PANDEMIC PREPAREDNESS &

RESPONSE: KEY LESSONS

Dr. Rana Jawad Asghar
Chief Executive Officer
GHSI (Global Health Strategists & Implementers)

TEDA Journalist Workshop

December 20th 2021
DID WE LEARN ANY LESSON FROM
1918 PANDEMIC??
 INFLUENZA PANDEMIC
• 500 million people ( 1/3rd of the world’s population) became infected
• Deaths 50 - 100 million worldwide

GHSI https://globalhsi.com/
 AFTER 100 YEARS INFLUENZA
• Population 7 Billion PANDEMIC
• 55 % live in cities ( 3.9 billion
people)
• 1 in 7 lives in a slum (in cities)
• Megacities serve as incubators
for new epidemics
• More than 30,000 commercial
flights/day
• World is very much connected
today
• Climate change
• Civil unrest

GHSI https://globalhsi.com/
 PAST PANDEMICS
• 1918 Pandemic (H1N1 virus)
• one-third of the world’s population became infected
• 50 million deaths
• 1957-1958 Pandemic (H2N2 virus)
• emerged in East Asia
• One million deaths

GHSI GlobalHSI.com
 • 1968 Pandemic (H3N2 virus)
• Deaths was 1 million worldwide mostly in elderly
• The H3N2 virus continues to circulate worldwide as a
seasonal influenza A virus
• Regular antigenic drift

GHSI GlobalHSI.com
 2009 H1N1 PANDEMIC (H1N1PDM09
• Nearly one-third of people over the age of VIRUS)
60 years had antibodies
• Different from H1N1 viruses that were
circulating at that time
• 575,400 people worldwide deaths
• 80 percent deaths were in people younger
than 65 years of age

GHSI GlobalHSI.com
 EBOLA OUTBREAK
2014-2016
• 7% to 8% of the health workforce was lost in some countries
• United States, UK, and Germany directly spent more than US$3.5 billion
• Total costs have been estimated at up to US$50 billion
WERE WE READY?
 INTERNATIONAL HEALTH
REGULATIONS (2005) (IHR)
Legal framework that defines countries’ rights and obligations in handling public health events
and emergencies that have the potential to cross borders

An instrument of international law that is legally-binding on 196 countries

Create rights and obligations for countries

Requirement to report public health events

https://www.who.int/health-topics/international-health-regulations#tab=tab_1
 GHSA & IHR

The GHSA is a multisector collaboration of 70 countries and

organizations that aims to strengthen countries’ capacities to
prevent, detect, and respond to infectious disease threats
It is acting as a complement to an earlier international agreement,
the International Health Regulations (IHR 2005), which were aimed
at preparedness
https://ghsagenda.org/
 JOINT EXTERNAL EVALUATIONS
(JEE)
• Voluntary, collaborative, multisectoral process
• To assess country capacities to prevent, detect and rapidly respond to
public health risks
• Helps countries identify the gaps within their human and animal health
systems in order to
• prioritize opportunities for enhanced preparedness and response
 RESOLVE READY SCORE
Country Score
Morocco 70
Saudi Arabia 76
Pakistan 50
Afghanistan 38
Sudan 57
UAE 91
Oman 84
Bahrain 80
Kuwait 74
Iraq 46
Qatar 69
Jordan 57
https://preventepidemics.org/
GHSI https://globalhsi.com/
 READY SCORE EM REGION

GHSI https://globalhsi.com/
 GHS INDEX OCT 2019
• Fewer than 7 percent of countries score in the highest tier in the category
assessing the prevention of the emergence or release of pathogens
• Only 19 percent of countries receive top marks (scoring a 66.7 out of 100 or
higher) in the category assessing early detection and reporting of epidemics
of potential international concern
• Fewer than 5 percent of countries score in the highest tier in rapid response
to and mitigation of spread of an epidemic.

GHSI https://globalhsi.com/
 WAS WORLD READY?
• We could be 100% compliant but NOT ready!
(A senior level government official)

• Quality measurements are much difficult

• +80 countries have done JEE
• 6,000 critical capacity gaps
• no systematic financing to address them
• Having a costing plan is no guarantee of funding

GHSI https://globalhsi.com/
DANGER WAS LURKING BUT WE
IGNORED IT
 DANGERS OF VARIANTS
Pandemic threats from influenza and emerging infections are very
real

The longer an outbreak lasts, the more opportunity the microbe has
to evolve into dangerous strains (variants)

