Public-private cooperation for pandemic preparedness and response
A call to action
The
next severe pandemic will not only cause great illness and loss of life
but could also trigger major cascading economic and societal
consequences that could contribute greatly to global impact and
suffering. Efforts to prevent such consequences or respond to them as
they unfold will require unprecedented levels of collaboration between
governments, international organizations, and the private sector. There
have been important efforts to engage the private sector in epidemic and
outbreak preparedness at the national or regional level.1,2
However, there are major unmet global vulnerabilities and international
system challenges posed by pandemics that will require new robust forms
of public-private cooperation to address.
The Event 201 pandemic
exercise, conducted on October 18, 2019, vividly demonstrated a number
of these important gaps in pandemic preparedness as well as some of the
elements of the solutions between the public and private sectors that
will be needed to fill them. The Johns Hopkins Center for Health
Security, World Economic Forum, and Bill & Melinda Gates Foundation
jointly propose the following:
- Governments,
international organizations, and businesses should plan now for how
essential corporate capabilities will be utilized during a large-scale
pandemic. During a severe pandemic, public sector efforts to
control the outbreak are likely to become overwhelmed. But industry
assets, if swiftly and appropriately deployed, could help to save lives
and reduce economic losses. For instance, companies with operations
focused on logistics, social media, or distribution systems will be
needed to enable governments’ emergency response, risk communications,
and medical countermeasure distribution efforts during a pandemic. This
includes working together to ensure that strategic commodities are
available and accessible for public health response. Contingency
planning for a potential operational partnership between government and
business will be complex, with many legal and organizational details to
be addressed. Governments should work now to identify the most critical
areas of need and reach out to industry players with the goal of
finalizing agreements in advance of the next large pandemic. The Global
Preparedness Monitoring Board would be well positioned to help monitor
and contribute to the efforts that governments, international
organizations and businesses should take for pandemic preparedness and
response.
- Industry, national governments, and
international organizations should work together to enhance
internationally held stockpiles of medical countermeasures (MCMs) to
enable rapid and equitable distribution during a severe pandemic.
The World Health Organization (WHO) currently has an influenza vaccine
virtual stockpile, with contracts in place with pharmaceutical companies
that have agreed to supply vaccines should WHO request them. As one
possible approach, this virtual stockpile model could be expanded to
augment WHO’s ability to distribute vaccines and therapeutics to
countries in the greatest need during a severe pandemic. This should
also include any available experimental vaccine stockpiles for any WHO
R&D Blueprint pathogens to deploy in a clinical trial during
outbreaks in collaboration with CEPI, GAVI, and WHO. Other approaches
could involve regional stockpiles or bi- or multinational agreements.
During a catastrophic outbreak, countries may be reluctant to part with
scarce medical resources. A robust international stockpile could
therefore help to ensure that low and middle resource settings receive
needed supplies regardless of whether they produce such supplies
domestically. Countries with national supplies or domestic manufacturing
capabilities should commit to donating some supply/product to this
virtual stockpile. Countries should support this effort through the
provision of additional funding.
- Countries,
international organizations, and global transportation companies should
work together to maintain travel and trade during severe pandemics.
Travel and trade are essential to the global economy as well as to
national and even local economies, and they should be maintained even in
the face of a pandemic. Improved decision-making,
coordination, and communications between the public and private sectors,
relating to risk, travel advisories, import/export restrictions, and
border measures will be needed. The fear and uncertainty experienced
during past outbreaks, even those limited to a national or regional
level, have sometimes led to unjustified border measures, the closure of
customer-facing businesses, import bans, and the cancellation of
airline flights and international shipping. A particularly fast-moving
and lethal pandemic could therefore result in political decisions to
slow or stop movement of people and goods, potentially harming economies
already vulnerable in the face of an outbreak. Ministries of Health and
other government agencies should work together now with international
airlines and global shipping companies to develop realistic response
scenarios and start a contingency planning process with the goal of
mitigating economic damage by maintaining key travel and trade routes
during a large-scale pandemic. Supporting continued trade and travel in
such an extreme circumstance may require the provision of enhanced
disease control measures and personal protective equipment for
transportation workers, government subsidies to support critical trade
routes, and potentially liability protection in certain cases.
