The World Health Organisation’s announcement that Covid-19 is no longer a global health emergency is welcome, but there has never been a better time to question whether our health systems are resilient enough and sufficiently prepared for the next pandemic. In other words, are they “always on”?
The short answer to that is no. As the immediacy of the pandemic fades and other pressures build, the political will to implement hard-won lessons from Covid-19 is fading. Pandemic prevention, preparedness and response is now struggling to make headway at the highest political levels, despite polls showing that people overwhelmingly want greater international collaboration on this and more investment in their national health systems.
Reducing these efforts means that the world is about to repeat the same mistakes made before Covid-19, when all governments were aware of the risks of a global pandemic but failed to collectively prepare for it. Those mistakes cost millions of lives and trillions of dollars.
To counter competing political pressures, maintain momentum and prevent fatigue, the world needs a forward-looking approach to disease prevention that can strengthen overall health-system resilience, align domestic and global priorities, maximise the return on investment and futureproof health infrastructures by enabling them through technology.
This is why the Tony Blair Institute and our partners in the Global Health Security Consortium advocate the “always on” approach. This means that health systems combine routine clinical care with the ability to respond rapidly to future health emergencies, such as pandemics.
Governments should keep investing in and developing dual-use “always on” capabilities. To address diverse health challenges and adapt to changing health needs and scenarios, they must be interoperable, scalable, reliable and secure. These capabilities will mean that countries can swiftly deploy new innovations, implement advanced disease surveillance and call on regionally distributed R&D and manufacturing hubs, enhanced by digital infrastructure.
The Benefits of “Always On”
An “always on” approach offers several health benefits, including:
Next-generation vaccines and novel injectable prophylactics for diseases such as tuberculosis, dengue, HPV, malaria, RSV, heart disease, high cholesterol and HIV/AIDS to help address the 10 million deaths per year caused by them, while improving baseline population health.
The extended application of genomic pathogen surveillance, leading to faster and more accurate disease detection to enable early interventions for improved patient outcomes and to prevent infections spreading.
Expansion of clinical-research capacity underpinned by digital infrastructure to accelerate the development and approval of new vaccines and treatments, making them more rapidly accessible to more people.
Importantly, an “always on” approach yields substantial economic benefits. Rather than responding in a panic to build vital health infrastructure from scratch, it is much more cost-effective to maintain it for constant use. For example, the standing infrastructure for life-course vaccination alone could lead to savings of more than $3.4 trillion globally during a future pandemic. By focusing on low-resource settings and regions, these investments could help to address health disparities, improving access to high-quality care for underserved populations, both within countries and globally.
Critically, an “always on” approach could be a vote-winner for political leaders. There is widespread support for pandemic preparedness and health-system strengthening, so it is vital that politicians see them as two sides of the same coin. For instance, in addition to laying grounds for future pandemic response, routine vaccination programmes can reduce the strain on health services, freeing up resources to be directed at improving other aspects of health care – or to be reserved for times of crisis.
What Does This Approach Look Like?
The “always on” approach can be illustrated by three real-life examples – achievable today – if governments lead on adopting the following actions:
Vaccination: This involves creating a programme that routinely delivers adult vaccines and long-acting injectables with a focus on disease prevention. To achieve this, a digitally enabled health infrastructure is required that supports R&D, manufacturing and delivery. Realising this vision requires bolstering not only the infrastructure for the development, manufacturing and delivery of vaccines, therapeutics and diagnostics, but also enhancing digital-health infrastructure – such as sovereign national databases and public-health data registries – as well as genomic sequencing and bioinformatics, especially in low and middle-income countries. In addition, fostering self-sustaining vaccine markets able to swiftly react to emerging pandemic threats depends on market-shaping strategies to generate demand. Effective demand forecasting, linked to manufacturing capacity and the existing product pipeline for next-generation vaccines and preventive injectables is integral to this process, as detailed in our new paper A Vision for Global Health: How Demand Forecasting, Supply Planning and Market Shaping Can Deliver a New Model for Global Vaccine Manufacturing.
Genomic pathogen surveillance: It is essential to establish surveillance systems at national and global levels to detect and monitor disease threats. This would boost sequencing and bioinformatics, integrate genomic sequencing into routine care and create more linkages between genomic data and other health metadata around the world. Ultimately, this “always on” approach will create the right conditions for continuing vigilance of disease threats while enhancing vital surveillance capabilities. However, it will be important to improve the data sharing of routine sampling in hospitals and communities to national databases as well as from national databases to global depositories. Additionally, there need to be better data integration with additional metadata from health systems, including on disease severity and vaccination coverage.
Clinical-research infrastructure: This involves developing a digitally enabled, coordinated clinical-research infrastructure for vaccines, therapeutics and diagnostics – and other medical countermeasures. This would bolster clinical research in low and middle-income countries, enabling research at lower cost in areas where the burden of disease is highest, accelerating patient access to new treatments and improving return on investment. Deepening the integration of biomedical innovations into routine clinical care will require clear and regular evidence-based guidance.
While WHO’s recent announcement marks a major milestone, it should also trigger renewed interest in long-term pandemic prevention, preparedness and response. As health ministers gather in Geneva for the World Health Assembly, which starts on 21 May, to chart the next steps in building resilient health systems that protect communities against both pandemics and everyday health threats, it is critically important for them to be backed by political leadership at the highest level. The adoption of an “always on” approach to disease prevention through targeted investments and the leveraging of advances made during the pandemic will create a more robust and equitable health-care infrastructure for all. This will improve day-to-day patient care and ensure our health-care systems are prepared to face whatever challenges lie ahead – protecting lives and livelihoods.