These mutations or evolutions could help the virus to break down

human defenses by increasing infectivity or by acquiring resistance

https://www.liebertpub.com/doi/abs/10.1089/hs.2019.0104
 NO ONE IS SAFE UNLESS ALL ARE SAFE
Even countries that are passing these evaluations we are just assessing compliance
with the IHR/GHSA requirements of preparedness and not actually assessing readiness

A country could be 100% compliant but not ready

This is akin to counting the number of guns in an army but not checking that they
could actually fire a bullet

https://www.liebertpub.com/doi/abs/10.1089/hs.2019.0104
 RESPONSE VS PREPAREDNESS
History shows us repeatedly that outbreak response costs more than
outbreak readiness. We should not wait until our weak defenses are
broken by a major pandemic
We have many very clever and dangerous foes. Danger to a
nation’s security does not come in the form of invading armies
alone. Think bacteria, parasites, viruses, and fungi!
Rana Jawad Asghar, Ann Marie Kimball, and Ali S. Khan. Health
Security. Dec 2019.504-506.http://doi.org/10.1089/hs.2019.0104
 PAKISTAN DILEMMA
Pakistan and India spend paltry amounts on health

70% of this is directly paid by the people in private healthcare

Most of the spending on health is consumed by hospitals, salaries of

health staff and other related expenses
Very little is left to prepare this nation from viral threats despite the
largest outbreaks of XDR typhoid and HIV in young children

• https://tribune.com.pk/story/2162310/gaping-hole-national-security
 FIGHTING IN THE DARK
The purpose of any disease surveillance system is to understand the real
spread of a disease
Only then we could make reasonable estimates and effective decision-
making
The daily dumping of laboratory data is not the health intelligence required

We need to stop being afraid of numbers, and let epidemiologists do their

job
https://tribune.com.pk/story/2271794/why-pakistan-covid-19-numbers-are-
not-real
 WHY PAKISTAN COVID19
NUMBERS ARE NOT REAL?
 Lack of understanding about value of disease
numbers
Nearly absent investment on disease surveillance
systems
PROBLEM WITH Poor human and financial resources
NUMBERS
Weak data collection

Unreliable numbers

Lack of trust

Administrative negative actions against those

who report real numbers
 CRIMINALIZING THE DISEASE

Administrative and security officials started managing pandemic

Cases and contacts were forcefully picked from houses by law enforcing agencies
Families separated
Patients stopped opting for specific COVID19 tests
Already weak disease numbers losses any value
Disease became a stigma
Any epidemic with stigma is too difficult to control
https://tribune.com.pk/story/2195967/dont-criminalise-disease
 HEALTH INTELLIGENCE
• Effective systems of health
intelligence
• Potential health threats are
identified early
• Controlled locally
• Going beyond ordinary disease
surveillance
• Funded on a par with funding of
countries for their other intelligence
agencies

https://tribune.com.pk/story/2275637/health-intelligence-to-deal-with-the-pandemic
 NATIONAL SECURITY
• Pakistan also needs to prioritise its
spending for preparedness
• Mitigate the threat by ensuring robust
disease surveillance and a response
system
• Network of public health laboratories
• Strong risk-communication strategies
• In the long term, we need to ensure
that public health is also considered an
important component of national
security.

https://tribune.com.pk/story/2162310/gaping-hole-national-security
 EVALUATING THE COSTS AND
BENEFITS OF NATIONAL SURVEILLANCE
AND RESPONSE SYSTEMS
• Surveillance and response should be evaluated
together because they are so closely intertwined
• The costs of response are dependent on the surveillance
system
• Benefits of the surveillance system are dependent on
response

http://www.who.int/csr/resources/publications/surveillance/WHO_CDS_EPR_LYO_2005_25.pdf

23/01/2022
 IS MONEY WILL SOLVE THE
PROBLEMS?
There are structural challenges in how public/Global health has
been funded and managed in the past

Most technical leadership of international & national organisations

was replaced by those with more expertise in finance and
management than public/global health
With minimal on-ground field experience in outbreak controls, they
were like generals who never fought on ground
• https://tribune.com.pk/story/2277003/covid-control-penny-wise-pound-foolish
 WHAT TO DO?
• Reorganize global health especially
in areas of health security
• Resources needs to be properly
allocated
• Transparency and accountability
must be an integral component of
“new’ global health
• Vaccines may have saved the day,
but pandemic threat is not over
from other similar microorganisms
 Dr. Rana Jawad Asghar PANDEMIC
PREPAREDNESS &
Chief Executive Officer
GHSI (Global Health Strategists &

RESPONSE: KEY
Implementers)
[email protected]
https://globalhsi.com/
[email protected]
LESSONS