tag:theconversation.com,2011:/us/topics/pandemic-preparedness-69672/articlesPandemic preparedness – The Conversation2023-11-01T14:03:32Ztag:theconversation.com,2011:article/2167932023-11-01T14:03:32Z2023-11-01T14:03:32ZDominic Cummings has exposed a hole at the heart of the British government – and a glaring problem with the way we choose prime ministers<p>The COVID inquiry is possibly the most sophisticated and <a href="https://academic.oup.com/pa/article/74/2/483/5861499">wide-ranging blame game</a> that has ever played out in British politics. That said, the great benefit of public inquiries, as opposed to parliamentary scrutiny, is that their breadth allows for an exploration of issues in a way that promotes <a href="https://www.cambridge.org/core/journals/ps-political-science-and-politics/article/abs/living-accountability-hot-rhetoric-cool-theory-and-uneven-practice/88E892FFA45B7294897DA9250686ED03">“cool thinking”</a> (balanced, reflective, evidence-based) over “hot rhetoric” (aggressive, adversarial, emotive). </p>
<p>Although hotly awaited, Dominic Cummings’s appearance before the inquiry was a fairly cool affair. Gone was the <a href="https://link.springer.com/article/10.1057/s41293-020-00148-2">“mad man in the wings”</a> who had caused controversy and chaos in Whitehall as chief adviser to former prime minister Boris Johnson. The edgy and unrepentant dissident who sat in the garden of No.10 and sought to justify his <a href="https://www.theguardian.com/politics/2021/may/26/dominic-cummings-says-he-did-not-tell-whole-truth-about-journeys-to-durham-barnard-castle">lockdown-breaking drive to Barnard Castle</a> replaced now by a far calmer character. </p>
<p>There were, of course, the juicy soundbites about poor planning (the Cabinet Office described as a “dumpster fire”) and even poorer leadership (Johnson apparently being “obsessed with older people accepting their fate and letting the young get on with life”). The scale of dysfunctionality was captured in the use of a new language of disarray and disorder. Johnson, for example, was known as <a href="https://www.youtube.com/watch?v=I39AZGzWjQs">“trolley”</a> due to his tendency to change direction. Shifts in policy were the result of “poppins” (moments when officials would “pop in” to see Boris Johnson to drip-feed thoughts of doubt into his mind).</p>
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<figcaption><span class="caption">A bunch of trolleys and poppins.</span></figcaption>
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<h2>Deep story</h2>
<p>None of this insight was new, of course. The fact that the pandemic became a “Kafkaesque nightmare”, as Cummings put it, was no revelation to those who had been following this sorry saga. But a deeper story did emerge in the course of Cummings’s evidence. </p>
<p>In sociological research the notion of a “deep story” – <a href="https://www.npr.org/2017/01/24/510567860/strangers-in-their-own-land-the-deep-story-of-trump-supporters">as sociologist Arlie Hochschild has demonstrated</a> with such insight – focuses on how people make sense of the world. Deep stories don’t need to be completely accurate, but they have to feel true to those who tell them. They are the stories people tell themselves to capture and manage pressures and disappointments, fears and anxieties.</p>
<p>In the COVID context, what’s most significant is the way in which a trail of WhatsApps and other social media messages have laid bare the “deep story” of how officials and advisers felt about their political masters. Expletive-laden messages between senior officials, the government described as a <a href="https://www.theguardian.com/politics/2023/oct/13/uks-top-civil-servant-said-government-looked-like-tragic-joke-during-pandemic">“terrible, tragic joke”</a> and even the admission by the country’s most senior civil servant that he was <a href="https://www.theguardian.com/politics/2023/oct/13/uks-top-civil-servant-said-government-looked-like-tragic-joke-during-pandemic">“not sure I can cope”</a>. </p>
<p>What these inquiry sessions with central political figures have really revealed was the frailty of human nature when expected to <a href="https://academic.oup.com/pa/article/73/2/253/5262273">govern under pressure</a> – which in itself leads to a focus on expertise. </p>
<p>The deeper issue, if not the story, emerging out of Cummings’s evidence was the existence of a governing system that was almost completely devoid of expertise. Plans did not exist. Systems were not connected. Data was not collected. Admissions of <a href="https://www.standard.co.uk/news/politics/dominic-cummings-lee-cain-government-covid-inquiry-boris-johnson-cabinet-b1117209.html">“dysfunctionality”</a> little more than a veil for an incredibly amateurish system staffed by generalists who were committed to <a href="https://books.google.co.uk/books/about/Muddling_Through.html?id=07eGQgAACAAJ&redir_esc=y">“muddling through”</a> when systemic responses were needed.</p>
<p>Where expertise was available in the form of its Scientific Advisory Group for Emergencies, the government lacked the capacity to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-923X.12885">understand or interrogate the advice it was given</a>.</p>
<p>The bigger picture is provided in former government minister <a href="https://www.penguin.co.uk/books/442034/politics-on-the-edge-by-stewart-rory/9781787332713">Rory Stewart’s book Politics on the Edge</a>, which charts in great detail how those with expertise and specialist knowledge within Whitehall are sidelined in terms of promotion and policy input. Journalist <a href="https://www.waterstones.com/author/ian-dunt/3424919">Ian Dunt makes a similar argument</a> in his critique of both ministers and the civil service – generalists jettisoned into a system based on non-stop churn.</p>
<h2>Shallow man</h2>
<p>And yet there is a dimension of this story that is not at all deep. Indeed, its shallowness is almost shocking. The core and undeniable concern that Cummings’s evidence reinforced relates to the issue of leadership. </p>
<p>The admission by Lee Cain, the former director of communications in No.10 under Johnson, that COVID <a href="https://news.sky.com/story/covid-inquiry-latest-laughable-to-say-i-was-pushing-herd-immunity-cummings-boris-johnson-was-obsessed-with-older-people-accepting-their-fate-12593360">“was the wrong crisis for this prime minister’s skillset”</a> demands deconstruction.</p>
<p>How did Johnson become prime minister, and what were the skills or attributes that he brought to the role? </p>
<p>This is not a partisan question. It is a proposal for sober reflection on how we give people power. </p>
<p>Arguably the most galling element of the evidence that the public inquiry is amassing about Johnson’s lack of leadership skills is that anyone who had done even the smallest amount of credible research on his personal and professional life up to July 2019 could only have concluded that he was totally unfit for office. </p>
<p>This is not a partisan point either. It is underscored by a vast seam of research and scholarship. Anyone who doubts this point might simply take a dip into Tom Bower’s biography which titles Johnson as <a href="https://www.theguardian.com/books/2020/oct/13/boris-johnson-the-gambler-by-tom-bower-review-the-defining-secret">The Gambler</a>. Andrew Gimson’s account of his <a href="https://www.simonandschuster.co.uk/books/Boris-Johnson/Andrew-Gimson/9781398502819">“rise and fall”</a> provides another weighty account of chaos and disaster. Sonia Purnell’s <a href="https://www.soniapurnell.com/just-boris">Just Boris: A Tale of Blond Ambition</a> outlines a life of entitlement and absurdity. </p>
<p>The deepest question unearthed by Cummings’s evidence is really one about how we select and support our political leaders. In Johnson’s case it’s worth remembering that he was elected and effectively anointed prime minister by Conservative party members, who constitute <a href="https://www.ft.com/content/1454fe21-5b2e-459c-966c-65fd48d52f8f">less than 1% of the electorate</a> in the United Kingdom (and a skewed and unrepresentative slice of the public at that). </p>
<p>We know from <a href="https://journals.sagepub.com/doi/full/10.1177/0032321721995632">May’s law of curvilinearity</a> that party activists tend to be more extreme in their views than the general public, and are likely to prize certain “qualities” (such as celebrity status, charisma and charm) over “basic skills” (organisational expertise or project management experience).</p>
<p>Celebrity, charisma and charm might be appropriate qualities for tea parties and fundraising dinners but they’re not much good for leading integrated pandemic response strategies.</p>
<p>That’s the deep and simple story.</p><img src="https://counter.theconversation.com/content/216793/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Flinders does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Giving evidence to the COVID inquiry, Boris Johnson’s former adviser exposed the dysfunction of an administration lacking in the expertise needed to manage a crisis.Matthew Flinders, Founding Director of the Sir Bernard Crick Centre for the Public Understanding of Politics, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2131702023-09-08T16:30:15Z2023-09-08T16:30:15ZWhy are those lost to COVID not formally memorialised? How politics shapes what we remember<p>Every Friday, volunteers gather on the Albert Embankment at the River Thames in London to lovingly retouch thousands of red hearts inscribed on a Portland stone wall directly opposite the Houses of Parliament. Each heart is dedicated to a British victim of COVID. It is a deeply social space – a place where the COVID bereaved come together to honour their dead and share memories.</p>
<p>The so-called <a href="https://www.nationalcovidmemorialwall.org/">National Covid Memorial Wall</a> is not, however, officially sanctioned. In fact, ever since activists from COVID-19 Bereaved Families for Justice (CBFFJ) daubed the first hearts on the wall in March 2021 it has been a thorn in the side of the authorities. </p>
<p>Featured in the media whenever there is a new revelation about <a href="https://theconversation.com/europe/topics/partygate-115248">partygate</a>, the wall is a symbol of the government’s blundering response to the pandemic and an implicit rebuke to former prime minister Boris Johnson and other government staff who breached coronavirus restrictions. </p>
<p>As one writer put it, viewed from parliament the hearts resemble “<a href="https://www.mirror.co.uk/news/uk-news/guerrilla-act-memorial-began-180000-26550275">a reproachful smear of blood</a>”. Little wonder that the only time Johnson visited the wall was under the cover of darkness to avoid the TV cameras. His successor Rishi Sunak has been similarly reluctant to acknowledge the wall or say what might take its place as a more formal memorial to those lost in the pandemic.</p>
<p>Though in April the UK Commission on COVID Commemoration presented Sunak with a <a href="https://www.gov.uk/government/news/the-uk-commission-on-covid-commemoration">report</a> on how the pandemic should be remembered, Sunak has yet to reveal the commission’s recommendations. </p>
<p>Lady Heather Hallett, the former high court judge who chairs the public inquiry into COVID, has attempted to acknowledge the trauma of the bereaved by commissioning a <a href="https://covid19.public-inquiry.uk/news/first-commemorative-tapestry-panels-unveiled-at-covid-inquiry-hearing-centre/">tapestry</a> to capture the experiences of people who “suffered hardship and loss” during the pandemic. Yet such initiatives are no substitute for state-sponsored memorials.</p>
<h2>What is remembered and what is forgotten?</h2>
<p>This political vacuum is odd when you consider that the United Kingdom, like other countries, engages in many other commemorative activities central to national identity. The fallen of the first world war and other military conflicts are commemorated in a Remembrance Sunday ceremony held every November at the <a href="https://www.britishlegion.org.uk/get-involved/remembrance/remembrance-events/remembrance-sunday">Cenotaph</a> in London, for example. </p>
<p>But while wars lend themselves to compelling moral narratives, it is difficult to locate meaning in the random mutations of a virus. And while wars draw on a familiar repertoire of symbols and rituals, pandemics have few templates.</p>
<p>For instance, despite killing more than 50 million globally, there are <a href="https://markhonigsbaum.substack.com/p/drinking-the-waters-of-lethe">virtually no memorials</a> to the 1918-1919 “Spanish” influenza pandemic. Nor does the UK have a memorial to victims of HIV/AIDS. As the memory studies scholar <a href="https://journals.sagepub.com/doi/10.1177/1750698020943014">Astrid Erll puts it</a>, pandemics have not been sufficiently “mediated” in collective memory. </p>
<p>As a rule, they do not feature in famous paintings, novels or films or in the oral histories passed down as part of family lore. Nor are they able to draw on familiar cultural materials such as poppies, gun carriages, catafalques and royal salutes. Without such symbols and schemata, Erll argues, we struggle to incorporate pandemics into our collective remembering systems.</p>
<p>This lacuna was brought home to me last September when tens of thousands of Britons flocked to the south bank of the Thames to pay their respects to Britain’s longest serving monarch. By coincidence, the police directed the queue for the late Queen’s lying-in-state in Westminster Hall over Lambeth Bridge and along Albert Embankment. </p>
<p>But few of the people I spoke to in the queue seemed to realise what the hearts signified. It was as if the spectacle of a royal death had eclipsed the suffering of the COVID bereaved, rendering the wall <a href="https://markhonigsbaum.substack.com/p/reign-of-silence">all but invisible.</a></p>
<h2>Waiting for answers</h2>
<p>Another place where the pandemic could be embedded in collective memory is at the public inquiry. Opening the preliminary hearing last October into the UK’s resilience and preparedness for a pandemic, Lady Hallett promised to put the estimated 6.8 million Britons mourning the death of a family member or friend to COVID at the heart of the legal process. “I am listening to them; their loss will be recognised,” she said.</p>
<p>But though Lady Hallett has strategically placed photographs of the hearts throughout the inquiry’s offices in Bayswater and has invited the bereaved to relate their experiences to “<a href="https://covid19.public-inquiry.uk/every-story-matters/">Every Story Matters</a>”, the hearing room is dominated by ranks of lawyers. And except when a prominent minister or official is called to testify, the proceedings rarely make the news.</p>
<p>This is partly the fault of the inquiry process itself. The hearings are due to last until 2025, with the report on the first stage of the process not expected until the summer of 2024. As Lucy Easthope, an emergency planner and veteran of several disasters, <a href="https://policy.bristoluniversitypress.co.uk/when-this-is-over">puts it</a>: “one of the most painful frustrations of the inquiry will be temporal. It will simply take too long.”</p>
<p>The inquiry has also been beset by bureaucratic obfuscation, not least by the Cabinet Office which attempted (unsuccessfully in the end) to <a href="https://www.judiciary.uk/wp-content/uploads/2023/07/Cab-Off-v-Covid-Enquiry-6.7.23-approved-judgment-002.pdf">block the release of WhatsApp messages</a> relating to discussions between ministers and Downing Street officials in the run-up to lockdown. </p>
<p>To the inquiry’s critics, the obvious parallel is with the Grenfell inquiry, which promised to “learn lessons” from the <a href="https://theconversation.com/europe/topics/grenfell-tower-39675">devastating fire</a> that engulfed the west London tower in 2017 but has so far ended up <a href="https://assets.grenfelltowerinquiry.org.uk/GTI%20-%20Phase%201%20report%20Executive%20Summary.pdf">blurring the lines of corporate responsibility</a> and forestalling a political reckoning.</p>
<p>The real work of holding the government to account and making memories takes place every Friday at the wall and the other places where people come together to spontaneously mourn and remember absent loved ones. These are the lives that demand to be “seen”. They are the ghosts that haunt our amnesic political culture.</p><img src="https://counter.theconversation.com/content/213170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Honigsbaum receives funding from the Higher Education Innovation Fund.</span></em></p>Hundreds of thousands of red hearts adorn a wall directly opposite parliament, yet successive prime ministers have nothing to say about officially marking the lives lost in the pandemic.Mark Honigsbaum, Senior Lecturer in Journalism, City, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2087202023-06-30T14:30:47Z2023-06-30T14:30:47ZCOVID: how incorrect assumptions and poor foresight hampered the UK’s pandemic preparedness<figure><img src="https://images.theconversation.com/files/535011/original/file-20230630-17-20iemj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3368&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-uk-march-20-2020-empty-1688998477">Loveandrock/Shutterstock</a></span></figcaption></figure><p>Matt Hancock, the former health secretary, has told the recently opened <a href="https://covid19.public-inquiry.uk/">COVID-19 Inquiry</a> that the UK’s pandemic planning was “<a href="https://www.bbc.co.uk/news/health-66029325">completely wrong</a>”. According to Hancock, the doctrine was “to plan for the consequences of a disaster” rather than stopping or containing the virus in the first place.</p>