International organizations including WHO, the International Air
Transport Association, and the International Civil Aviation Organization
should be partners in these preparedness and response efforts.
- Governments
should provide more resources and support for the development and surge
manufacturing of vaccines, therapeutics, and diagnostics that will be
needed during a severe pandemic. In the event of a severe
pandemic, countries may need population-level supplies of safe and
effective medical countermeasures, including vaccines, therapeutics, and
diagnostics. Therefore, the ability to rapidly develop, manufacture,
distribute, and dispense large quantities of MCMs will be needed to
contain and control a global outbreak. Countries with enough resources
should greatly increase this capability. In coordination with WHO, CEPI,
GAVI, and other relevant multilateral and domestic mechanisms,
investments should be made in new technologies and industrial
approaches, that will allow concomitant distributed manufacturing. This
will require addressing legal and regulatory barriers among other
issues.
- Global business should recognize the economic burden of pandemics and fight for stronger preparedness.
In addition to investing more in preparing their own companies and
industries, business leaders and their shareholders should actively
engage with governments and advocate for increased resources for
pandemic preparedness. Globally, there has been a lack of attention and
investment in preparing for high-impact pandemics, and business is
largely not involved in existing efforts. To a significant extent this
is due to a lack of awareness of the business risks posed by a pandemic.
Tools should be built that help large private sector companies
visualize business risks posed by infectious disease and pathways to
mitigate risk through public-private cooperation to strengthen
preparedness. A severe pandemic would greatly interfere with workforce
health, business operations, and the movement of goods and services.3
A catastrophic-level outbreak can also have profound and long-lasting
effects on entire industries, the economy, and societies in which
business operates. While governments and public health authorities serve
as the first line of defense against fast-moving outbreaks, their
efforts are chronically under-funded and lack sustained support. Global
business leaders should play a far more dynamic role as advocates with a
stake in stronger pandemic preparedness.
- International organizations should prioritize reducing economic impacts of epidemics and pandemics.
Much of the economic harm resulting from a pandemic is likely to be due
to counterproductive behavior of individuals, companies, and countries.
For example, actions that lead to disruption of travel and trade or
that change consumer behavior can greatly damage economies. In addition
to other response activities, an increase in and reassessment of
pandemic financial support will certainly be needed in a severe pandemic
as many sectors of society may need financial support during or after a
severe pandemic, including healthcare institutions, essential
businesses, and national governments Furthermore, the ways in which
these existing funds can now be used are limited. The International
Health Regulations prioritize both minimizing public health risks and
avoiding unnecessary interference with international traffic and trade.
But there will also be a need to identify critical nodes of the banking
system and global and national economies that are too essential to fail –
there are some that are likely to need emergency international
financial support as well. The World Bank, the International Monetary
Fund, regional development banks, national governments, foundations, and
others should explore ways to increase the amount and availability of
funds in a pandemic and ensure that they can be flexibly used where
needed.
- Governments and the private sector
should assign a greater priority to developing methods to combat mis-
and disinformation prior to the next pandemic response.
Governments will need to partner with traditional and social media
companies to research and develop nimble approaches to countering
misinformation. This will require developing the ability to flood media
with fast, accurate, and consistent information. Public health
authorities should work with private employers and trusted community
leaders such as faith leaders, to promulgate factual information to
employees and citizens. Trusted, influential private-sector employers
should create the capacity to readily and reliably augment public
messaging, manage rumors and misinformation, and amplify credible
information to support emergency public communications. National public
health agencies should work in close collaboration with WHO to create
the capability to rapidly develop and release consistent health
messages. For their part, media companies should commit to ensuring that
authoritative messages are prioritized and that false messages are
suppressed including though the use of technology.
Accomplishing
the above goals will require collaboration among governments,
international organizations and global business. If these
recommendations are robustly pursued, major progress can be made to
diminish the potential impact and consequences of pandemics. We call on
leaders in global business, international organizations, and national
governments to launch an ambitious effort to work together to build a
world better prepared for a severe pandemic.