Preparing for and preventing future pandemics requires commitment to public health infrastructure, effective communication
Presenter: Michael Stevens, MD, MPH, West Virginia University, Richmond
Preparing for the next pandemic: lessons learned from COVID-19. Presented April 27, 2023.
Another respiratory viral pandemic is coming, but the United States is ill prepared, lacking strong central public health infrastructure and international cooperation and support. Although incredible advances in science have been made, capitalizing on them will take continued investment not only financially but from individuals, including internists, and professional societies, said Michael Stevens, MD, MPH, West Virginia University, Richmond.
With people living closer together and humans encroaching on natural environments and animal habitats, in addition to fast and accessible international travel, the next pandemic “is likely to be soon,” he said.
Individuals and professional societies will be critical in interpreting and communicating key information to patients and communities, advocating for public health and healthcare system improvements, and responding in real-time to newly identified viral threats.
Opposition to routine public health and social measures, such as wearing properly fitting masks and undergoing vaccination, hindered control of the COVID-19 pandemic. A lack of social trust and confidence in government advice and extensive misinformation were partly responsible. Unfortunately, these missteps are likely to be repeated unless a vocal national statement replaces the current patchwork of often contradictory state directives.
In preparing for the next pandemic, internists can practice critically evaluating public health guidance specific to infectious diseases, look for and embrace media opportunities, and learn how to best share key health messages via the media, including learning how to effectively communicate what is currently known and not known about the pandemic and the assumptions that inform current guidance, he said.
Internists should also advocate for strong, tactical, and expert responses from national organizations during crises, encourage national organizations to create pandemic response infrastructure and expertise, and advocate for national organization support for key legislation and ongoing public health funding. Recognizing that politics had a negative impact on the ability of the U.S. Centers for Disease Control and Prevention (CDC) to respond effectively to the pandemic, especially early, internists need to work to understand the strengths and limitations of the U.S. public health system, and advocate for a stronger, more coordinated U.S. public health system, a stronger, more independent CDC, and continuous investment in public health infrastructure.
Support for the development of infection prevention expertise is also critical, he said, noting that 80% of US counties do not have an infectious disease (ID) physician and that 208 million people in the United States live in counties without or with low ID physician coverage. Further, nearly 40% of current infection preventionists are nearing retirement, which will only serve to exacerbate the shortage.
Next-generation sequencing techniques, which are becoming less expensive, have been critical for surveillance of novel SARS-CoV-2 variants and will be important to inform mitigation strategies during the next pandemic, as sequencing technologies may be used for other diseases. Their use expanded during the COVID-19 pandemic from primarily research to public health applications. Maintenance of viral sequencing machines and the reagents required for testing are still expensive, and sequencing requires sophisticated equipment, complex workflows, and significant personal expertise, he said in citing some of the challenges. Wastewater surveillance will be a valuable resource; it has been used to detect SARS-CoV-2 in a community and can show activity before it would be detected by symptomatic spread.
Pragmatic approaches to research will be essential. The Randomized Evaluation of Covid-19 Therapy (RECOVERY) trial is a great model, said Dr. Stevens, having enrolled more than 47,000 patients from nearly 200 hospitals in 6 countries, from which 4 effective therapies were identified, including dexamethasone, for COVID-19 infection. “It may have saved millions of lives, including people living in low- and middle-income countries,” he said.
The mRNA technology will revolutionize medicine, he predicted. It is “enormously promising” for rapid development of potential vaccine targets and had astounding effectiveness in reducing the rate of adverse outcomes from COVID-19. Despite this success, vaccine access was inequitable, which may have limited the success of combatting the COVID-19 pandemic, potentially contributing to the emergence of viral variants.
Successful suppression of a pandemic virus on a population level requires “prosociality,” he argued. It involves a range of social and public health measures, including testing and isolating when sick and mask wearing, structural commitment and investment to promote health and social care, and a societal commitment to mutual aid. “Prosociality is important between individuals and governments,” he said. “On balance, we performed poorly during the pandemic to date,” as many in the U.S. focused on individual freedom, and autonomy.
References
Sachs JD, Karim SSA, Aknin L, et al. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet 2022; 400(10359):1224-1280. doi: 10.1016/S0140-6736(22)01585-9
Soares-Weiser K, Lasserson T, Jorgensen KJ, et al. Policy makers must act on incomplete evidence in responding to COVID-19. Cochrane Database Syst Rev 2020; 11:ED000149. Published 2020 Nov 20. doi: 10.1002/14651858.ED000149
Snyder GM, Passaretti CL, Stevens MP. Hospital approaches to universal masking after public health "unmasking" guidance [published online ahead of print, 2023 Mar 22]. Infect Control Hosp Epidemiol 2023; 1-2. doi: 10.1017/ice.2023.9
Wenzel RP. An unforgiving virus and the silent CDC. The Globe Post 7/28/20. https://theglobepost.com/2020/07/28/silent-cdc/
Walensky RP, McQuillen DP, Shahbazi S, Goodson JD. Where Is the ID in COVID-19?. Ann Intern Med 2020; 173(7):587-589. doi: 10.7326/M20-2684
US Centers for Disease Control and Prevention. National Wastewater Surveillance System. https://www.cdc.gov/nwss/wastewater-surveillance.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fnwss%2Fwastewater-surveillance%2Findex.html
RECOVERY. Randomised Evaluation of Covid-19 Therapy. University of Oxford. https://www.recoverytrial.net
Disclosures
Michael Stevens, MD, MPH, has no relationships with entities whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.