<p>While there is truth in this claim, it doesn’t give us the whole picture. Hancock was repeatedly asked during his appearance about something called Exercise Cygnus. In 2016, the UK government engaged in <a href="https://www.gov.uk/government/publications/uk-pandemic-preparedness/annex-a-about-exercise-cygnus">a series of exercises including Cygnus</a> to assess their preparedness and response to a pandemic outbreak of influenza.</p>
<p>As the global scale of the COVID pandemic was starting to become apparent in the first half of February 2020, the UK applied the lessons from these exercises to plan for a wide range of scenarios. Based on the scientific evidence available at that time, they anticipated that a “reasonable worst-case scenario” could involve up to 80% of the UK population being infected (with only 50% of those infected showing symptoms). However, it was hoped that the majority of cases would have relatively mild disease.</p>
<p>This information was contained in planning assumptions labelled “officially sensitive” that were shared between a range of healthcare authorities and that I had access to at the time. Some of the figures were also published in <a href="https://www.standard.co.uk/news/health/coronavirus-worst-case-scenario-government-document-a4371726.html">the media</a>.</p>
<p>The concept of “herd immunity” played a key role in the existing mathematical models. Herd immunity is the idea that once a sufficiently large proportion of the susceptible population is infected and subsequently acquires immunity, the <a href="https://www.who.int/news-room/questions-and-answers/item/herd-immunity-lockdowns-and-covid-19">whole population</a> becomes protected. The thinking was that herd immunity for COVID might be achieved once 80% of the UK population had been infected, or perhaps even earlier.</p>
<p>Underlying all this was the assumption that, in the absence of effective vaccines at that time, the <a href="https://www.britannica.com/science/case-fatality-rate">case fatality rate</a> from the new virus (the proportion of infected people who end up dying) would not be so high that herd immunity could only be achieved at the cost of many lives.</p>
<p>Unfortunately, the actual COVID mortality figures – first from China, then other east and southeast Asian countries, and by the second half of February 2020 also <a href="https://www.bbc.co.uk/news/world-middle-east-51787238">from Italy</a> – showed that the initial case fatality rate of COVID was much higher than had been modelled in the UK scenarios. </p>
<p>Without effective vaccines, any attempt at herd immunity had to be abandoned as too many people would have died in the meantime.</p>
<h2>Flawed assumptions</h2>
<p>The assumption that any new viral pandemic would develop along similar lines as previous influenza pandemics was arguably the key flaw in the UK’s planning doctrine. </p>
<p>Countries that had been significantly affected by the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/severe-acute-respiratory-syndrome-sars">severe acute respiratory syndrome</a> (Sars) outbreak in 2002–2004 – principally China but also other Asian countries – didn’t make the same mistake. Those countries recognised important biological similarities between COVID (or SARS-CoV-2) and SARS (or SARS-CoV-1) and quickly took action against COVID by means of <a href="https://www.nber.org/papers/w27100">intensive testing and quarantine policies</a>. </p>
<p>In contrast, the UK lost valuable time between mid-February and mid-March while COVID cases and subsequent deaths were rapidly beginning to rise. The effect on older adults and other vulnerable people in UK care homes was <a href="https://www.bbc.co.uk/news/52674073">especially severe</a>.</p>
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<img alt="A healthcare worker wearing PPE looks at a clipboard." src="https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535013/original/file-20230630-12495-y2xpsk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The COVID inquiry is ongoing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-icu-doctor-checking-patient-medical-1884350062">Cryptographer/Shutterstock</a></span>
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<p>In the end, the UK’s first wave of COVID was only slowed and eventually stopped by the introduction of a lockdown in the <a href="https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020">fourth week of March 2020</a>.</p>
<h2>Poor planning</h2>
<p>Hancock’s statement raises a key question about the extent to which errors in the UK’s pandemic planning could have been foreseen at the time. Notably, the UK’s healthcare planning authorities could have taken a wider view of the potential nature of viral pandemics. </p>
<p>The earlier Sars outbreak had been largely confined to China, although it spread to more than 20 other countries through worldwide air travel, and was contained within <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/severe-acute-respiratory-syndrome-sars">a few short months</a>. Therefore, the risk of future outbreaks of this type in the UK was regarded as relatively low. Nevertheless, it wouldn’t have been unreasonable to include the global re-emergence of a Sars-type virus as one of the possible, albeit more extreme, pandemic scenarios analysed in the UK’s planning exercises in 2016.</p>
<p>Even given the wrong assumption regarding the nature of the new virus, some issues could have been anticipated better. For example, it was well known that the supply chain for personal protective equipment (PPE), which is vital for health and care staff, had become increasingly dependent on low-cost <a href="https://www.gov.uk/government/news/over-22-million-pieces-of-protective-equipment-shipped-to-uk-from-china">suppliers in China</a>. If the UK’s pandemic planning exercises had taken a more global perspective, the breakdown in the <a href="https://www.bbc.co.uk/news/uk-northern-ireland-52091054">PPE supply chain</a> in the spring of 2020, which caused huge financial waste (and apparent corruption), could have been better anticipated. </p>
<p>Other questions, such as when effective <a href="https://www.bbc.co.uk/news/health-54027269">COVID vaccines</a> would become available, were much harder to predict.</p>
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Read more:
<a href="https://theconversation.com/how-to-prepare-for-a-pandemic-137116">How to prepare for a pandemic</a>
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<p>In sum, no planning exercise can cover all eventualities. But a key requirement for policymakers should be to learn as fast and effectively as possible while events unfold. </p>
<p>The business concept of “<a href="https://www.davidjteece.com/dynamic-capabilities">dynamic capability</a>” – that is, an organisation’s ability to configure and reconfigure its assets, processes and capabilities so as to respond effectively to rapidly changing external circumstances – is useful here. Building and strengthening this capability should be a prerequisite for policymakers and planners in government.</p>
<p>In regards to Hancock’s comment that the planning was “completely wrong”, one could say that the UK plans were indeed flawed in their key assumption (of an influenza rather than a coronavirus pandemic), but also that policymakers should have learned the true nature of the new virus more quickly than they did.</p><img src="https://counter.theconversation.com/content/208720/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Van Der Meer receives funding from NHS Lanarkshire, NHS Golden Jubilee and the Scottish Government.</span></em></p>Former health secretary Matt Hancock told the COVID inquiry that the UK’s pandemic planning was ‘completely wrong’. An expert looks back to early 2020 to assess this statement.Robert Van Der Meer, Professor of Management Science, University of Strathclyde Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1906582022-09-15T02:28:33Z2022-09-15T02:28:33ZWe were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself<p>A global report released <a href="https://www.thelancet.com/commissions/covid19">today</a> highlights massive global failures in the response to COVID-19.</p>
<p>The report, which was convened by The Lancet journal and to which we contributed, highlights widespread global failures of prevention and basic public health.</p>
<p>This resulted in an estimated 17.7 million excess deaths due to COVID-19 (including those not reported) to September 15.</p>
<p>The report also highlights that the pandemic has reversed progress made towards the United Nations <a href="https://sdgs.un.org/goals">Sustainable Development Goals</a> in many countries further impacting on health and wellbeing.</p>
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<p>The report, from <a href="https://covid19commission.org">The Lancet COVID-19 Commission</a>, found most governments were ill-prepared, too slow to act, paid too little attention to the most vulnerable in their societies, and were hampered by low public trust and an epidemic of misinformation.</p>
<p>However, countries of the Western Pacific – including East Asia, Australia and New Zealand – adopted <a href="https://theconversation.com/australias-response-to-covid-in-the-first-2-years-was-one-of-the-best-in-the-world-why-do-we-rank-so-poorly-now-187606">more successful</a> control strategies than most.</p>
<p>This had resulted in an estimated 300 deaths per million in the region
(around <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7EAUS">558 per million</a> in Australia and <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7ENZL">382 per million</a> in New Zealand to September 12). This is compared with more than 3,000 per million in the <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7EUSA">United States</a> and the <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7EGBR">United Kingdom</a>. </p>
<p>The report also sets out 11 key recommendations for ending the pandemic and preparing for the next one.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/imagining-covid-is-like-the-flu-is-cutting-thousands-of-lives-short-its-time-to-wake-up-190545">Imagining COVID is 'like the flu' is cutting thousands of lives short. It's time to wake up</a>
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<h2>Co-operation lacking</h2>
<p>The report is the result of two years’ work from global experts in public policy, health, economics, social sciences and finance. We contributed to the public health component.</p>
<p>One of the report’s major criticisms is the failure of global cooperation for the financing and distribution of vaccines, medicines and personal protective equipment for low-income countries. </p>
<p>This is not only <a href="https://theconversation.com/wealthy-nations-starved-the-developing-world-of-vaccines-omicron-shows-the-cost-of-this-greed-172763">inequitable</a> but has raised the risk of <a href="https://theconversation.com/new-covid-variants-have-changed-the-game-and-vaccines-will-not-be-enough-we-need-global-maximum-suppression-157870">more dangerous variants</a>.</p>
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<p>The report highlighted the critical role of strong and equitable public health systems. These need to have: strong relationships with local communities; investment in behavioural and social science research to develop more effective interventions and health communication strategies; and continuously updated evidence.</p>
<h2>11 recommendations</h2>
<p>The report made 11 recommendations to end the pandemic and prepare for future ones.</p>
<p><strong>1. Vaccines plus other measures</strong> – establishing global and national “vaccination plus” strategies. This would combine mass immunisation in all countries, ensure availability of testing and treatment for new infections and long COVID, coupled with public health measures such as face masks, promotion of safe workplaces, and social and financial support for self-isolation.</p>
<p><strong>2. Viral origins</strong> – an unbiased, independent and rigorous investigation is needed to investigate the origins of SARS-CoV-2, the virus that causes COVID-19, including from a natural spillover from animals or a possible laboratory-related spillover. This is needed to prevent future pandemics and strengthen public trust in science and public authorities.</p>
<p><strong>3. Bolster the World Health Organization</strong> and maintain it as the lead organisation for <a href="https://theconversation.com/too-late-already-bolted-how-a-faster-who-response-could-have-slowed-covid-19s-spread-160860">responding to emerging infectious diseases</a>. Give WHO new regulatory authority, more backing by national political leaders, more contact with the global scientific community and a larger core budget.</p>
<p><strong>4. Establish a global pandemic agreement</strong> and strengthen <a href="https://theconversation.com/at-what-point-is-a-disease-deemed-to-be-a-global-threat-heres-the-answer-185547">international health regulations</a>. New pandemic arrangements should include bolstering WHO’s authority, creating a global surveillance and monitoring system for infectious disease outbreaks. It would also include regulations for processing international travellers and freight under global pandemic conditions, and the publication of an annual WHO report on global pandemic preparedness and response.</p>
<p><strong>5. Create a new WHO Global Health Board</strong> to support WHO decision-making especially on controversial matters. This would be composed of heads of government representing each of the six WHO regions and elected by the member states of those regions.</p>
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<p><strong>6. New regulations to prevent pandemics</strong> from natural spillovers and research-related activities and for investigating their origins. Prevention of <a href="https://theconversation.com/5-virus-families-that-could-cause-the-next-pandemic-according-to-the-experts-189622">natural spillovers</a> would require better regulation of domestic and wild-animal trade and enhancement of surveillance systems for pathogens (disease-causing micro-organisms) in domestic animals and humans. The <a href="https://globalhealth.org/programs/world-health-assembly/">World Health Assembly</a> should also adopt new global regulations on biosafety to regulate international research programs dealing with dangerous pathogens.</p>
<p><strong>7. A ten-year global strategy</strong> by <a href="https://www.dfat.gov.au/trade/organisations/g20">G20 (Group of Twenty)</a> nations, with accompanying finance, to ensure all WHO regions, including the world’s poorer regions, can produce, distribute, research and develop vaccines, treatments and other critical pandemic control tools. </p>
<p><strong>8. Strengthen national health systems</strong> based on the foundations of public health and universal health coverage and grounded in human rights and gender equality.</p>
<p><strong>9. Adopt national pandemic preparedness plans</strong>, which include scaling up community-based public health systems, investment in a skilled workforce, investment in public health and scientific literacy to “immunise” the public against dis-information, investment in behavioural and social sciences research to develop more effective interventions, protection of vulnerable groups, establishment of safe schools and workplaces, and actions to improve coordinated surveillance and monitoring for new variants.</p>
<p><strong>10. Establishment of a new Global Health Fund</strong> where – with the support of WHO – there is increased and effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care. </p>
<p><strong>11. Sustainable development and green recovery plans</strong>. The pandemic has been a setback for sustainable development so bolstering funding to meet sustainability goals is needed.</p>
<h2>Unlock a new approach</h2>
<p>To improve the world’s ability to respond to pandemics we need to unlock a new approach. The key component to any meaningful transformation is to collaborate and work towards a new era of multilateral cooperation. </p>
<p>Governments in Australia, Aotearoa New Zealand and elsewhere have talked about “building back better”. We need to take the lessons learnt from the failures of the past few years and build a stronger framework. This will not only help reduce the dangers of COVID-19 but also forestall the next pandemic and any future global crisis. </p>
<p>By reassessing and strengthening global institutions and co-operation, we can build and define a more resilient future.</p>
<hr>
<p><em>Chris Bullen, Professor of Public Health, University of Auckland, co-authored this article and The Lancet COVID-19 Commission report on which it was based.</em></p><img src="https://counter.theconversation.com/content/190658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Thwaites is Chair of Monash Sustainable Development Institute and ClimateWorks Australia which receive funding for research, education and action projects from the Australian and state governments as well as from philanthropy and industry. He is former Deputy Premier of Victoria and a member of the Australian Labor Party.</span></em></p><p class="fine-print"><em><span>Liam Smith receives funding from a number of government schemes, government bodies and private sector funders. </span></em></p><p class="fine-print"><em><span>Margaret Hellard receives funding from a number of government funding schemes and government bodies and philanthropic organisations for work on COVID-19.
