The COVID-19 pandemic reminds us how unprepared the world is to detect and respond to emerging infectious diseases. We must make smart investments now to simultaneously navigate COVID-19 and to prepare future pandemics.

Source: McKinsey & Company

By Matt Craven, Adam SabowLieven Van der Veken, and Matt Wilson

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Reprinted for educational purposes and social benefit, not for profit. 

The COVID-19 pandemic has exposed overlooked weaknesses in the world’s infectious-disease-surveillance and -response capabilities—weaknesses that have persisted in spite of the obvious harm they caused during prior outbreaks. Many countries, including some thought to have strong response capabilities, failed to detect or respond decisively to the early signs of SARS-CoV-2 outbreaks. That meant they started to fight the virus’s spread after transmission was well established. Once they did mobilize, some nations struggled to ramp up public communications, testing, contact tracing, critical-care capacity, and other systems for containing infectious diseases. Ill-defined or overlapping roles at various levels of government or between the public and private sectors resulted in further setbacks. Overall, delayed countermoves worsened the death toll and economic damage.

Correcting those weaknesses won’t be easy. Government leaders remain focused on navigating the current crisis, but making smart investments now can both accelerate COVID-19 response and strengthen public-health systems to reduce the chance of future pandemics. Investments in public health and other public goods are sorely undervalued; investments in preventive measures, whose success is invisible, even more so. Many such investments would have to be made in countries that cannot afford them.

Nevertheless, now is the moment to act. The world has seen repeated instances of what former World Bank president Jim Kim has called a cycle of “panic, neglect, panic, neglect,” whereby the terror created by a disease outbreak recedes, attention shifts, and we let our vital outbreak-fighting mechanisms atrophy.1 And while some are calling the COVID-19 crisis a 100-year event, we might come to see the current pandemic as a test run for a pandemic that arrives soon, with even more serious consequences. Imagine a disease that transmits as readily as COVID-19 but kills 25 percent of those infected and disproportionately harms children.

The case for strengthening the world’s pandemic-response capacity at the global, national, and local levels is compelling. The economic disruption caused by the COVID-19 pandemic could cost between $9 trillion and $33 trillion—many times more than the projected cost of preventing future pandemics. We have estimated that spending $70 billion to $120 billion over the next two years and $20 billion to $40 billion annually after that could substantially reduce the likelihood of future pandemics (Exhibit 1). These are high-level estimates with wide error bars. They do not include all the costs of strengthening health systems around the world. A comprehensive program of health-system strengthening at all levels would cost substantially more and also contribute to effective outbreak management. Our preliminary findings call for further investigation, but we hope the overall message is clear: infectious diseases will continue to emerge, and a vigorous program of capacity building will prepare the world to respond better than we have so far to the COVID-19 pandemic.

In this article, we describe the five areas that such a program might cover: building “always on” response systems, strengthening mechanisms for detecting infectious diseases, integrating efforts to prevent outbreaks, developing healthcare systems that can handle surges while maintaining the provision of essential services, and accelerating R&D for diagnostics, therapeutics, and vaccines (Exhibit 2).

1. From ‘break glass in case of emergency’ response systems to always-on systems and partnerships that can scale rapidly during pandemics

2. From uneven disease surveillance to strengthened global, national, and local mechanisms to detect infectious diseases

3. From waiting for outbreaks to an integrated epidemic-prevention agenda

4. From a scramble for healthcare capacity to systems ready to surge while maintaining essential services

5. From underinvestment in R&D for emerging infectious diseases to a renaissance…

Humans have done more to overcome the threat posed by infectious diseases in the past 100 years than during the previous 10,000. The widespread availability of antibiotics allows us to manage most bacterial infections. HIV remains a serious condition, but it isn’t usually an immediately life-threatening one for people with access to antiretroviral therapy, thanks to the innovations of the past 35 years. And the past decade has seen remarkable progress in our ability to cure hepatitis C.

However, important gaps remain. Public-health leaders have frequently called attention to the threat posed by emerging infectious diseases. Even before the COVID-19 outbreak, the pandemic threat posed by known pathogens such as influenza and by an unknown “pathogen X” was well understood.3 The pace of innovation in antibiotics is not keeping pace with the increases in antimicrobial resistance. Current regulatory and incentive structures fail to reward innovations that can help counteract emerging infectious diseases or resistant bacteria. It is difficult for companies to project the financial returns from interventions for diseases that emerge sporadically and may be controlled before clinical trials are complete (as happened during the West Africa Ebola outbreak). That is especially true of interventions for diseases that mainly affect people in low-income countries.

R&D efforts in response to the COVID-19 pandemic have been unprecedented: hundreds of vaccine and therapeutic candidates are being evaluated. While these efforts have been extremely exciting, many eyes will also be focused on whether the market dynamics (such as economics, competitive dynamics, and demand) in the coming months demonstrate that healthy markets are possible for pandemic-response products and how these dynamics will affect incentives for future development.

Building on the momentum created by COVID-19-related R&D, there is potential to spark a renaissance in infectious-disease R&D (Exhibit 8). The renaissance might focus on several necessities that the response to the COVID-19 pandemic has highlighted. One necessity is a portfolio of options. We can be cautiously optimistic about the potential of an effective COVID-19 vaccine being available during 2021—but only because so many candidates are in the works. Another necessity is flexible manufacturing capacity that can be deployed rapidly to make massive quantities of the most effective vaccines and therapeutics. A third necessity is intervention across a range of potential outbreak pathogens, requiring active programs for more than ten diseases.

Delivering such necessities will require building on the early success of initiatives such as CEPI to reimagine product-development pathways, from funding models and collaboration platforms to regulatory review and access agreements. Spending $15 billion to $35 billion in the first two years and $4 billion to $6 billion per year thereafter (for a ten-year total of $47 billion to $83 billion) would fund these activities:

  • accelerating the development of diagnostics, therapeutics, and vaccines against known threats—including influenza, for which effective R&D might yield significant advances
  • accelerating the development of next-generation antibiotics to counter the threat of AMR
  • establishing and funding platforms for the development of diagnostics, therapeutics, and vaccines against emerging infectious diseases
  • maintaining the capacity to manufacture five billion doses of vaccine and large quantities of therapeutics

 

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