthenationsshouldgearupforfuturepandemics?JGlobHealth Cite as: 1 , ShineStephen IssacA,VijayVR,KrishnanN,JacobJ,StephenS,RadhakrishnanRV, Dhan 2 1 , 2021 •Vol. 11 • 03075
2 ]. A spillover ]. Aspillover ------
VIEWPOINTS VIEWPOINTS 2021 •Vol. 11 • 03075 tion. ent modeofpubliccommunica possible, andutilizingatranspar ing technologytothefullestextent ness planbasedonevidence,us standardized pandemicprepared Each countrymustestablisha would seekfor a newsocialcontract,andtechnology wouldplayanever-important roleinsociety. the spreadofpandemicinSouth Korea,Germany,Australia,Thailand,andChina[ “chatbot” technology,telemedicine, dataplatforms,andcontacttracingtoolswereinstrumental incurtailing viruses coalesceofdeadliness andcontagiousnesschallengedeverynation,ArtificialIntelligence (AI)based awareness, which enabled themto build moreresponsive strategies to prevent further damages [ lessening theimpact.Governments, whopossessedrobustandresilienttechnologieshadreal-time situational outspread, educate the public, notify danger, endowing those on the ground to be aware of the situation, thus within specifieddistancefromplaceswhereconfirmedcases hadbeen[ outbreak [ drive-through screening centers were installed for safe and effective screening to forestall a massive community were usedtoensurecontactlessmovementanddeliveries[ to fortifycontacttracing[ sitioning systems,quickresponsecodes,cardtransactionlogs, andclosed-circuittelevisionsweremadeuseof execution oftheseschemesreliedondigitaltechnologyincollaboration withartificialintelligence.Globalpo testing, contact tracing, and vigilant quarantine. Co-ordination and data management mandated for efficacious ally. CountriesthatreportedlowmortalityratefromCOVID havecommonstrategies,namelysurveillance, Innovative technologieshaveassistedinpromptrecognition ofcoronavirusandkeepupdatedthedataglob DIGITAL TECHNOLOGY vestment inhealthcaresystem,namelyNew-Zealand,Japan,South-Korea,Thailand,Canada. partnership (South-Korea) [ essential healthcare[ care systemcoulddetrimentallydevoidthefinanciallypoorinprocuringhealthfacilities.Agovern it mayfailtomeettheneedaswasseeninEngland[ cess tohealthcareforallindividuals;inanemergency, attributingtotheirlengthywaittimesandoverusage, care is the key to attain UHC in any country. Althoughgovernment funded health care system provides ac but bring forth widesocietalrisk[ and priceytreatment.Obstaclestotimelydiagnosiscaseisolationnotonlyaffectonanindividualbasis, whichcanwardoffgrievousclinicaloutcomes all isincentivizedtovestincost-efficientprophylacticservices, antined athomeandseverecasesaremanagedhospital.UniversalHealthCoverage(UHC)orMedicarefor Outbreak mitigation relies on expeditious diagnosing and isolation of cases; wherein, less severe cases are quar [ response plansswiftly,othersfailedtoactquicklyandtheirhealthcaresystemshavebeenoverwhelmed patient needsandprotectingtheirhealthcareworkers.Whilesomecountriescouldexecutepandemic- COVID-19 pandemichasstretchedthehealthcaresystemaroundworld,testingtheircapabilitytocater UNIVERSAL HEALTHCOVERAGE cost barrier[ head, authorizepharmaceuticalfarenegotiation,curtailexecutivepay,acceleratecasereporting,andalleviate
− ences inordertopreventfuturepandemics. regular basistoreflectchangesinglobalguidelines,scientificevidence,andhistoricalexperi ing evidenceintonationalandsub-nationallevels,theseplansshouldbeupdatedona Nations must prepare for a pandemic by planning, implementing, re-designing, and translat 3 , 6 5 ]. Smart-watch and mobile applications were developed, which warned people when they came ]. Smart-watchandmobileapplicationsweredeveloped,which warnedpeoplewhentheycame ]. CountriesthatcouldcombatCOVID-19effectivelyhadattainedUHCwiththeirrelentlessin 4 ]. UHC can be provided through a single payer system (Taiwan) or in public-private ]. UHCcanbeprovidedthroughasinglepayersystem(Taiwan)orinpublic-private - - - - 6 ]. Drones, autonomous robots, self-driving cars, and facial recognition technologies ]. Drones,autonomousrobots,self-drivingcars,andfacialrecognition technologies 3 ]. A single payer system would amalgamate administrative expenses, reduce over ply of medicine, and health technology are critical elements to ensure access to ply ofmedicine,andhealthtechnologyarecriticalelementstoensureaccess functioning health-information system, sound system of procurementand sup foundation forUHC.InvestmentinPHCworkforce,goodgovernance,well- to accomplishglobalhealthsecurityandbackupresilientsystemsasa phenomenal inbuildingcommunityandcountryresilience.PHCsarecritical force [ tion, preventoverburdeninginhospitals,andsafeguardtheirhealthcarework (PHC) could prevent outbreaks, protect the public from further spread of infec public and the health system, and countries with a strong primary health care any emergency, primarycareremainastheinitialpointofcontactbetween the tackle crisiseffectivelyaswasseeninCanada,SouthKorea,andTaiwan[ ment monitored and regulated public-private partnered health care system could 3 ]. Robust financing structure and investment in quality primary health ]. Robustfinancingstructure and investmentinqualityprimaryhealth 3 , 4 ]. During the Ebola virus disease outbreak in West-Africa, PHC was ]. DuringtheEbolavirusdiseaseoutbreakinWest-Africa,PHCwas 2