Margaret Hellard also receives funding from Gilead Sciences and Abbvie for research unrelated to COVID-19.</span></em></p>We found most governments were ill-prepared, too slow to act, paid too little attention to the most vulnerable, and were hampered by low public trust and an epidemic of misinformation.John Thwaites, Chair, Monash Sustainable Development Institute & ClimateWorks Australia, Monash UniversityLiam Smith, Director, BehaviourWorks, Monash Sustainable Development Institute, Monash UniversityMargaret Hellard, Adjunct Professor, Monash University; Associate Director and Head, Centre for Population Health, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1863222022-07-12T16:31:32Z2022-07-12T16:31:32ZStronger democracies have seen fewer excess deaths during COVID – new research<figure><img src="https://images.theconversation.com/files/473430/original/file-20220711-18-xctoxj.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5774%2C3384&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/coronavirus-covid19-people-stylish-black-medical-1704287305">Lucem_mecul/Shutterstock</a></span></figcaption></figure><p>Through the COVID-19 pandemic, it has become clear that an effective response to an emergency of this nature goes beyond the health system. While strengthening health infrastructure such as surveillance, testing and hospitals is key, we’ve also seen the use of <a href="https://pubmed.ncbi.nlm.nih.gov/34813628/">non-pharmaceutical interventions</a> like face masks, school closures and lockdowns. Some of the most important public health interventions, such as <a href="https://openknowledge.worldbank.org/handle/10986/33635">income protection schemes</a>, have not come from the health sector at all.</p>
<p>So to prepare for and respond to pandemics, countries must be able to strengthen collaboration and investment across the <a href="https://committees.parliament.uk/work/335/whole-of-government-response-to-covid19/">whole of government</a>, and engage <a href="https://www.who.int/publications/i/item/whole-of-society-pandemic-readiness">all sections of society</a>. </p>
<p>To better understand the role of governance in pandemic response, we designed <a href="https://jech.bmj.com/content/early/2022/06/29/jech-2022-218920">a study</a> to investigate the link between the strength of democratic governance and excess death rates across countries. We found that, generally, countries with stronger democratic governance have seen fewer excess deaths during the pandemic.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-do-governments-ever-truly-listen-to-the-science-134308">Coronavirus: do governments ever truly listen to 'the science'?</a>
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</em>
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<p>More than <a href="https://covid19.who.int/">6 million COVID deaths</a> have been recorded globally since the pandemic began. But this figure underestimates the full impact of the pandemic. </p>
<p>One metric that can help us assess the true impact of COVID is <a href="https://pubmed.ncbi.nlm.nih.gov/32910871/">excess mortality</a>. This takes the total number of deaths since the pandemic began and compares it against pre-pandemic levels, capturing the wider effects of the pandemic and government responses. </p>
<p>For example, in some countries, deaths due to <a href="https://wjes.biomedcentral.com/articles/10.1186/s13017-021-00395-8">road traffic accidents</a> fell as a result of restrictions on mobility. In other countries, disruption to healthcare services coupled with people’s reluctance to attend hospitals led to <a href="https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007085">an increase in deaths</a> from heart attacks. </p>
<p>Measuring excess deaths is also useful because a significant number of COVID deaths go unrecorded in some countries due to a lack of access to healthcare and testing. Further, determining a cause of death is not always clear-cut, so what might be considered a COVID death in one country might not in another. </p>
<h2>What we did</h2>
<p>We used open-access sources to gather country-level data <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852240/">on excess deaths</a> from January 2020 to September 2021, alongside national democratic governance scores from just before the pandemic. For the latter we used the Varieties of Democracy (<a href="https://www.v-dem.net/">V-Dem</a>) index, which looks at how well-embedded democratic principles are within countries, based on assessments from experts on the ground. </p>
<p>We also collected data on several factors that could explain differences in excess death rates across countries. These included socioeconomic factors (like inequality and wealth), vaccination rates, the occurrence of other diseases, and health system performance. We then built regression models, which use data to look at how one variable affects another, to understand whether democratic governance was associated with excess deaths.</p>
<p><strong>Excess deaths and democracy scores around the world</strong></p>
<figure class="align-center ">
<img alt="A map of the world with different countries shaded in different colours to indicate excess mortality (top map) and V-Dem score (bottom map)." src="https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473407/original/file-20220711-20-papg1r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://jech.bmj.com/content/early/2022/06/29/jech-2022-218920">Journal of Epidemiology & Community Health, BMJ Journals</a>, <span class="license">Author provided</span></span>
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<p>We found that Norway, for example, had both a high democratic governance score and a low excess mortality rate. Conversely, Belarus had a low democratic governance score and a high excess mortality rate. Although not every country fit this trend, on average across the 78 countries we included, a one-point increase in the <a href="https://www.v-dem.net/dsarchive.html">V-Dem score</a> was associated with 2.18 fewer excess deaths per 100,000 people. </p>
<p>This was after we accounted for age, gender, national wealth and access to healthcare. And the association was only partially accounted for by vaccination rates. </p>
<p>What’s more, the relationship remained strong even after we added other variables and looked at slightly different data. For example, when we used a different index to measure democratic governance.</p>
<p><a href="https://v-dem.net/weekly_graph/deliberative-democracy">Deliberative governance</a>, where inclusive decisions are made for the common good, was a specific feature of democracy significantly associated with fewer excess deaths. A political system in which decisions are reached through community engagement, stakeholder consultation, reasoned justification and respect for counterarguments would score highly on this scale. </p>
<h2>Limitations</h2>
<p>There were some limitations in our analysis. First, we weren’t able to include all countries due to a lack of available data. Second, we didn’t follow countries over time, so it’s not possible to confirm a causal relationship between strength of governance and excess deaths. </p>
<p>Third, we measured democratic governance before COVID. Although this likely reflects governance during the pandemic, there may have been some differences that we weren’t able to capture. </p>
<p>Researchers have previously observed that as countries become more democratic, they see reductions in deaths. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484695/">study</a> found that a one-point increase in democratic scores reduced deaths by roughly 2% from tuberculosis, transport injuries and non-communicable diseases combined. </p>
<p>There could be various reasons for this, including government accountability, the dispersion of power, community participation, media freedoms, and the use of evidence in public policy. Democracy, through public participation, should also focus attention on <a href="https://pubmed.ncbi.nlm.nih.gov/33097491/">social, economic and health inequalities</a>. Many of these factors, although not unique to democracies, are features of democratic governance that have been important during COVID. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-we-learned-from-tracking-every-covid-policy-in-the-world-157721">What we learned from tracking every COVID policy in the world</a>
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<p>At the global level, recommendations on pandemic response have centred on compliance with the World Health Organization’s <a href="https://www.who.int/teams/ihr/ihr-review-committees/covid-19/">International Health Regulations</a>. This legally binding instrument focuses on strengthening public health systems in a narrow sense.</p>
<p>Our findings show that the way societies are governed is important for public health. For pandemic preparedness, the public must be able to trust authorities and institutions. The machinery of the state must coalesce around communities to consider trade-offs and make evidence-based decisions. </p>
<p>It has taken a pandemic to reveal the many social and political vulnerabilities facing countries. Much work remains to better understand and address these.</p><img src="https://counter.theconversation.com/content/186322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vageesh Jain does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The way societies are governed seems to have influenced how they’ve fared in terms of excess deaths during the pandemic.Vageesh Jain, NIHR Academic Clinical Fellow in Public Health Medicine, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1849632022-06-29T14:35:42Z2022-06-29T14:35:42ZFive actions to prepare African countries better for the next pandemic<figure><img src="https://images.theconversation.com/files/471377/original/file-20220628-12-fvim7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">COVID restrictions measures caused major disruptions to people's lives. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Globally, cases of COVID-19 and related deaths are lower in June 2022 than they were at the beginning of the year. But the infection numbers are <a href="https://ourworldindata.org/grapher/daily-covid-deaths-7-day?country=DNK%7EDOM%7ECOD%7ECIV%7EDJI%7EDMA">rising</a>. Africa is <a href="https://www.dropbox.com/s/shpqwsrbx1w2xti/WHO_Africa_situation_report_2022_06_16.pdf?dl=0">no exception</a>. </p>
<p>The past two years have caused unimaginable disruption of normal life. And these disruptions continue to delay the <a href="https://www.afdb.org/en/news-and-events/press-releases/african-economic-outlook-2022-africas-2021-economic-rebound-impacted-lingering-covid-19-pandemic-and-russia-ukraine-war-51865">recovery of economies</a> and <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.856397/full">health systems in Africa</a>. </p>
<p>To meet the continuing health system challenges and avoid the same fate in future pandemics, African countries must take bold actions to repair their health systems and make them more resilient. </p>
<p>The <a href="https://theindependentpanel.org/">Independent Panel</a> for Pandemic Preparedness and Response set up by the the World Health Organization (WHO) released its second report in May 2022. In advising on how to curtail the current pandemic and prepare better for the next one, the report draws on scientific research and expert round-table discussions. </p>
<p>I contributed to this report, <a href="https://live-the-independent-panel.pantheonsite.io/wp-content/uploads/2022/05/Transforming-or-tinkering_Report_Final.pdf">Transforming or Tinkering? Inaction lays the groundwork for another pandemic</a>, which recommends global and local actions. As different continents and countries are at different stages on the road to meeting these recommendations, African countries should extract the actions relevant to them and work these into their health systems and epidemic preparedness plans.</p>
<p>The recommendations from this new report build on those from <a href="https://theindependentpanel.org/documents/">previous reports</a> by the panel. They looked at five aspects: equitable access to tools; health financing; the WHO’s role in surveillance, detection and alert; political leadership; and preparedness. The new report updates the recommendations to fix a still broken public health system.</p>
<h2>Five actions to fix the system</h2>
<p><strong>1. Make tools available to all equally</strong></p>
<p>The first action the panel recommends is to stop the current COVID-19 pandemic through equitable access to health tools such as medical supplies. </p>
<p>In <a href="https://www.who.int/initiatives/act-accelerator/about">2020 the WHO</a> launched the ground-breaking Access to <a href="https://www.who.int/initiatives/act-accelerator">COVID-19 Tools Accelerator</a>. This global collaboration was intended to accelerate development, production and equitable access to COVID-19 tests, treatments and vaccines. It is now widely accepted that, when judged against equitability and access, the accelerator has not met expectations. For example while the <a href="https://ourworldindata.org/covid-vaccinations">global vaccine coverage</a> for the first vaccine dose is 66%, for Africa this figure is 17.8%. </p>
<p>The panel recommends a comprehensive and independent evaluation of the Access to COVID-19 Tools Accelerator, involving civil society. The aim would be to learn lessons and improve it. African experts should contribute, because the continent has suffered most from inequitable access to COVID-19 medical products such as <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00511-3/fulltext">rapid tests</a> and <a href="https://reliefweb.int/report/world/sub-saharan-africa-millions-denied-vaccines-deepening-inequality-and-human-suffering">vaccines</a>.<br>
African governments should call for global intellectual property waiver policies for COVID-19 tests, treatments and vaccines and use these to grow domestic pharmaceutical capabilities. They should also push for a pre-negotiated platform to facilitate equitable and timely access to medical products on the global market during emergencies. </p>
<p><strong>2. Make finance available</strong></p>
<p>The second recommendation is to have a preparedness financing structure that “involves and serves every country”. Funds set aside for pandemic preparedness and response, primarily by G20 nations, were inadequate for the the COVID-19 response. Dispersion was slow and the little available funds resulted in lower-income countries incurring <a href="https://theindependentpanel.org/wp-content/uploads/2021/05/Background-Paper-14-Financing-Pandemic-Preparedness-and-Response.pdf">more debt</a>. Going forward, international pandemic funding should be based on ability to pay and <a href="https://theindependentpanel.org/wp-content/uploads/2021/05/Background-Paper-14-Financing-Pandemic-Preparedness-and-Response.pdf">needs prioritisation</a>.</p>
<p><strong>3. Strengthen the WHO</strong></p>
<p>The panel also called for strengthening the authority and financing of the WHO through increased member state fees. The aim would be to augment WHO’s function of surveillance and detecting new threats leading to earlier warning. Differences in COVID-19 epidemiology and impact clearly <a href="https://www.nature.com/articles/s41591-021-01491-7">demonstrated</a> that Africa’s health policy requirements must be informed by local events and data rather than global trends. So the <a href="https://www.afro.who.int/">WHO’s regional body</a> needs more support to respond in ways that are relevant to the African context. </p>
<p><strong>4. Improve political leadership</strong></p>
<p>The report identified a lack of coordination between national governments, regional bodies, UN agencies and other stakeholders. The recommendations call for a UN political declaration on pandemic preparedness and the establishment of a UN Council for Pandemic Preparedness. African countries should be represented on these bodies. Strengthening the authority of the WHO’s African body and the African Union to rapidly announce potential pandemic threats, investigate them and recommend interventions without <a href="https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_18-en.pdf">country impediment</a> will expedite appropriate responses. </p>
<p><strong>5. Prepare</strong></p>
<p>The report makes several suggestions for preparing for the next pandemic. At a global scale it recommends formalising a periodic review of universal health coverage. And countries should conduct transparent reviews of their COVID-19 responses and learn lessons for future pandemics.</p>
<p>But COVID-19 has clearly shown that <a href="https://www.ghsindex.org/">current indices</a> of preparedness, such as COVID-19 readiness status, did not distinguish between lack of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8604723/">preparedness and vulnerability</a>. Africa was rated as poorly prepared for COVID-19 but was actually less vulnerable because of many factors, including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8604723/">demography and outdoor lifestyle</a>. Therefore, preparedness indices should be revised to have a more comprehensive perspective of preparedness, vulnerability and resilience.</p>
<p>The next pandemic is unlikely to be COVID. The world must plan for new threats. The G7 has an ambition to be able to develop biological intervention to future pandemic threats within <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/992762/100_Days_Mission_to_respond_to_future_pandemic_threats__3_.pdf">100 days</a>. But the experience of the <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/1744-8603-7-33">10 year</a> wait for HIV antiretrovirals and challenges accessing <a href="https://www.afro.who.int/news/africa-needs-ramp-covid-19-vaccination-six-fold">COVID-19 vaccinations</a> shows that the wait will be much more than 100 days for innovations from other continents to reach Africa. Therefore African countries needs to strengthen its basic public health interventions that protect across many different pathogens. </p>
<p>Superimposing responses to a new disease on already weak health systems in Africa has further <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.856397/full">weakened them</a>. So in addition to public health, Africa’s preparedness plans need to focus on health system strengthening and resilience.</p>
<h2>The next pandemic</h2>
<p>When acting on the panel’s recommendations, African countries must adapt them to address their specific health system weaknesses, such as the ability to produce medical supplies domestically. </p>
<p>African governments and institutions also need to improve medical procurement and regulatory processes through already existent regional institutions and structures. </p>
<p>Only through domesticating the recommendations will African countries derive the greatest benefit and support from global initiatives.</p><img src="https://counter.theconversation.com/content/184963/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francisca Mutapi is affiliated with WHO AFRO.
