Measuring our ability to respond to future pandemics

January 4th, 2021 / By Travis Bias, DO, MPH, FAAFP

Fragmented systems lead to fragmented pandemic responses. Or that’s what I took from this Lancet piece published recently. 

The opportunities to improve the U.S. public health and health care systems are well documented. The U.S. has now registered the most cases and deaths from COVID-19 in the world. Why then was the U.S. ranked #1 in a major pandemic preparedness model?

Essentially, the Lancet piece highlights how country-level COVID-19 responses differed depending on investments in either global health security capabilities or prioritization of universal health coverage, and the need for better alignment between the two areas.

Beyond this, however, was the critical call-out of the inability of pandemic preparedness measures, such as the Global Health Security (GHS) Index, to anticipate such a lacking response to an infectious threat such as COVID-19. This GHS Index was guided by an expert advisory panel, it leveraged publicly available data from entities such as the World Health Organization along with country-level regulations and legislation, and attempted to take into account geopolitical implications to build its assessment of every country’s ability to prevent, detect and respond to biological threats. Included in this was an examination of just how battle-tested health systems were in responding to previous pandemics. 

Health security is defined as “the activities required…to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries.” Whether it was the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, the emergence of H1N1 Influenza in 2009, the Ebola Virus Disease scare in 2014, or even the spread of Zika virus in 2015, we have seen how an outbreak abroad can threaten us at home. Thus, it is important to assess and strengthen our capacity to protect those within our borders.

But what happens when a sophisticated model such as the GHS Index fails to accurately predict a country’s actual pandemic response and its sequela? How do such indices measure governance or political will during future crises, and how do they take into account coordination of seemingly strong individual capabilities? In the U.S. specifically, where are state-run public health systems and a fragmented health care delivery system accounted for in these assessments?

The GHS Index ranked the United States and United Kingdom #1 and #2 respectively, out of 195 countries. However, these two countries have had some of the highest reported cases and deaths due to COVID-19 of any country worldwide. 

The GHS Index states clearly that no country is fully prepared for pandemics, recognizing that better integrated and bolstered financing schemes to fill gaps and political will, among other interventions, are necessary to adequately address a biological threat in the future.

Whether a country or a local health system, what can we learn from this COVID-19 crisis to ensure we are never so blindsided again? How can we measure and test our ability to respond in the event of a crisis? And, perhaps most importantly, how can our systems remain resilient and able to continue our core functions to manage exacerbations of chronic disease and even keep up with vaccine schedules to prevent the emergence of damaging byproducts from hyper focus on the current crisis?

In future rankings or models, we must better take into account human behavior, including that of inevitably fallible (human) leaders. Heavily qualitative measurements such as these take into account subjective inputs, but the more objective measures must be carefully vetted or weighted. Many times, platforms measure inputs because they can and because the goal is to give the appearance of completeness. This approach may produce predictable outputs, or results that alleviate worries, but it may ultimately lead us down a road of false reassurance where we are blindsided by crisis and unprepared to serve essential patient or constituent needs.

All stakeholders would be better served by an honest assessment and rigorous test of our ability to face infectious threats. This will be a strong step towards ensuring a more resilient and stable system in service to patients during future crises.

Travis Bias, DO, MPH, FAAFP, is a Family Medicine physician and clinical transformation consultant at 3M Health Information Systems.