3 ]. Escalated out of pocket expenditure in private health ]. Escalatedoutofpocketexpenditureinprivatehealth 6 ]. Thermalscanner, biometricfeverscreening, and 3 ]. Technology can help forbid the ]. Technologycanhelpforbidthe www.jogh.org • 3 ]. The post-COVID era ]. Thepost-COVIDera doi: 10.7189/jogh.11.03075 6 ]. While the ]. While the - - 3 ]. In ]. In 3 ]. ]. ------www.jogh.org • authors, usedwithpermission). Photo: Strategiestocombatpandemic(designedbythe doi: 10.7189/jogh.11.03075 place couldmitigate risk,minimizetheimpact, andswiftlyresumeactivities [ to thesortofdecisionstheywould beforcedtomake[ not onlytotesthowemergency planswould holdupunderstrain,butalsotoacclimatizethehealthauthorities pact ofahypotheticalH2N2influenza pandemiconUnitedKingdom.Thepurposeofsuch asimulationwas Englandtoestimatetheim nus-2016’, a3daysimulationexercise wascarriedoutbyNationalHealthService, preparedness plansmustbetried outduringtheinter-pandemic periods[ health emergency, focusshouldbeontostrengtheningexistingsystemsinplace;whilethosenovelpandemic rooted ontheexistentstateofaffairsdeterminedbynational andglobalriskappraisals.Duringtimesofpublic demic preparednessplan,pandemicsofvaryingseverityshould beconsidered;thoughtheresponseshould ternational statutelawassociatedtocommunicablediseaseprevention andcontrol[ in worldwide guideline or in accordance toscientificbase, past experiences,andoralterationinnational orin tional and sub-national preparedness and response plans. It should be periodically revised at par with changes for pandemicisanunrelentingprocedureofdesigning,executing, re-designing,andtransformingitintona changes drivenbyhumans,itwouldn’t beasurprisetowitnessanotherpandemicin afewyears[ Pandemics wereoncepredictedtobea‘onceincenturyevent’. Butwithextentofsocialandenvironmental PANDEMIC PREPAREDNESSPLAN ing, weightofevidenceandtheequipoisechancesthatanynoveltechnique,test,ortreatmentmightwork. tice inordertofindtherighttimechange.Theadoptionofnovelmethodsshouldbebasedonclinicaljudg The policy decision makers, health authorities, and clinicians need to benimble in their reasoning and prac research scientistformerly,pavedwayfortheirearlyanddiligentevidencebasedresponsetoCOVID-19[ their policiesthatlackedevidenceinCOVID-19management[ tice change.TherewereinstancesofpublicoutcryinUnitedKingdomandStatesAmericaowingto pace with which the pandemic spreads is a menace to traditionalmodelsof knowledge translationandprac relevant evidence,physician’sclinicalexpertise,andthepatientpreferredvaluespreferences[ determination about care of each individual patient. The foundation of EBP is laid on the integration of most Evidence basedpractice(EBP)ispainstaking,explicit,andsensibleusageofpresentbestevidenceinmaking EVIDENCE BASEDPRACTICE
ing trust,amplifyingfears,andsometimesleadingtoharmfulbehaviors[ has grosslyregressedmanynation’sresponsetothepandemicbyundermin Numerous instancesofmisinformationanddisinformationhavesurfacedthat TRANSPARENT ANDPRO-ACTIVECOMMUNICATION cacy ofproactivecommunicationinhaltingapandemic[ pandemic. South Korea, Ghana, and Germany reiterated the necessity and effi and empowering the public with the right information regarding managing a book, WhatsApp,andInstagramplayedapivotalroleinswiftlydisseminating communication ofthefacts.Thewidespreadusesocialmedia,namelyFace public trust in the government, which in turn is possible through transparent all theserequiredpublicsupportanditwouldn’t bepossiblewithoutgaining were efficientnormsinhaltingthespreadofcurrentpandemic[ usage offacemask,maintainingsocialdistancing,andhandhygienepractices be feasibleforlowandmiddle-incomecountries;while,evidencessuggestthat vestment indigitaltechnologyandattaininguniversalhealthcoveragemaynot use ofresources,allwhicharerequisiteforanefficaciousresponse[ bringdownconfusionandpromoteeffective enhanced diseasesurveillance, aging risk,whichwouldallowpublictoembraceprotectiveconduct,alleviate scanty [ organizing wouldmandatetime,andresourcesbe directinterventions curs. Intimesofpublichealthemergency, treatmentoptionswouldbescarce, is deficient,attemptsaretobemadebuildreliancebeforeanemergency oc bipartisan communication.Innationswherepeople’sfaithontheirgovernment munication about ‘what is known’. Ensuring public faith necessitate an open transparent communicationabout‘whatisnotknown’asimportantcom 7 ]. Pro-active communication would be the most important tool in man 3
12 ]. Countries that had pandemic preparedness plan in ]. Countriesthathadpandemic preparednessplanin 3 ]. While in Germany, their chancellor being a ]. WhileinGermany,theirchancellorbeinga 11 ]. Inoneofitskind,‘ExerciseCyg 3 , 4 ]. It is also imperative to have ]. Itisalsoimperative tohave 11 ]. Whilepreparingapan 2021 •Vol. 11 • 03075 7 , 8 ]. 9 2 ]. However, ]. Preparing ]. Preparing 10 8 ]. The ]. The ]. In 7 ]. A ]. A 3 ]. ]. ------
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doi:10.7326/M19-2415
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doi:10.1513/AnnalsATS.202006-587ED The authors completed the ICMJE Unified Competing Interest form (available upon request from The authors completed the ICMJE Unified Competing Interest form (available upon request from . Accessed2May2021. Conceptualization:AI.Datacuration:AI,RVR. Visualization:JJ.Writing –originaldraft:AI,
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