She chairs the WHO African Region Monitoring COVID-19 Vaccine Effectiveness (AFRO-MoVE) Scientific Advisory Committee.</span></em></p>African countries must take bold actions to repair their health systems and make them more resilient.Francisca Mutapi, Professor in Global Health Infection and Immunity. and co-Director of the Global Health Academy, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1841492022-06-13T20:04:13Z2022-06-13T20:04:13ZHow should an Australian ‘centre for disease control’ prepare us for the next pandemic?<figure><img src="https://images.theconversation.com/files/467900/original/file-20220609-20-fx1spb.jpg?ixlib=rb-1.1.0&rect=58%2C72%2C4761%2C3159&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pensive-female-entrepreneur-face-mask-working-1709723323">Shutterstock</a></span></figcaption></figure><p>Over the past two years, Australians have become familiar with the threat of infectious disease outbreaks. COVID won’t be the last pandemic to affect our lives. </p>
<p>Early, aggressive restrictions were generally seen as necessary. But they also caused hardship, exacerbated inequality and undermined trust in government.</p>
<p>The pandemic exposed differences between states and territories. We saw inadequate national coordination of disease tracking, data analysis, lab capacity to process PCR tests, <a href="https://www.mja.com.au/journal/2021/communicating-patients-and-public-about-covid-19-vaccine-safety-recommendations">vaccination uptake</a> and <a href="https://www.mja.com.au/journal/2021/coronavirus-covid-19-vaccination-information-must-pay-attention-health-literacy">communication</a>. This prompted renewed calls for the establishment of an Australian centre for disease control (CDC). </p>
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Read more:
<a href="https://theconversation.com/bungled-vaccine-rollout-welcome-financial-support-heres-what-aussies-thought-of-morrisons-covid-response-181149">Bungled vaccine rollout, welcome financial support – here's what Aussies thought of Morrison's COVID response</a>
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<p>Before the election, Labor leader Anthony Albanese expressed the view that Australia’s COVID response had been undermined by a breakdown in our federated system and noted Australia was the only OECD country without a CDC. He committed to <a href="https://www.alp.org.au/policies/australian_cdc">establishing one</a> if elected.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1313205825733709825"}"></div></p>
<p>So what should an Australian CDC look like? And how can it improve our response to future infectious disease outbreaks?</p>
<h2>What is a CDC?</h2>
<p>There is no single definition of a CDC. Broadly, it’s a national agency that promotes public health through the control and prevention of disease and disability. </p>
<p>The <a href="https://www.cdc.gov/">US Centers for Disease Control and Prevention (US-CDC)</a> employs more than 10,000 staff. It focuses on infectious diseases, food-borne diseases, environmental health, injury prevention, health promotion, and non-communicable diseases such as obesity and diabetes. </p>
<p>But the US-CDC has been <a href="https://www.npr.org/sections/health-shots/2022/01/07/1071449137/cdc-is-criticized-for-failing-to-communicate-promises-to-do-better">criticised</a> for being overly bureaucratic, lacking innovation and being “missing in action” during the COVID pandemic, when the Trump administration completely sidelined scientific guidance. This demonstrates the importance of such an entity being free from political interference.</p>
<p>Other examples include the <a href="https://www.ecdc.europa.eu/en">European Centre for Disease Prevention and Control</a> (ECDC), a networked European Union agency with a restricted focus on infectious diseases. It delivers disease surveillance and epidemic intelligence to guide regional and national responses in member states. </p>
<figure class="align-center ">
<img alt="COVID alert on a screen." src="https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467915/original/file-20220609-14-9gc61d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The US-CDC was criticised as being ‘missing in action’ during the pandemic.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/11bjTWQ9mV0">Markus Spiske/Unsplash</a></span>
</figcaption>
</figure>
<p>In the United Kingdom, the <a href="https://www.gov.uk/government/organisations/uk-health-security-agency">UK Health Security Agency</a> (UKHSA) recently replaced Public Health England. It has a slightly broader focus on protecting people and communities from the impact of infectious diseases and chemical, biological and nuclear incidents. </p>
<p>The <a href="https://www.canada.ca/en/public-health.html">Public Health Agency of Canada</a> has the broadest remit of all. It includes preventing disease and injury, responses to public health threats, promotion of physical and mental health, and providing information to support informed decision making.</p>
<h2>What does Australia need?</h2>
<p>In Australia, states and territories are legally responsible for public health protection and providing the infrastructure for disease surveillance and response. A national CDC would need to work within our unique federated system. </p>
<p>The COVID pandemic showed Australia lacks a rapidly responsive national mechanism to:</p>
<ul>
<li>collate, analyse and monitor disease surveillance data</li>
<li>coordinate outbreak control responses</li>
<li>evaluate the effectiveness of these responses</li>
<li>undertake rapid research to inform policy and guide decision-making. </li>
</ul>
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<strong>
Read more:
<a href="https://theconversation.com/victorias-draft-pandemic-law-is-missing-one-critical-element-stronger-oversight-of-the-governments-decisions-170623">Victoria's draft pandemic law is missing one critical element – stronger oversight of the government's decisions</a>
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<p>Comprehensive infectious disease surveillance and near real-time data analysis is critical for coordinating national disease control responses, such as restricting population movement or contact tracing. </p>
<p>This surveillance and analysis requires an experienced workforce with expertise in epidemiology, microbiology and infection prevention and control. </p>
<figure class="align-center ">
<img alt="Doctor or nurse puts on her PPE" src="https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467916/original/file-20220609-22-dlhhuv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Experts need real-time data to determine when to use restrictions or other public health measures.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/hYcSP6SpoK0">Viki Mohamed/Unsplash</a></span>
</figcaption>
</figure>
<p>A new national system will need to improve on the current model, which has served us well in many respects, despite its limitations. The risk is that something hastily implemented can worsen the situation, by establishing less effective mechanisms, duplicating efforts and wasting resources.</p>
<p>Specifically, a new system will require more effective mechanisms for data collation and sharing between states and territories, as well as workforce upskilling and building of core capacities, such as genomic testing of bugs, in all states and territories. </p>
<p>A national CDC will need sufficient funding and a governance structure that allows effective engagement with academic experts and policy makers, with protection from government interference. </p>
<p>Most importantly, it will need a transparent process that provides independent evidence-based advice to government. Australians need assurance that public health responses are based on evidence not politics.</p>
<p>Recent outbreaks of Japanese encephalitis and monkeypox also highlight the need for coordination between human and animal disease surveillance.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/monkeypox-in-australia-what-is-it-and-how-can-we-prevent-the-spread-183526">Monkeypox in Australia: what is it and how can we prevent the spread?</a>
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<h2>The way forward</h2>
<p>Following Labor’s election victory, there is risk that the establishment of an Australian CDC may be rushed through for a “quick win”. However, careful consideration and consultation is needed on how best to position such an entity.</p>
<p>It will need to engage with government and policymakers, while ensuring its decisions are independent, evidence-based and without political bias. It will also need to prioritise effective public communication and community engagement.</p>
<p>The best starting point is to define key principles that will guide its establishment and to commit to an open process that works closely with states and territories.</p>
<p>Important questions will need to be answered, such as whether an Australian CDC will encompass both infectious and non-communicable diseases, such as heart disease and diabetes. And where such a centre should be located to ensure it’s seen as a national asset without jurisdictional bias.</p>
<p>The ongoing impacts of COVID and multiple new threats make the need for concrete action to improve our national surveillance and response capacity increasingly urgent.</p><img src="https://counter.theconversation.com/content/184149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jocelyne Basseal is the President of the Australasian Medical Writers Association (AMWA).</span></em></p><p class="fine-print"><em><span>In the past, I have been a member of the Commicable Disease Network of Australia (CDNA), Public Health Laboratory Network (PHLN) and and Innnfection Control Expert Group (ICEG), and (ex officio) of the Australian Health Protection Principle Committee.
in 2020-21, I received funding, from the Commonwealth Department of Health for reviews of COVID-19 outbreaks in residential aged care facilities. </span></em></p><p class="fine-print"><em><span>Tania Sorrell receives funding from the NHMRC and the ARC for research on pandemic preparedness and genomics in food-borne disease and from the NSW Office of Health and Medical Research for COVID vaccine studies.</span></em></p><p class="fine-print"><em><span>Ben Marais does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Prime Minister Anthony Albanese has promised to create an Australian centre for disease control-style organisation to manage future pandemics. Here’s what it needs to do.Ben Marais, Associate Professor in Paediatrics and Child Health, University of SydneyJocelyne Basseal, Senior Executive Officer, Sydney Institute for Infectious Diseases, University of SydneyLyn Gilbert, Honorary Professor Faculty of Health and Medical Science, Univeristy of Sydney; Senior Researcher Sydney Institue for Infectious Disease, University of Sydney., University of SydneyTania Sorrell, Professor, Clinical Infectious Diseases, Director, Sydney Institute for Infectious Diseases, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1736362022-01-13T19:48:45Z2022-01-13T19:48:45ZIn a pandemic, ignoring science affects everyone. Citizenship education can help ensure that doesn’t happen<figure><img src="https://images.theconversation.com/files/439270/original/file-20220104-25-1doptb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3443%2C2117&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Disregard for public health, like protests at hospitals challenging vaccine passports, seen at this event in September 2021 in Toronto, show schools need to expand how they teach what it means to be a responsible global citizen. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young </span></span></figcaption></figure><p>Since early 2020, our way of life has changed dramatically. COVID-19 has transformed how we study, learn and work — even how we shop, eat and gather.</p>
<p>Throughout the pandemic, <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/public-health-measures-mitigate-covid-19.html">Canada has implemented individual and community-based measures</a> to protect its citizens. While <a href="https://www.environicsinstitute.org/docs/default-source/default-document-library/cot2021-report1-final_corrected-ap-19.pdf?sfvrsn=6f378628_0">most Canadians have trusted and listened to the scientists and public health experts</a>, too many have ignored the science — <a href="https://theconversation.com/covid-19-freedom-rallies-actually-undermine-liberty-heres-why-161863">protesting mask wearing, social distancing and vaccination</a>.</p>
<p>Those who have failed to comply with these protocols have prolonged the pandemic and put their fellow citizens at risk. This troubling issue requires attention and future action, <a href="https://doi.org/10.1007/s11125-021-09594-2">including addressing it through education</a>. </p>
<h2>Responsible citizenship and education</h2>
<p>Responsible citizenship is fundamental in a democratic society — and with it comes the responsibility to not engage in behaviour that endangers the health and well-being of neighbours. </p>
<p>Noted professors of citizenship education, Joel Westheimer and Joseph Kahne, tie <a href="https://doi.org/10.3102%2F00028312041002237">good citizenship</a> to an active democratic citizenry. They stress the importance of teaching about following the law and becoming a personally responsible citizen, engaging in civic affairs and becoming a participatory citizen, and challenging social inequities by becoming a justice-oriented citizen.</p>
<p>In recent years, as a result of growing global challenges — such as <a href="https://globecit.com/global-citizenship-in-a-covid-19-world/">poverty, hunger, public health and climate change</a> — the concept of responsible citizenship has expanded to include <a href="https://journals.sfu.ca/jgcee/index.php/jgcee/article/view/213/443">global belonging and commitment</a>. </p>
<p>Global citizenship seeks to <a href="https://teachingsocialstudies.org/2021/08/05/global-citizenship-education-and-liberal-democracy/">unite people within and across countries in common cause to bridge national divides to address seminal challenges facing the world</a>. Global citizenship in many ways seeks to fulfil the <a href="https://sdgs.un.org/goals">United Nations Sustainable Development Goals</a> designed to confront pressing global issues. </p>
<p>In schools, “<a href="https://en.unesco.org/themes/gced">global citizenship education</a>” aims to provide students with the knowledge, skills and values to become responsible citizens and learn to address a range of generational challenges. Schools in several countries, <a href="https://www.doi.org/10.5038/2577-509X.4.2.1121">including Canada, have started to recognize the importance of these educational goals</a>. Several provinces, such as Alberta, British Columbia, Manitoba, Nova Scotia, Ontario and Québec, have <a href="https://www.unicef.ca/sites/default/files/imce_uploads/UTILITY%20NAV/TEACHERS/DOCS/GC/ChartingGlobalEducationinElementarySchools.pdf">integrated global citizenship education into their social studies curricula</a> in the past few decades. </p>
<p>Canadian intergovernmental bodies representing every provincial ministry of education, including the <a href="https://www.cmec.ca/en/">Council of Ministers of Education, Canada (CMEC)</a>, have emphasized the importance of global citizenship education among other priorities. In its recent <a href="https://static1.squarespace.com/static/5af1e87f5cfd79c163407ead/t/5e20d79f9713f543996da6ad/1579210656022/Pan-Canadian+Systems-Level+Framework+on+Global+Competencies_EN.pdf"><em>Pan-Canadian Systems-Level Framework on Global Competencies</em></a>, CMEC laid out six global competencies for students: global citizenship and sustainability; critical thinking and problem solving; innovation, creativity and entrepreneurship; learning to learn and to be self-aware and self-directed; and collaboration. </p>
<figure class="align-center ">
<img alt="A man in a face mask walks past a wall spraypainted with 'covid is a lie' and 'the news is the virus.'" src="https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440782/original/file-20220113-19-m8eif3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">After the COVID-19 pandemic, curriculum should engage students in discussions about how responses to public health messaging interact with being a responsible global citizen.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<h2>Contemplating post-pandemic citizenship</h2>
<p>Despite these curricular trends, issues that have come to light in the pandemic have shown that the goals of global citizenship education must adapt. </p>
<p>These include the disregard for public health protocols, the undermining of science, the spread of misinformation and the lack of concern for others (particularly for seniors, <a href="https://www.cdc.gov/aging/covid19/covid19-older-adults.html#:%7E:text=Older%20adults%20are%20more%20likely,60s%2C%2070s%2C%20and%2080s.">who are more likely to get very ill with COVID-19</a>, and for those with underlying health conditions).</p>
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<strong>
Read more:
<a href="https://theconversation.com/the-urgent-need-for-media-literacy-in-an-age-of-annihilation-117958">The urgent need for media literacy in an age of annihilation</a>
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<p>It is increasingly important that the next generation of Canadian students learn how to navigate the many increased challenges of a post-COVID-19 world. Research from the Center for Global Development noted that “<a href="https://www.cgdev.org/blog/the-next-pandemic-could-come-soon-and-be-deadlier">the next pandemic could be much sooner and more severe than we think</a>.” </p>
<p>In light of the lessons of COVID-19, schools across Canada should consider offering a social studies elective course that emphasizes post-pandemic values, including commitment to public health, empathy and compassion, self-sacrifice and a co-operative spirit. Such a “post-pandemic citizenship” education could help prepare the next generation of Canadians to promote the kind of values sometimes lacking during the pandemic. </p>
<h2>Health literacy, compassion</h2>
<p>First, the course should include issues of public health. It could, for example, use online tools and platforms to teach students <a href="https://www.who.int/activities/improving-health-literacy">health literacy</a>. As noted by the World Health Organization, health literacy implies equipping people to “play an active role in improving their own health, engage successfully with community action for health, and push governments to meet their responsibilities in addressing health and health equity.”</p>
<p>Researchers from the Healthy Schools Lab at the University of Alberta noted that when education went online due to pandemic closures, provincial guidelines for at-home learning <a href="https://hslab.ca/2020/03/24/health-and-physical-education-in-the-midst-of-a-pandemic">did not include a focus on health and physical education</a>.</p>
<p>The course also could examine how other countries handled COVID-19 and prior epidemics or ask students to devise a plan for combating the next pandemic. </p>
<figure class="align-center ">
<img alt="Students standing in a hallway in face masks." src="https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439747/original/file-20220106-12389-1tsh5k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students should have the opportunity to devise plans to combat pandemics.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Second, there should be an emphasis on empathy and compassion, including its impact on positive health outcomes. In Canada, there have been efforts to impart empathy in the classroom and these efforts should continue. For example, Canadian educator Mary Gordon founded <a href="https://rootsofempathy.org/">Roots of Empathy</a> more than two decades ago. This program seeks to <a href="https://www.usnews.com/news/best-countries/articles/2017-12-20/canadian-classroom-program-aims-to-teach-children-compassion">develop students’ emotional and social competencies, resulting in less aggression and bullying</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/strong-relationships-help-kids-catch-up-after-6-months-of-covid-19-school-closures-145085">Strong relationships help kids catch up after 6 months of COVID-19 school closures</a>
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<h2>Self and community interest</h2>
<p>At the same time, the course should stress self-sacrifice. From reviewing case studies on those who disregarded public health recommendations at the expense of others, to debating situations where <a href="https://doi.org/10.22381/KC83202012">collective responsibility should transcend individual self-interest</a>, these lessons can be instructive. </p>
<p>For instance, the Winnipeg School Division recently released an <a href="https://www.winnipegsd.ca/page/8804/education-for-sustainable-development">Education for Sustainable Development Plan</a> to teach students about collective responsibility in such areas as human rights, environmental protection and reducing poverty. </p>
<p>Studies of collective responsibility should include examining issues around equity due to the <a href="https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19.html">disproportionate impact of the pandemic on marginalized communities in Canada</a>. </p>
<p>Studying documents like the <a href="https://www.canada.ca/en/canadian-heritage/services/how-rights-protected/guide-canadian-charter-rights-freedoms.html">Canadian Charter of Rights and Freedoms</a> also can shed light on the critical role of government mitigation strategies in supporting the collective dignity and rights of citizens. </p>
<h2>Collective good at stake</h2>
<p>By embracing a co-operative spirit, students can appreciate local examples of community involvement, or consider when public and private sector institutions should collaborate for the good of society at home and abroad. </p>
<p>For instance, <a href="https://www.international.gc.ca/world-monde/stories-histoires/2021/education_covid-19.aspx?lang=eng">Toronto’s Bloorview School Authority, which provides school programs to children with special needs who are undergoing intensive therapies, has partnered with UNICEF Canada</a> to raise funds for necessary school equipment for students in Malawi. A Bloorview teacher noted that the project, known as <a href="https://www.unicefusa.org/mission/protect/education/kids-need-desks-kind">Kids in Need of Desks</a>, helps students understand what it means to be global citizens in a pandemic. This is even as they deal with their own learning disruptions due to COVID-19 while managing other challenges.</p>
<p>This is just a starting point. Over time, Canadian schools will need to continue to re-examine and rewrite social studies curricula to groom the next generation of citizens for a post-pandemic world. The collective good and responsible citizenship are at stake.</p><img src="https://counter.theconversation.com/content/173636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evan Saperstein does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The failure to observe public health protocols during the pandemic requires attention and action. Revitalizing global citizenship education in schools should be part of addressing the problem.Evan Saperstein, Postdoctoral Fellow, Citizenship Education and History Teaching Research Lab, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702432021-10-28T10:24:25Z2021-10-28T10:24:25ZNipah virus: could it cause the next pandemic?<figure><img src="https://images.theconversation.com/files/427769/original/file-20211021-25-6u33j0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fruit bats are the main animal host of the nipah virus</span> <span class="attribution"><a class="source" href="https://pixabay.com/photos/fruit-bats-bats-megabats-chiroptera-5586143/">BTS-BotrosTravelSolutions / Pixabay</a></span></figcaption></figure><p>The severe and devastating consequences of the coronavirus pandemic were undoubtedly made worse by a substantial lack of pandemic preparedness, with the exception of East and South East Asia, which had built up defences after their experience with SARS in 2003. So it is crucial that governments begin to develop strategies to protect us if other deadly viruses emerge. </p>
<p>A recent outbreak of Nipah virus in India has raised the question of whether we should start to consider it as a future threat, and look to build up our arsenal of defences now.</p>
<p>The rapid development of vaccines against the novel coronavirus, SARS-CoV-2, have provided a pathway out of this pandemic. So, if vaccines for other potentially dangerous viruses could be developed and stockpiled, they could be rolled out as soon as any new outbreak is detected. We would then be ahead of the curve and a pandemic could be avoided. </p>
<p>This approach is laudable - but it assumes that viruses with pandemic potential can be identified in advance, which is not easy to do. And it also runs the risk that a “don’t worry, there’s a vaccine” mindset might cause simpler preventative methods to be overlooked.</p>
<p>Nipah virus was first identified in Malaysia in 1998. Cases such as the <a href="https://www.cbsnews.com/news/nipah-virus-outbreak-india-kerala/">recent death of a boy</a> in Kerala, India have raised <a href="https://www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts">concerns</a> that it could mutate and increase its efficiency of transmission, leading <a href="https://www.thesun.co.uk/health/16394382/nipah-virus-kills-half-victims-next-pandemic-threat-gilbert/">to widespread circulation.</a></p>
<p>That scenario is frightening as the virus currently has a case fatality rate of over 50% and there is no vaccine or tried-and-tested treatment. </p>
<p>But before we can invest resources into vaccine development against Nipah we need to assess whether it is a realistic pandemic threat. And even if it is, there are other viruses out there, so we must understand where it should rank on the list of priorities.</p>
<h2>Assessing the pandemic risk of Nipah</h2>
<p>To assess the risk we need to look at how the virus transmits and replicates. </p>
<p>Nipah is a paramyxovirus. It is related to a human virus, human parainfluenza virus, one of the handful of viruses that cause the common cold. Its natural host is the fruit bat, the large and small flying foxes which are distributed across South and Southeast Asia. All cases of human infection with the Nipah virus to date have been due to direct or indirect contact with infected bats. </p>
<p>The infection in bats is sub-clinical, so goes largely unnoticed. Virus is excreted in the urine which, via grooming and crowding, ensures transfer within and between colonies. </p>
<p>Fruit or fruit juice contaminated by bat urine is the principal route of virus transmission to people. </p>
<p>A <a href="https://www.pnas.org/content/117/46/29190">long-term study in Bangladesh</a>, where regular Nipah virus outbreaks occur among its people, suggests that bat population density, virus prevalence and people drinking raw date palm sap are the main factors explaining the pattern of transmission. The bats contaminate the sap while it is being tapped from the date palm tree, and it is then consumed locally. </p>
<p>That is an important finding. As we have seen with SARS-CoV-2, better transmitting viruses evolve while the virus is circulating among its human, not animal, hosts. So, keeping the number of infections in people to a minimum not only minimises the death rate from Nipah itself but also reduces the chance of virus adaptation. Stop the transmission and you stop the pandemic threat. </p>
<figure class="align-center ">
<img alt="A tree with many branches with green leaves and hanging date palm fruit" src="https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427766/original/file-20211021-16-1bmb8qn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The fruit of the date palm tree is a key source of transmission from bat to human.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/date-palm-palm-tree-dates-223250/">Simon/Pixabay</a></span>
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<p>In the cases of human infection, so far, there has been limited spread to only close contacts of the primary infected individual, such as family members or, if the person is hospitalised, hospital staff. </p>
<p>General transmission does not occur, mainly because the proteins the Nipah virus uses to enter cells, the receptors, are concentrated in brain and central nervous tissues. </p>
<p>Nipah infection leads to death by acute encephalitis in most cases as the virus replicates best in the tissues where it is easy for the virus to enter the cells.</p>
<p>The virus does replicate to a small degree in the vasculature, the blood vessels which provide a route for the virus to travel from consumed foodstuffs to the nervous system. But the central nervous system preference also suggests why onward transmission is limited. The virus cannot easily transmit from there. </p>
<p>Of course a very sick individual will have virus everywhere, but as with Ebola, the virus is not efficiently transmitted by the respiratory route and requires touch or transfer of body fluids. Very close contact is required to infect someone else.</p>
<p>The chance of the virus changing to replicate in the upper respiratory tract, from where it certainly would be more transmissible, is small, and while this does not rule out pandemic potential it significantly lessens its probability. Like other regular zoonotic infections, the spillover event itself from bat to human, and the immediate people affected is more the issue than the potential for epidemic spread. </p>
<p>There is a case for a Nipah vaccine, but more for emergency use in those in contact with a primary case than for a vaccination campaign in general. </p>
<p>The case against it rests on the fact that absolute numbers are low, costs high and outbreaks so sporadic that a clinical trial would be very difficult to organise. Research has shown that therapeutic antibody is effective and that would make a far more practical treatment option in the short term. </p>
<p>In my view, Nipah does not pose a high risk of causing a pandemic. Its current pattern of outbreak is likely to remain the norm. Instead, as has been discussed elsewhere, we need to ensure that surveillance, improved awareness and effective <a href="https://pubmed.ncbi.nlm.nih.gov/34389832/">public health measures</a> are in place and adhered to. They will have a much bigger impact on the control of Nipah virus cases in the immediate future. </p>
<p>As for pandemic preparedness in the medium and long term, we need to turn our attention to identifying which other viruses pose a threat and work to develop vaccines and other defensive measures against those.</p><img src="https://counter.theconversation.com/content/170243/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Jones receives funding from BBSRC, Wellcome Trust and the Bill and Melinda Gates Foundation. </span></em></p>Virologists are beginning to assess which other viruses could have pandemic potentialIan Jones, Professor of Virology, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1608602021-05-13T09:45:22Z2021-05-13T09:45:22ZToo late, already bolted: how a faster WHO response could have slowed COVID-19’s spread<figure><img src="https://images.theconversation.com/files/400477/original/file-20210513-19-19ab05g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/px9z5Zijwo8">Victor He/Unsplash</a></span></figcaption></figure><p>Urgent global action is needed to end the COVID-19 pandemic and prepare for future threats, according to a <a href="https://theindependentpanel.org/mainreport/">new report</a> by the Independent Panel for Pandemic Preparedness and Response.</p>
<p>The panel, co-chaired by former New Zealand prime minister Helen Clark and former Liberian president Ellen Johnson Sirleaf, criticises the World Health Organization (WHO) for its tardy actions during the first months of 2020. </p>
<p>The WHO was slow to warn of person-to-person transmission after it <a href="https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/">first received this information</a> in Wuhan, China, in early January. </p>
<p>And it was slow to declare a <a href="https://www.who.int/news/item/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)">public health emergency</a> of international concern (PHEIC), which it did on January 30. </p>
<p>The WHO also opposed international travel restrictions that, if implemented earlier, might have slowed the international spread of the virus. By the time the PHEIC was declared, COVID-19 had spread to 18 countries outside China.</p>
<h2>But WHO’s hands were tied</h2>
<p>While this may appear just a scathing criticism of the world’s peak health body, the WHO had its hands tied by the international framework that governs the response to emerging infectious diseases and pandemics, the <a href="https://www.who.int/publications/i/item/9789241580496">International Health Regulations</a> (IHR). </p>
<p>These regulations were drafted in 2005 in response to the <a href="https://www.who.int/health-topics/severe-acute-respiratory-syndrome#tab=tab_1">SARS</a> (severe acute respiratory syndrome) and <a href="https://www.ncbi.nlm.nih.gov/books/NBK22151/">H5N1</a> (avian flu) pandemics and endorsed by member nations in 2007. </p>
<p>The regulations imposed new requirements that must be met before the WHO director general could act on emergencies, rather than enabling the WHO to act immediately and independently. </p>
<p>The regulations also <a href="https://gh.bmj.com/content/5/5/e002629">prohibit</a> international travel restrictions in public health emergencies.</p>
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Read more:
<a href="https://theconversation.com/fortress-australia-what-are-the-costs-of-closing-ourselves-off-to-the-world-160612">'Fortress Australia': what are the costs of closing ourselves off to the world?</a>
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<h2>Many member nations failed to act</h2>
<p>The report describes February 2020 as a “lost month”, referring to the time between the declaration of a PHEIC and the <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020">WHO statement</a> on March 11 that characterised COVID-19 as a pandemic. </p>
<p>The panel found this was due to a lack of understanding that the PHEIC declaration was the loudest possible alarm open to the director general. The pandemic declaration was not based on International Health Regulation guidelines. </p>
<p>The panel found a number of countries took a wait-and-see attitude during February 2020, allowing the virus to spread uncontrollably.</p>
<p>Effective and high-level coordinating bodies were critical to a country’s ability to adapt to changing information. Yet only a few countries set in motion comprehensive and coordinated COVID-19 protection and response measures. </p>
<p>Of the 28 country responses the panel analysed in depth, only a handful adopted aggressive containment strategies, including China, New Zealand, South Korea, Singapore, Thailand and Vietnam. </p>
<p>Some others had uncoordinated approaches that devalued science, denied the potential impact of the pandemic, delayed comprehensive action and allowed distrust to undermine efforts. While not named, the United States and Brazil were probably among them.</p>
<p>The report praises the role of the African Union and the <a href="https://africacdc.org/covid-19/">Africa CDC</a> in leading a continent-wide coordinated response. </p>
<p>It also singles out research and development as a major achievement, especially in vaccine development.</p>
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Read more:
<a href="https://theconversation.com/over-700-health-experts-are-calling-for-urgent-action-to-expand-global-production-of-covid-vaccines-159701">Over 700 health experts are calling for urgent action to expand global production of COVID vaccines</a>
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<h2>Preparation was inadequate</h2>
<p>Despite the lessons learned from previous outbreaks of SARS, H1N1 (avian flu), Zika, MERS (Middle East respiratory syndrome) and Ebola, preparedness was vastly underfunded. </p>
<p>The US government, led by the Centres for Disease Control, established the <a href="https://ghsagenda.org/">Global Health Security Agenda</a>, a group of 70 countries — including Australia – committed to building global capabilities to implement the International Health Regulations. But the Trump administration defunded most of the US CDC’s activities under the agenda.</p>
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Read more:
<a href="https://theconversation.com/defunding-the-who-was-a-calculated-decision-not-an-impromptu-tweet-136620">Defunding the WHO was a calculated decision, not an impromptu tweet</a>
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<p>After the H1N1 pandemic, Australia reviewed its <a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/review-2011-l/%2524File/lessons%2520identified-oct11.pdf">health sector response</a> and made many recommendations for future preparedness. However, inaction followed. Australia has not run a large-scale <a href="https://www.abc.net.au/news/2020-04-20/coronavirus-australia-ran-its-last-pandemic-exercise-in-2008/12157916">pandemic simulation exercise</a> since 2008.</p>
<p>Australia also dropped the ball on regional pandemic preparedness. After the SARS outbreak in 2003, the government developed a five-year regional <a href="https://www.dfat.gov.au/sites/default/files/ode-peid-evaluation-final-report.pdf">emerging diseases</a> and pandemics strategy, which received A$100 million from the Howard government. Yet the second five-year strategy attracted very little funding.</p>
<h2>Fixing the global system</h2>
<p>The panel urges immediate action to end the pandemic through:</p>
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<li>accelerated vaccination </li>
<li>proven measures such as masks and social distancing</li>
<li>testing and contact tracing.</li>
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<p>However, the focus of its recommendations is on future preparedness. </p>
<p>The panel is convinced a Global Health Threats Council at the most senior level is vital to future success. It would help secure high-level political leadership and ensure attention to pandemic prevention, preparedness and response is sustained over time. Such a body is long overdue. </p>
<p>To ensure the WHO is more agile, the panel recommends an increase in the proportion of funding that is unearmarked for specific programs and countries. This would allow for financial reserves to respond to sudden, unexpected events. It also needs an improved surveillance system, quicker alerts for emerging virus threats, and authority to publish information and dispatch expert missions immediately.</p>
<p>Transparency, speed, flexibility to act more independently and better resourcing are critical to the reforms proposed. Efforts to do this will need unqualified support from its member nations, starting at this month’s <a href="https://www.who.int/about/governance/world-health-assembly">World Health Assembly</a>. </p>
<p>After the disruptive years of the Trump presidency, the WHO needs restoration. Australia is influential and should be at the forefront of ensuring this happens.</p><img src="https://counter.theconversation.com/content/160860/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Toole receives funding from the National Health and Medical Research Council. </span></em></p>The first few months of 2020 were critical to the World Health Organization’s response to COVID-19. But the latest report into what happened wasn’t all damning.Michael Toole, Professor of International Health, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1569272021-03-12T16:02:40Z2021-03-12T16:02:40ZCOVID-19: a moment of reckoning for the World Health Organization<p><em>This is a transcript of episode six of The Conversation Weekly podcast <a href="https://theconversation.com/covid-19-where-does-the-world-health-organization-go-from-here-podcast-156907">“COVID-19: where does the World Health Organization go from here?”</a>. In this episode, three experts in global health explain why COVID-19 has been a moment of reckoning for the World Health Organization (WHO), and where it goes from here. And to mark <a href="https://theconversation.com/uk/topics/covid-19-pandemic-first-anniversary-101210">one year since the WHO declared COVID-19 a pandemic</a>, we hear from Conversation editors around the world on the situation where they live.</em></p>
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<p><em>NOTE: Transcripts may contain errors. Please check the corresponding audio before quoting in print.</em></p>
<p>Gemma: It’s been a year since the World Health Organization declared COVID-19 a pandemic. In this week’s episode, we’ll be looking at how the WHO has responded over the past year, and where it goes from here. </p>
<p>Ana Amaya: We’re in a strange time where the WHO will only be strengthened or weakened – there’s no possibility of it going back to the status quo.</p>
<p>Peter Gluckman: If you look at the multilateral system as a whole, it’s failed the citizens of the world to quite a significant extent.</p>
<p>Dan: The Conversation is a network of newsrooms scattered around the globe. So this week, we’re gonna hear from editors in a bunch of places, and hear what the pandemic’s like where they’re living. And also, how experts in their countries are talking about it. </p>
<p>Gemma: From The Conversation, I’m Gemma Ware in London. </p>
<p>Dan: And I’m Dan Merino in San Francisco and you’re listening to The Conversation Weekly, the world explained by experts. </p>
<p>Gemma: So we’re all tired of talking about coronavirus. And yet whenever I speak to someone who’s in a different parts of the world to me, I instinctively ask them, what’s it like where you are, what’s the coronavirus situation? So I’m in London, you’re in San Francisco. Dan, what are things like in California?</p>
<p>Dan: They’re getting better. We’re still in a pandemic, but they’re better. My housemate just got her first vaccine, hooray. Case numbers are going down. In the United States as a whole 40,000 people were infected on March 7, which is still a ton of new cases, but way less than the peak, which was 250-300,000 a day. So improvements, I’ll take it. And Gemma, how are you doing in London? </p>
<p>Gemma: In London, we appeared to be squashing the worst part of this deadly second wave. So on March 8, cases were at their lowest daily level in five months, just under 5,000. Schools are reopening. The vaccine campaign is picking up speed, so I think 33% of the populations had the first dose of the vaccine. The situation is still really precarious, but it is improving. What about the restrictions where you are Dan? What are you allowed to do? What aren’t you allowed to do? </p>
<p>Dan: Last week actually, the California governor just lifted bans on indoor dining. So you can go eat food and doors, which I’m not personally going to do anytime soon, but it’s a good sign. You guys?</p>
<p>Gemma: At the moment, you’re not really allowed to do anything, you can meet one person outside. But there’s a timetable in place and that is helping people look forward and plan things. So everyone’s looking forward to this day on March 29, when we’re going to be allowed to meet six people outside, maybe for a picnic or a cup of tea. </p>
<p>Dan: Six is a lot of people. I don’t know if I’ve seen six people in one place in, you know, months. </p>
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Read more:
<a href="https://theconversation.com/coronavirus-one-year-on-two-countries-that-got-it-right-and-three-that-got-it-wrong-155923">Coronavirus one year on: two countries that got it right, and three that got it wrong</a>
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<p>Dan: So Gemma, it’s always fascinating talking to you because you in the UK, me in the US – our countries did not do a very good job of dealing with the pandemic. But we have colleagues in the conversation who live and work across the globe. So we reached out to them and asked what’s the situation like where you are?</p>
<p>Hannah Hoag: Hello, I’m Hannah Hoag, the deputy editor for The Conversation in Toronto, Canada. This week marks the one-year anniversary of the coronavirus pandemic. Things are starting to feel like they’re getting better, but there’s still a long way to go. In Toronto, we’ve been in some form of lockdown for more than a hundred days. Schools closed for the winter break and they didn’t reopen for in-person learning until mid-February. We’ve been able to go into pharmacies and grocery stores and get takeout food from restaurants, but gyms, pools, and even ski hills have been closed for most of the winter. We’ve had a stay at home order since December 26. And it seems to be working actually. Toronto’s daily case counts have dropped steadily for weeks. We’re seeing about 1,500 cases per week now in Toronto, which is close to what we saw during the peak of the first wave. </p>
<p>The vaccine rollout’s been slow though. Only 200,000 doses have been administered in Toronto. Roughly 1.5% of the Canadian population is fully vaccinated and about 4.5% have received at least one dose.</p>
<p>Ika Krismantari: Hi, I’m Ika. I’m the editorial head of The Conversation Indonesia. I live in Depok about 20km from the capital and things are quite normal here. People are still going out without wearing masks, and you can hear the background noise of cars and motorcycles passing in front of my house, during these last hours, even though the cases just went up today almost 7,000 cases.</p>
<p>One year after living with the virus, Indonesia has not made any progress. We’re still in the very same spot, if not going backwards. Since last October, Indonesia still ranks as the nation with the most COVID-19 cases and the highest fatality rate in south-east Asia due to the government’s failure to come up with solid policy making. Instead of turning to science for answers, some of Joko Widodo’s ministers recommended prayers and traditional herbal drinks to cure the disease. The government offers subsidies, encouraging the economic sector to run business as usual. Ironically, all these efforts to save the economy have failed and it has put our hard-won democracy under threat with the government attacking activists for criticizing its policy.</p>
<p>Lionel: My name is Lionel Cavicchioli. I am a health editor at The Conversation in Paris. Here in France, the situation of the epidemic is slowly degrading with more than 5,000 daily new cases of COVID and almost 400 deaths every day. Almost 4,000 people are currently in intensive care due to the virus. A curfew starting at 6.00 PM to 6.00 AM has been in place since January 16, and in the most affected regions, some cities are once again locked down, but only during weekends. The schools are still open, but the question of their closure remains debated. Paediatricians are concerned about the impact of the potential closure on children’s health, but on the other hand, some epidemiologists think that the fact that schools are still open might help the virus to spread. On the positive, vaccination is rising at fast pace and the authorities hope that it will permit to avoid a new national lockdown.</p>
<p>Ina Skosana: Hello, I’m Ina Skosana in Johannesburg. South Africa recently reduced its lockdown to alert level one. The country is just coming out of a resurgence in COVID-19 cases. In December, the cases that we were recording were as high as 21,000 on a single day. Now the country is reporting around 1,000 cases daily.
This means that while the curfew is still in place, the hours have been reduced to between midnight and 4.00AM. Wearing masks in public, however, is still mandatory. Some restrictions on social gatherings have also been lifted. So social gatherings are allowed, but with the limitation on the number of people, depending on the size of the venue. This means that the situation appears to be improving, but the threat of another surge of infections continues.</p>
<p>Liam Petterson: Hi, my name’s Liam Petterson, I’m an assistant editor in the health and medicine team in Australia. I’m based in Melbourne, which is the capital of the state of Victoria. So Victoria has recorded now 11 days in a row of zero new local cases of COVID, which is pretty exciting. We had a <a href="https://theconversation.com/victorias-statewide-lockdown-ends-data-can-tell-us-what-to-do-next-time-155450">snap of five-day lockdown</a> just recently in mid-Feb, after some cases escaped from hotel quarantine. But that was gotten under control pretty quickly. So now everything’s pretty much opened up again. So we can now go to pubs, restaurants, retail shops, even live sport is going ahead. Schools are open and we can have up to 30 people over to our house – if you’ve got that many friends. We still do have to wear a mask though at the supermarket or in public transport.</p>
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Read more:
<a href="https://theconversation.com/after-a-year-of-pain-heres-how-the-covid-19-pandemic-could-play-out-in-2021-and-beyond-156380">After a year of pain, here's how the COVID-19 pandemic could play out in 2021 and beyond</a>
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<p>In terms of vaccines, the vaccine rollout in Australia has just started too, a couple of weeks ago. We’ve vaccinated about 90,000 people to date. And one modelling study that we published an article on few months ago, suggested we need to give out 200,000 vaccines a day to get the adult population in Australia vaccinated by October. So we’re a little bit behind that target at the moment.</p>
<p>Elena Sanz: Hi, my name Elena Sanz and I’m a health editor for The Conversation based in Spain. February was the month with the highest number of deaths since the first wave, and unemployment reached 4 million people in the third wave of COVID. The epidemiological curve has been falling for five weeks. The 14-day cumulative number of coronavirus cases per 100,000 inhabitants is now below 150. Obviously it’s too soon to be optimistic: the curve could get out of control once more anytime. The Health Out charity has estimated that to emerge completely from the risk zone, the cumulative incidence must be below 50 cases per 100,000 inhabitants. Hope for the best and prepare for the worst. As our epidemiological situation improves, some Spanish regions prepare relaxation of coronavirus measures. At the same time, central government is calling regional authorities not to let their guard down, at least until we have vaccinated 70% of the population. But we are really far away from the numbers. By the moment only 3% of the population has been administered two doses. </p>
<p>Gemma: That was Hannah Hoag, Ina Skosana, Lionel Cavicchioli, Ika Krismantari,
Liam Petterson and Elena Sanz.</p>
<p>Dan: We’ll be hearing from a few of our colleagues again at the end of the episode as they recommend some excellent stories written by academics they worked with. </p>
<p>Gemma: But first, we’re going to talk about the World Health Organization. </p>
<p>Dan: Yeah, it’s not had a good year. </p>
<p>Gemma: No, it hasn’t. It’s faced a lot of criticism over the way it initially handled the pandemic. </p>
<p>Dan: Donald Trump was of course one of the main protagonists here. </p>
<p>Gemma: Yes. The Trump administration decided to <a href="https://theconversation.com/defunding-the-who-was-a-calculated-decision-not-an-impromptu-tweet-136620">suspend funding</a> to the WHO in April 2020. Now, the US usually contributes around <a href="https://www.bbc.co.uk/news/world-us-canada-52289056">US$400 million a year</a> to the WHO, so this was a big blow, just as it was trying to raise more money to help countries tackle the pandemic.</p>
<p>Dan: And Trump also announced plans to completely withdraw the US from the WHO, but Joe Biden quickly reversed that when he was sworn in.</p>
<p>Gemma: Things are on a slightly more even keel now. But there are still big questions being asked of the organisation’s response to the early days of the pandemic. I spoke to three experts in global health to find out where the WHO goes from here. </p>
<p>Peter: Quite clearly in what is the biggest existential crisis and the biggest public health crisis since the second world war, the international organisation didn’t meet what was expected of it.</p>
<p>Gemma: This is Peter Gluckman. </p>
<p>Peter: I’m former chief science advisor to the prime minister of New Zealand. I am president of the International Network of Government Science Advice, President-elect of the International Science Council. And I head Koi Tū, the Centre for Informed Futures at the Universtiy of Auckland. </p>
<p>Gemma: He says it wasn’t just the WHO which was at fault.</p>
<p>Peter: The United Nations has not itself engaged with an issue which is clearly more than a health issue. We’ve not had a meeting of the world’s leaders. The security council has not engaged. So I think if you look at the multilateral system as a whole, it’s failed the citizens of the world to quite a significant extent over the last year.</p>
<p>Gemma: Peter says that the international rules that are meant to prevent a virus from spreading around the world just didn’t work. </p>
<p>Peter: What we’re seeing is that the International Health Regulations of 2005 were not fit for purpose in the sense that at least one nation didn’t comply with the the articles of the convention. </p>
<p>Gemma: These regulations, which are binding in international law, were last revised in 2005, a few years after the SARS outbreak. </p>
<p>Peter: Secondly, the WHO clearly had its own problems, which relate to the fact that WHO’s decision-making is never solely technical. It always involves a political component to it. And I think one of the issues we must learn from this is that there’s a need to separate the technical from the political. And I think that we’re seeing that geopolitical issues influenced heavily some of those early responses of the WHO system, despite the fact that there are good technical people within the agency.</p>
<p>Gemma: The early stages of the COVID-19 outbreak in Wuhan, and the WHO’s response to it, are now being pored over from every angle by a number of different inquiries. Central among them is the Independent Panel for Pandemic Preparedness, chaired by Ellen Johnson Sirleaf, the former president of Liberia, and Helen Clark, the former prime minister of New Zealand. </p>
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<p>In its <a href="https://theindependentpanel.org/wp-content/uploads/2021/01/Independent-Panel_Second-Report-on-Progress_Final-15-Jan-2021.pdf">interim report</a>, published in January, the panel said, and I quote: “The World Health Organization has been underpowered to do the job expected of it.” </p>
<p>Andrew: Here we go. OK, I think it’s recording.</p>
<p>Gemma: OK, fantastic. All right, so first of all, could I get you to just introduce yourself say your full name and your position. </p>
<p>Andrew: I’m Andrew Lakoff, I’m a professor of sociology at the University of Southern California, and I have been doing research on the way that experts in public health and global security prepare and respond to health emergencies.</p>
<p>Gemma: Andrew says that it’s important to understand the things that the WHO got right in its reponse to COVID-19, and what it got wrong.</p>
<p>Andrew: The WHO was very quick to declare COVID-19 a public health emergency of international concern back in January of 2020, and to use that declaration to alert countries of the world that they needed to prepare for the onset of a deadly pandemic.</p>
<p>What I think WHO can be criticised for, I guess, at a couple of levels, first of all, there have been several times when it has proven, either incorrect or behind the curve on the science involved as its issued guidance. One of its main roles is to issue technical guidelines to national governments on how to respond to a health emergency. So for example, early on, it didn’t emphasise a mask-wearing mandates. It’s also been, it seems behind the curve on the science of aerosol transmission of the virus. And, also very early on, the really important issue of asymptomatic transmission of the virus, WHO seemed not to get that right.</p>
<p>Gemma: So you just mentioned some of the scientific question marks about its response, but it’s also been criticised for the way it investigated the beginning and the way it was able to get information out of China right at the start. What kind of constraints does the WHO operate under the limits its initial response to a pandemic?</p>
<p>Andrew: So it’s important to remember that WHO does not have sovereignty over its member states, it relies on national governments to allow its outbreak investigators in to perform an investigation of an outbreak like COVID-19 or any other dangerous disease. So in the case of the early stages of the pandemic, WHO was arguably engaged in very, active public diplomacy. And I think it’s been criticised, probably rightfully so, for being overly differential to China in the early stages and even into the present as international investigators have sought to understand the origins of the pandemic.</p>
<p>Gemma: Tensions have mounted in recent weeks surrounding the WHO’s investigation into the origins of COVID-19. A WHO team of scientists finally went to Wuhan in January to carry out an investigation. There have been delays to the publication of the final report, and in early March, a <a href="https://www.aljazeera.com/news/2021/3/4/who-inspectors-to-scrap-interim-report-on-probe-of-covid-origin">separate group of scientists wrote an open letter</a>, calling for a new international inquiry citing what they termed “structural limitations” to the WHO’s one. </p>
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Read more:
<a href="https://theconversation.com/i-was-the-australian-doctor-on-the-whos-covid-19-mission-to-china-heres-what-we-found-about-the-origins-of-the-coronavirus-155554">I was the Australian doctor on the WHO's COVID-19 mission to China. Here's what we found about the origins of the coronavirus</a>
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<p>Andrew says an important element of the origins investigation will be how its findings – and where they apportion blame or responsibility – are used to help prepare for future pandemics. </p>
<p>Andrew: If the origin of this one is understood to have to do with a zoonotic transmission, a spillover from wildlife into human populations, that would lead to a whole set of possible reform measures and initiatives that would try to prevent that in the future. If the source of the outbreak were something else, whether it’s the accidental lab leak hypothesis or the frozen food hypothesis that China has recently been promulgating, presumably that would lead to an entirely different set of prevention and preparedness measures in the future.</p>
<p>Gemma: When I asked Peter Gluckman about how important the outcome of the origins investigation would be to the future, he said he thought it would be of limited long-term value, given the delay in the inspection team gaining access to Wuhan.</p>
<p>Peter: Whatever it finds will be interesting, but it’s almost of prurient interest now rather than fundamental interest.</p>
<p>Gemma: He says that the question of what the world could have done differently it had known more, earlier, is still worth thinking about. </p>
<p>Peter: What if we’d known more at the time when it started to leak out of China, would it have made a fundamental difference? Many of us think it could have, but we don’t know. And therefore all we can do is learn from our assessment of almost of a hypothetical counterfactual and plan for the next pandemic based on what we think we might have done better.</p>
<p>Gemma: A year into the pandemic, that question is clearly focusing minds about the future, and not just in the corridors of the WHO’s headquarters in Geneva. </p>
<p>Ana Amaya: Hello, my name is Ana Amaya and I am an assistant professor at Pace University, and I’m also associate research fellow at the United Nations University Institute on Comparative Regional Integration Studies. </p>
<p>Gemma: Ana researches global health security, particularly how developing countries in the global south interact with organisations such as the WHO. She told me about some of the conversations going on about the need for reform.</p>
<p>Ana: In terms of the WHO, generally from several countries in the global south, it is clear that the status quo is no longer acceptable. There are increasing calls for greater representation at the decision-making level. By reducing the influence and share of earmarked funding as well as redistributing funds and sort of moving away from what they see as a very Geneva-centric institution to redistributing more funds to the regional offices. There are also calls for more inclusion of voices from the global south, not only the governments, but also civil society and other actors. </p>
<p>Gemma: Ana recently published <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00659-7">new research looking at the role regional organisations</a>, such as Mercosur, in South America, or Asean in south-east Asia, can play in reacting to health emergencies like epidemics. </p>
<p>Ana: What we found is that regional organisations can very much serve as a bridge between global and national policy levels. They can also support a better disease surveillance, mobilise supply chains, facilitate trade for better distribution of goods, and importantly, they can also support the production and procurement of medicines and supplies.</p>
<p>Gemma: Ana says that regional organisations aren’t perfect and come with their own politics and regional tensions. But they have helped co-ordinate effective responses in the past, and she points to the outbreak of SARS in the 2003 as a good example. </p>
<p>Ana: The response to SARS from Asean very much stemmed from this understanding that these countries could not control SARS on their own. And so they developed a number of meetings to develop practical advice, to support their member states as well as very strict measures to contain the spread of the virus in the continent. And so that was a very early on success from that regional organisation and very much what led to not only part of the revision of the International Health Regulations, but also Asean becoming much more involved in health issues.</p>
<p>For COVID-19, we have seen a number of different initiatives from regional organisations. For example, we know that the Southern Common Market or Mercosur was able to support the bulk purchasing and pooled purchasing of their member states of essential medicines and medical supplies. </p>
<p>We also see, the African Union being able to unilaterally negotiate and secure millions of doses of vaccines for its member states.</p>
<p>Gemma: But Ana doesn’t think that these regional organisations, most of which were originally set up to deal with trade issues, can ever replace a global organisation like the WHO when it comes to the world’s health. Nor does she think that a completely new global health organisation should be set up after the pandemic. </p>
<p>Ana: I’m very wary of calls for new institutions because this will likely create fragmentation and parallel efforts which can only lead to lack of policy coherence and ultimately waste of resources. </p>
<p>Gemma: But that she says something has got to change. </p>
<p>Ana: We’re in a strange time where the WHO will only be strengthened or weakened, there’s no possibility of it going back to the status quo, pre-pandemic. And so I think the likelihood of it gaining more power is significant. But again, pandemics and health emergencies that have happened in the past and WHO continues to try to find its role.</p>
<p>Gemma: This isn’t the first time that the WHO has faced criticism of its handling of a major disease outbreak, but not always for the same reasons. Here’s Andrew Lakoff again. </p>
<p>Andrew: In 2009, you’ll recall the early stages of the outbreak of H1N1, or swine flu, and this was in a period when global health authorities were really worried about the danger of a pandemic of influenza.</p>
<p>And so at the early stages WHO issued very strong warnings to countries to put their national preparedness plans in place, to develop mass vaccination campaigns and so on, and countries responded. They ordered millions of doses of vaccine through advanced purchase agreements with vaccine manufacturers and they put in place these campaigns. Then it turned out by the fall that H1N1 was less severe than was expected and they faced a lot of criticism, especially from European countries for having overreacted, for having sounded the alarm too strongly and national populations were hesitant to get vaccinated. And indeed, WHO was criticised for being too close to the pharmaceutical industry and its experts were accused of having had a conflict of interest in declaring an alert, so strongly and so early.</p>
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Read more:
<a href="https://theconversation.com/why-the-who-often-under-fire-has-a-tough-balance-to-strike-in-its-efforts-to-address-health-emergencies-137464">Why the WHO, often under fire, has a tough balance to strike in its efforts to address health emergencies</a>
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<p>Gemma: After that, Andrew says the WHO became more cautious about declaring a public health emergency of international concern. </p>
<p>Andrew: That caution then got them into trouble in 2014 with the Ebola epidemic in West Africa.</p>
<p>The epidemic began in the spring, but by the time WHO declared an emergency, it was late summer and the outbreak was out of control in west Africa. And the response by that point, global observers argued had been catastrophic. And so WHO was widely criticised for not having responded proactively enough in the case of Ebola.</p>
<p>Gemma: Every time the WHO declares that an outbreak is a public health emergency, an investigation takes place afterwards to assess how the organisation responded and to come up with some recommendations.</p>
<p>Andrew: Now in the aftermath of the Ebola epidemic, the recommendations were that WHO consolidate its emergencies programme and do a much better job of coordinating emergency response early on. And indeed they did put together a new emergencies programme in the years after the Ebola epidemic and you’ve seen that emergencies program quite active during the pandemic of COVID-19. </p>
<p>Gemma: Andrew says that the the WHO is clearly an organisation that is used to transforming itself after crises like this. But again, the solutions are limited by what its member states agree to – and the funding they provide. </p>
<p>The past year has also shown just how vulnerable the WHO is if a core member state pulls out. When I asked Ana Amaya how the departure – and then return – of the US was being seen in the global south, she said there were two camps.</p>
<p>Ana: There are some who believe that it was an opportunity to really reform the institution and to sort of remove the institution from the influence of these large countries. But again now with the entry of China and the big influence that it also wields, I believe, and others also believe that this China-US axis very much creates a little bit of a counterpart to each other and can even out the conversations. But again, they are countries that very much look for their own interests and this is why groupings of countries can really help balance those big powers, right. And I do see the potential for, a change not only in global decision-making, but also addressing these global health inequities following COVID-19. </p>
<p>Gemma: The WHO has been in almost a perpetual state of reform for the past few years. In 2019, just a few months before the outbreak of coronvirus, its director-general Dr Tedros Adhanom Ghebreyesus <a href="https://www.who.int/director-general/speeches/detail/transforming-for-impact">announced a sweeping programme of reforms</a> to the organisation’s structure. But now, calls for change are growing louder. Peter Gluckman has been pushing for the world’s leaders to use this moment as a catalyst. </p>
<p>Peter: If we take lessons after the Chernobyl nuclear event, when parties that previously were not willing to talk about a convention on a nuclear accidents suddenly came together, both Russia, Ukraine and the US quickly were early on <a href="https://www.iaea.org/topics/nuclear-safety-conventions/convention-early-notification-nuclear-accident">signatories in a new convention</a>, which was rapidly achieved. </p>
<p>Gemma: This lead to the creation of a specific organisation, based in Vienna, to deal with nuclear accidents. The scale of the disaster at Chernobyl created a window of opportunity that focused minds, and required world leaders to put politics aside to think through what was needed. </p>
<p>Peter: And I think we’re at that point, with this pandemic. </p>
<p>Gemma: Peter co-authored an article in late 2020 for The Conversation suggesting that the world needed a <a href="https://theconversation.com/who-reform-a-call-for-an-early-warning-protocol-for-infectious-diseases-148078">new early-warning protocol for infectious diseases</a>, that would work alongside the WHO but be separate from it. </p>
<p>Peter: You wouldn’t want to undo the WHO, you still need a global agency at the UN level, a major agency around global health, but you could separate out into a separate bureau, a technical agency around pandemic and infectious disease. You could require countries to to sign up to a much more compliant regime of notification, sample and information exchange, particularly genetic information which is now critical. You could in that protocol include an inspection element and you certainly would want it to have information exchange capabilities and rapid response capabilities.</p>
<p>Gemma: Part of what he’s suggesting would be to give this new convention or bureau the power to send in inspectors, even without the agreement of the country where a potential viral threat is emerging. He says this is particularly important as we don’t know where the next pandemic could come from. </p>
<p>Peter: There are potentials for other forms of sources of viruses ranging from, you know maker laboratories, which are springing up around the world and genetic engineering through to the biological warfare and so forth. And that’s another reason I think for a stronger protocol, which acknowledges these issues, particularly because the convention on biological warfare does not have an inspection regime and does not have a scientific support mechanism. So I think if we were to redo a convention here or a new protocol, it should cover all sources of viral risk, irrespective of how it might emerge.</p>
<p>Gemma: Others are taking up similar ideas. In December, Charles Michel, the president of the European Council, <a href="https://www.consilium.europa.eu/en/press/press-releases/2020/12/03/press-release-by-president-charles-michel-on-an-international-treaty-on-pandemics/">proposed a new global pandemic treaty</a>. When I asked Peter about this he said it had related origins to the discussions that he’d been having. </p>
<p>Peter: In fact, a lot of work was then done through a part of the international network for government science advice, which is called the Foreign Ministers Science and Technology Advisory Network.</p>
<p>Gemma: There’s been a lot of discussion going on behind the scenes. Science advisers from around 30 countries, as well as those from the European Commission, have started work on a draft protocol. In late January, the WHO’s director-general Dr Tedros said he supported the <a href="https://www.reuters.com/article/us-health-coronavirus-who-treaty-idUSKBN29P1CI">European proposal for a pandemic treaty</a>. He announced the WHO would <a href="https://www.nature.com/articles/d41586-021-00162-4">put together a working group</a> to explore the idea.</p>
<p>Peter: And we’re currently writing a more extensive background paper covering the various points that we think any new protocol or convention might cover.</p>
<p>Gemma: Still, Peter says there’s no point being idealistic about whatever new system does emerge. </p>
<p>Peter: Whatever is produced is going to have flaws in the sense that of a member state, even if it signs an agreement, refuses to cooperate, there’s relatively little that the global community can do about it.</p>
<p>Gemma: There’s no specific time frame for these discussions. It’s possible reforms could be discussed in May at the World Health Assembly, a meeting of national health ministers. But Peter thinks it may need to go to the very top.</p>
<p>Peter: I personally think at the end of the day, this will need a global summit at the level of prime ministers and presidents to make substantial progress. So I think that if we don’t take this opportunity now, it would be a sad mistake. </p>
<p>Dan: I really wonder if world leaders are going to listen to Peter, take this opportunity. </p>
<p>Gemma: It sounds like they’re going to need to, if the WHO is going to change in any meaningful way. In the show notes, you can read an <a href="https://theconversation.com/who-reform-a-call-for-an-early-warning-protocol-for-infectious-diseases-148078">article by Peter Gluckman</a> about his proposals and another by Andrew Lakoff on the <a href="https://theconversation.com/why-the-who-often-under-fire-has-a-tough-balance-to-strike-in-its-efforts-to-address-health-emergencies-137464">way that the WHO has reacted to crises</a> in the past. </p>
<p>Dan: To end the show this week, we’ve got a few recommendations of stories written by academics to highlight the one-year anniversary of COVID-19.</p>
<p>Hannah: My recommendation for this week is a story by Byram Bridle. He’s a researcher in the pathology department at the University of Guelph, and he’s written about the effect of hand-sanitizing, mask wearing and the lack of social contact and <a href="https://theconversation.com/a-year-of-covid-19-lockdown-is-putting-kids-at-risk-of-allergies-asthma-and-autoimmune-diseases-155102">might have on children’s immune systems</a>. Normally, infants and toddlers are exposed to all kinds of microbes, which help their immune systems develop. So there’s some concern that raising kids in these isolated and sanitised environments could put them at risk for allergies and asthma. We still don’t know this for sure, but it might be an unintended consequence of what taking these extra precautions does. And, it makes parents think about what they could do to expose their kids to the microbial world. Maybe by doing some more gardening or cuddling with dogs and cats. </p>
<p>Gemma: That was Hannah Hoag in Toronto. And our second recommendation comes from Lionel Cavicchioli in Paris.</p>
<p>Lionel: On March 11, it will be one year since the coronavirus epidemic became a pandemic. One year later, we already have several vaccines available, but no antiviral drugs. I asked Dominique Costagliola, research director at the French National Institute of Health and Medical Research, <a href="https://theconversation.com/covid-19-quelles-sont-les-pistes-les-plus-prometteuses-en-matiere-de-therapies-156479">why and what are the most promising leads at the moment?</a> This eminent epidemiologist has devoted much of her career to the fight against HIV. She told me that there are still no conclusive clinical trial results and that this is not so surprising, because we don’t actually have any effective drugs for curing short-term viral infections. In addition, to avoid the emergence of resistant coronaviruses, several effective antiviral molecules would be needed to treat patients on the model of what is used in the fight against AIDS. Let’s say, we are not there yet.</p>
<p>Gemma: Alright, that’s it for this week. Thanks to all the academics who’ve spoken to us for this episode. </p>
<p>Dan: You can find links to all the expert analysis we’ve mentioned in this episode – and tonnes of other good reading – in the show notes. And if you learnt loads and want to read more, click the link to <a href="https://theconversation.com/newsletter?utm_campaign=PodcastTCWeekly&utm_content=newsletter&utm_source=podcast">sign up to our free daily email</a>. </p>
<p>You can also find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a> or on Instagram at <a href="https://www.instagram.com/theconversationdotcom/?hl=en">theconversationdotcom</a>. We’d also love to hear your thoughts on the show. Send us an email at podcast@theconversation.com. </p>
<p>Gemma: Lots of people around the world helped make this episode a reality. Thanks to Liam Petterson, Megan Clement, Ika Krismantari, Ina Skosana, Martin La Monica, Lucía Cabellero, Elena Sanz, Lionel Cavicchioli, Hannah Hoag, Sunanda Creagh and Stephen Khan. And final thanks to Alice Mason and Imriel Morgan. </p>
<p>Gemma: This episode is co-produced by Mend Mariwany and me, with sound design by Eloise Stevens. </p>
<p>Dan: Our theme music is by Neeta Sarl. Thank you so much everyone for listening this week and we’ll talk to you soon.</p><img src="https://counter.theconversation.com/content/156927/count.gif" alt="The Conversation" width="1" height="1" />
A transcript of episode six of The Conversation Weekly podcast, including a round-up editors on the coronavirus situation around the world.Gemma Ware, Head of AudioDaniel Merino, Associate Breaking News Editor and Co-Host of The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1505082020-12-09T13:19:02Z2020-12-09T13:19:02ZForeign policy is Biden’s best bet for bipartisan action, experts say – but GOP is unlikely to join him on climate change<figure><img src="https://images.theconversation.com/files/373620/original/file-20201208-21-tadscl.jpg?ixlib=rb-1.1.0&rect=0%2C31%2C4153%2C2729&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As vice president, Joe Biden – seen here on left, in 2016 – had a working relationship with the Republican Senate majority leader, Mitch McConnell. Is that possible now?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/vice-president-joe-biden-left-and-senate-majority-leader-news-photo/504733202?adppopup=true">Tom Williams/CQ Roll Call)</a></span></figcaption></figure><p>Republicans and Democrats may have more common ground than it seems, a new survey finds. </p>
<p><a href="https://www.foreignaffairs.com/articles/united-states/2020-11-03/americans-want-engage-world">Our survey</a> – conducted in August and September in partnership with the Chicago Council on Global Affairs and the University of Texas at Austin – asked more than 800 government officials, congressional staffers, researchers, journalists and advocates to assess the likelihood of unified American efforts to address critical international challenges by 2022. They identified several foreign policy issues where building bipartisan policies was “more likely than not.” </p>
<p>Bipartisanship was one of the <a href="https://www.theatlantic.com/ideas/archive/2020/09/bidens-illusory-bipartisanship/616431/">central messages of President-elect Joe Biden’s campaign</a>. </p>
<p>Our research did not assess the possibility of unified action on domestic issues, which many experts <a href="https://www.nytimes.com/2020/08/20/us/politics/biden-congress.html">see as exceedingly unlikely</a>. But it found four foreign policy issues where Democrats and Republicans might come together.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Trump stands with a document in front of him, surrounded by people including Vice President Mike Pense and son-in-law Jared Kushner" src="https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373622/original/file-20201208-19-asyhv9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Trump at the signing of the United States-Mexico-Canada Trade Agreement on Jan. 29.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-donald-trump-stands-after-signing-the-united-news-photo/1197377744?adppopup=true">Drew Angerer/Getty Images</a></span>
</figcaption>
</figure>
<h2>1. China</h2>
<p>Behind the poisonous partisanship on display in Washington, Democrats and Republicans mostly <a href="https://www.foreignaffairs.com/articles/united-states/2020-10-07/bipartisan-foreign-policy-still-possible">agree on U.S.-China policy</a>. </p>
<p>During the Trump administration, Congress acted in a bipartisan manner to sanction China for persecuting <a href="https://www.reuters.com/article/us-usa-china-xinjiang/trump-signs-bill-pressuring-china-over-uighur-muslim-crackdown-idUSKBN23O3EW">the Uighurs</a>, a Muslim ethnic minority, and for <a href="https://www.politico.com/news/2020/07/14/trump-hong-kong-china-sanctions-361636">repressing pro-democracy protesters in Hong Kong</a>. </p>
<p>Democrats and Republicans also agreed that the United States needed to overhaul how it <a href="https://www.reuters.com/article/us-usa-congress-development/congress-eying-china-votes-to-overhaul-development-finance-idUSKCN1MD2HJ">finances overseas development</a> to compete with China, which has <a href="https://theconversation.com/china-turns-on-the-charm-and-angers-trump-as-it-eyes-a-global-opportunity-in-coronavirus-crisis-136132">earned goodwill from Africa to Latin America</a> by building roads, dams and other critical infrastructure. </p>
<p>More than nine out of 10 foreign policy officials and experts we surveyed thought it at least somewhat likely that the U.S. will make a major effort during the next two years to counter the continuing rise of China. Among those who expect such an effort, 87% think it is more likely than not to be bipartisan. </p>
<h2>2. Pandemic preparedness</h2>
<p>Despite the severe <a href="https://www.cnbc.com/2020/12/01/coronavirus-stimulus-update-senators-to-unveil-relief-bill.html">politicization of COVID-19</a>, bipartisanship is within reach on future global health challenges, our study shows. </p>
<p>Six out of seven foreign policy professionals anticipate a big push within the next two years to prepare for another global pandemic. Of those, 78% think it will attract support from both sides of the aisle. </p>
<p>A <a href="https://www.nytimes.com/2020/07/24/business/economy/republicans-democrats-coronavirus-survey.html">substantial gap</a> separates the two parties on the preferred balance between protecting public health and maintaining normal economic activity during the coronavirus pandemic. But the parties have worked together in the past to <a href="https://www.kff.org/global-health-policy/fact-sheet/the-u-s-presidents-emergency-plan-for-aids-relief-pepfar/">reduce the global spread of HIV/AIDS</a> and to invest in the <a href="https://www.reuters.com/article/us-health-coronavirus-usa-congress/u-s-house-passes-8-3-billion-bill-to-battle-coronavirus-senate-vote-due-thursday-idUSKBN20R2V6">development of coronavirus vaccines</a>. </p>
<h2>3. Cyberthreats</h2>
<p>Cooperation is feasible, too, to protect Americans’ digital information from overseas adversaries. </p>
<p>After numerous state-sponsored attacks on U.S. computer networks by countries including China, North Korea, Russia and Iran, Congress is close to approving bipartisan legislation to establish a White House <a href="https://www.scmagazine.com/home/security-news/government-and-defense/potential-national-cybersecurity-director-inches-towards-reality/">cybersecurity czar</a>. </p>
<p>By 2022, more than three-quarters of officials and experts predict Democrats and Republicans will have come together on other major steps to protect the United States against international cyberattacks. </p>
<h2>4. Trade</h2>
<p>Trade is another policy area Democrats and Republicans may rally around, according to our research. </p>
<p>It <a href="https://theconversation.com/why-biden-will-find-it-hard-to-undo-trumps-costly-america-first-trade-policy-149340">won’t be easy to undo Trump’s “America First” policy</a>, which imposed tariffs on key imports like steel and closed off foreign markets to American manufacturers. But 65% of those expecting a major effort by 2022 to expand international trade anticipate that it will be bipartisan. </p>
<p>There is precedent for such collaboration. Trump’s <a href="https://www.vox.com/2018/10/3/17930092/usmca-mexico-nafta-trump-trade-deal-explained">United States-Mexico-Canada trade agreement</a> was passed with bipartisan approval earlier this year.</p>
<h2>Going alone on climate</h2>
<p>Americans today are <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2015/03/15/everything-you-need-to-know-about-our-polarized-politics-in-the-palm-of-your-hand/">more polarized</a> than at any time since the Civil War, and Congress is bitterly divided. </p>
<p>But history shows foreign policy can rise above the partisan fray. And dozens of Republican former national security officials <a href="https://www.defendingdemocracytogether.org/national-security/">endorsed Biden’s candidacy</a> because they were “profoundly concerned about the nation’s security and standing in the world under Donald Trump.”</p>
<p>Biden’s nominations of foreign policy officials who are highly regarded across the aisle, such as <a href="https://theconversation.com/from-america-first-to-america-together-who-is-antony-blinken-bidens-pick-for-secretary-of-state-150739">Anthony Blinken for secretary of state</a>, lay the groundwork for bipartisan action. </p>
<p>Still, our survey identified one major issue where experts believe Biden will struggle to gain Republican support: the global climate crisis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Five young Native Americans in front of the US Capitol building." src="https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373623/original/file-20201208-14-dch6ec.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Native American youths at the Global Climate Strike, Sept. 20, 2019, in Washington, D.C.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/native-american-youth-speak-in-front-of-the-u-s-capitol-news-photo/1169849446?adppopup=true">Samuel Corum/Getty Images</a></span>
</figcaption>
</figure>
<p>Six of 10 Americans see climate change as a <a href="https://www.pewresearch.org/fact-tank/2020/04/16/u-s-concern-about-climate-change-is-rising-but-mainly-among-democrats/">critical threat</a>, and Biden signaled the importance of the issue by naming <a href="https://theconversation.com/how-biden-and-kerry-could-rebuild-americas-global-climate-leadership-150120">former Secretary of State John Kerry his climate envoy</a>, a new Cabinet-level position.</p>
<p>But Republicans are much <a href="https://www.thechicagocouncil.org/publication/lcc/first-time-majority-americans-say-climate-change-critical-threat">less concerned about climate change than other Americans</a>, research shows. Only a few GOP legislators acknowledge that even <a href="https://www.statesman.com/opinion/20190923/opinion-democrats-and-republicans-must-find-common-ground-on-climate-change">gradual steps must be taken</a>. The two parties are sharply split over such basic policies as whether to mandate <a href="https://www.politico.com/news/2020/06/30/democrats-unveil-sweeping-plan-to-tackle-climate-change-345503">reductions in greenhouse gas emissions</a>. </p>
<p>[<em>Get our most insightful politics and election stories.</em> <a href="https://theconversation.com/us/newsletters/politics-weekly-74/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=politics-most">Sign up for The Conversation’s Politics Weekly</a>.]</p>
<p>Only 18% of the foreign policy professionals in our survey who foresee a major climate initiative by 2022 think that it will be bipartisan.</p>
<p>To aggressively tackle the climate crisis, Biden will likely need to rely <a href="https://energy.utexas.edu/sites/default/files/Polit-Feasibility-Decarb-US-Electricity.pdf">largely on executive action</a> – <a href="https://insideclimatenews.org/news/23122016/obama-climate-change-legacy-trump-policies">just as President Barack Obama did</a>.</p>
<p><em>Dina Smeltz, a senior fellow at the Chicago Council on Global Affairs, contributed to the researching and writing of this article</em>.</p><img src="https://counter.theconversation.com/content/150508/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jordan Tama receives funding from the Carnegie Corporation of New York and the Raymond Frankel Foundation.</span></em></p><p class="fine-print"><em><span>Joshua Busby receives funding from the Strauss Center for International Security and Law and the Clements Center for National Security at the University of Texas. </span></em></p><p class="fine-print"><em><span>Michael J. Tierney receives funding from the Carnegie Corporation of New York.</span></em></p><p class="fine-print"><em><span>Jonathan Monten and Joshua D. Kertzer do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A survey of 800 foreign policy experts identified four international issues where Republicans and Democrats may actually cooperate to get something done – and one area of severe disagreement.Jordan Tama, Associate Professor of International Relations, American University School of International ServiceJonathan Monten, Lecturer in Political Science and Director of the International Public Policy Program, UCLJoshua Busby, Associate Professor, The University of Texas at AustinJoshua D. Kertzer, Paul Sack Associate Professor of Political Economy, Harvard Kennedy SchoolMichael J. Tierney, Director of William & Mary's Global Research Institute and George and Mary Hylton Professor of Government and International Relations, William & MaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1437562020-08-04T19:56:06Z2020-08-04T19:56:06ZThese dogs are trained to sniff out the coronavirus. Most have a 100% success rate<figure><img src="https://images.theconversation.com/files/351013/original/file-20200804-16-1fpvzpn.jpg?ixlib=rb-1.1.0&rect=32%2C106%2C5411%2C3884&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>What does a pandemic smell like? If dogs could talk, they might be able to tell us.</p>
<p>We’re part of an international research team, <a href="https://www.rfi.fr/en/science-and-technology/20200502-france-trains-dogs-to-detect-coronavirus-in-corsica-research-project">led by</a> Dominique Grandjean at France’s National Veterinary School of Alfort, that has been training detector dogs to sniff out traces of the novel coronavirus (SARS-CoV-2) since March.</p>
<p>These detector dogs are trained using sweat samples from people infected with <a href="https://www.biorxiv.org/content/10.1101/2020.06.03.132134v1.full">COVID-19</a>. When introduced to a line of sweat samples, most dogs can detect a positive one from a line of negative ones with 100% accuracy.</p>
<p>Across the globe, coronavirus detector dogs are being trained in the United Arab Emirates (UAE), Chile, Argentina, Brazil and Belgium. </p>
<p>In the UAE, detector dogs – stationed at various airports – have already started <a href="https://www.thenational.ae/lifestyle/travel/watch-uae-police-dogs-detect-covid-19-at-dubai-airport-1.1057176">helping efforts</a> to control COVID-19’s spread. This is something we hope will soon be available in Australia too.</p>
<h2>A keen nose</h2>
<p>Our international colleagues found detector dogs were able to detect SARS-CoV-2 in infected people when they were still <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180/">asymptomatic</a>, before later testing positive.</p>
<p>When it comes to SARS-CoV-2 detection, we don’t know for sure what the dogs are smelling. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350988/original/file-20200804-22-1kpnw4i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">On average, dogs have about 220 million scent receptors.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The volatile organic compounds (VOCs) given off in the sweat samples are a complex mix. So it’s likely the dogs are detecting a particular profile rather than individual compounds. </p>
<p>Sweat is used for tests as it’s <a href="https://covid19.nj.gov/faqs/coronavirus-information/about-the-virus/can-the-coronavirus-spread-through-sweat">not considered infectious</a> for COVID-19. This means it presents less risk when handling samples. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-the-new-coronavirus-saliva-test-and-how-does-it-work-141877">Explainer: what's the new coronavirus saliva test, and how does it work?</a>
</strong>
</em>
</p>
<hr>
<h2>COVID-19 sniffing dogs in Australia</h2>
<p>Here in Australia, we’re currently working with professional trainers of detector dogs in South Australia, Victoria and New South Wales. The most common breed used for this work so far has been the German shepherd, with various other breeds also involved. </p>
<p>We are also negotiating with health authorities to collect sweat samples from people who have tested positive to the virus, and from those who are negative. We hope to start collecting these within the next few months.</p>
<p>We will need to collect thousands of negative samples to make sure the dogs aren’t detecting other viral infection, such as the common cold or influenza. In other countries, they’ve passed this test with flying colours.</p>
<p>Once operational, detector dogs in Australia could be hugely valuable in many scenarios, such as screening people at airports and state borders, or monitoring staff working in aged care facilities and hospitals daily (so they don’t need repeat testing).</p>
<p>To properly train a dog to detect SARS-CoV-2, it takes: </p>
<ul>
<li><p>6-8 weeks for a dog that is already trained to detect other scents, or</p></li>
<li><p>3-6 months for a dog that has never been trained. </p></li>
</ul>
<h2>Could the dogs spread the virus further?</h2>
<p>Dogs in experimental studies have not been shown to be able to <a href="https://science.sciencemag.org/content/368/6494/1016">replicate the virus</a> (within their body). Simply, they themselves are not a source of infection. </p>
<p>Currently, there are two case reports in the world of dogs being potentially contaminated with the COVID-19 virus by their owners. Those dogs didn’t become sick.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hong-kong-dog-causes-panic-but-heres-why-you-neednt-worry-about-pets-spreading-covid-19-133304">Hong Kong dog causes panic – but here's why you needn't worry about pets spreading COVID-19</a>
</strong>
</em>
</p>
<hr>
<p>To further reduce any potential risk of transmission to both people and dogs, the apparatus used to train the dogs doesn’t allow any direct contact between the dog’s nose and the sweat sample. </p>
<p>The dog’s nose goes into a stainless steel cone, with the sweat sample in a receptacle behind. This allows free access to the volatile olfactory compounds but no physical contact. </p>
<p>Furthermore, all the dogs trained to detect COVID-19 are regularly checked by nasal swab tests, rectal swab tests and blood tests to identify antibodies. So far, none of the detector dogs has been found to be infected.</p>
<h2>Hurdles to jump</h2>
<p>Now and in the future, it will be important for us to identify any instances where detector dogs may present false positives (signalling a sample is positive when it’s negative) or false negatives (signalling the sample is negative when it’s positive). </p>
<p>We’re also hoping our work can reveal exactly which volatile olfactory compound(s) is/are specific to COVID-19 infection. </p>
<p>This knowledge might help us understand the disease process resulting from COVID-19 infection – and in detecting other diseases using detector dogs.</p>
<p>This pandemic has been a huge challenge for everyone. Being able to find <a href="https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180/">asymptomatic people</a> infected with the coronavirus would be a game-changer – and that’s what we need right now. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350760/original/file-20200803-17-yspcfa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A COVID-19 detector dog enrolled in the NOSAIS program led by professor Dominique Grandjean and Clothilde Julien from the Alfort Veterinary School (France).</span>
</figcaption>
</figure>
<h2>A friend to us (and science)</h2>
<p>Perhaps we shouldn’t be surprised about dogs’ ability to detect COVID-19, as we already know their noses are amazing. </p>
<p>Dogs can help detect <a href="https://www.sciencedaily.com/releases/2019/01/190115144053.htm">hypoglycaemia in diabetics</a>, warn people who are about to have an <a href="https://epilepsyfoundation.org.au/understanding-epilepsy/epilepsy-and-seizure-management-tools/seizure-alert-dogs/">epileptic seizure</a> and have been used to <a href="https://www.medicalnewstoday.com/articles/323620">sniff out some cancers</a>. </p>
<p>Their great potential in dealing with the current pandemic is just one of myriad examples of how dogs enrich our lives. </p>
<hr>
<p><em>We acknowledge Professor Riad Sarkis from the Saint Joseph University (Beirut) and Clothilde Lecoq-Julien from the Alfort Veterinary School (France) for first conceiving the idea underpinning this work back in March.</em></p><img src="https://counter.theconversation.com/content/143756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Hazel is affiliated with the RSPCA (South Australia) and is a member of the Dog & Cat Management Board of South Australia.</span></em></p><p class="fine-print"><em><span>Anne-Lise Chaber does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We’re working with professional trainers in South Australia, Victoria and New South Wales to train dogs to sniff out COVID-19. They could be highly valuable in managing the spread of infection.Susan Hazel, Senior Lecturer, School of Animal and Veterinary Science, University of AdelaideAnne-Lise Chaber, One Health Lecturer, School of Animal and Veterinary Science, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1422772020-07-14T20:01:44Z2020-07-14T20:01:44ZUltraviolet radiation is a strong disinfectant. It may be what our schools, hospitals and airports need<figure><img src="https://images.theconversation.com/files/347025/original/file-20200713-34-1ktnonp.jpg?ixlib=rb-1.1.0&rect=89%2C59%2C4902%2C3270&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>You may remember when US President Donald Trump suggested exposing coronavirus patients to UV (ultraviolet) light – or “just very powerful light” – to help treat them. </p>
<p>The use of UV light is not, in any way, a viable treatment for people infected with SARS-CoV-2. However, due to its powerful sterilisation abilities, this technology does have great potential for managing the COVID-19 pandemic in other ways.</p>
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<h2>What is UV light?</h2>
<p>The visible light we see every day belongs in a unique region of the whole <a href="https://imagine.gsfc.nasa.gov/science/toolbox/emspectrum1.html">electromagnetic spectrum</a>. The full spectrum is composed of radio waves, microwaves, infrared, visible light, ultraviolet, X-rays and gamma rays – all emitting and carrying energy.</p>
<p>Of these, ultraviolet (UV), X-ray and gamma rays are high-frequency waves. These can have <a href="https://pubmed.ncbi.nlm.nih.gov/24382094/">serious consequences</a> for our health.</p>
<p>The Sun emits <a href="https://www.who.int/uv/faq/whatisuv/en/index2.html">three types</a> of UV radiation: UVA, UVB and UVC. Prolonged UV exposure is associated with skin cancer. Thankfully, our planet’s atmosphere <a href="https://www.who.int/uv/uv_and_health/en/#:%7E:text=As%20sunlight%20passes%20through%20the,less%20affected%20by%20the%20atmosphere.">shields us from the majority</a> of the Sun’s UVB emissions and all UVC emissions. </p>
<h2>Affordable and accessible</h2>
<p>UVC has the ability to kill germs and is an alternative to chemical disinfection. UVC can be <a href="https://nymag.com/strategist/article/does-uv-light-kill-germs-best-sterilizer.html">used</a> to sterilise objects, <a href="https://www.water-research.net/index.php/water-treatment/water-disinfection/uv-disinfection">water</a>, surfaces and materials – whether it’s to clean your phone, a <a href="https://www.bbc.com/news/business-51914722">hospital floor</a>, or an <a href="https://metro.co.uk/2020/03/05/buses-blasted-uv-light-rid-coronavirus-12352400/">entire bus</a> in China. </p>
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Read more:
<a href="https://theconversation.com/mobile-phones-are-covered-in-germs-disinfecting-them-daily-could-help-stop-diseases-spreading-135318">Mobile phones are covered in germs. Disinfecting them daily could help stop diseases spreading</a>
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<p>The technology needed to generate UVC is <a href="https://www.nature.com/articles/s41598-018-21058-w">not new</a> and there is no reason to suggest this technology could not be implemented cost-effectively. Several companies have developed <a href="https://www.forbes.com/sites/forbes-personal-shopper/2020/04/02/these-uv-sanitizers-can-kill-off-bacteria-and-viruses-including-the-coronavirus-that-caused-covid-19/#70a07e886b03">an array</a> of lamps, machines and even robots capable of sterilising a range of surfaces. </p>
<h2>Isn’t it dangerous?</h2>
<p>It’s well established UV radiation is <a href="https://www.cancer.org/cancer/cancer-causes/radiation-exposure/uv-radiation.html#:%7E:text=Based%20on%20the%20available%20data,UVC">carcinogenic</a> (causes cancer) for humans. </p>
<p>Devices that emit UVC should be calibrated to ensure optimal microbial killing power and are more effective when placed close to the surface or object being treated. When turned off, UVC emission <a href="https://www.arpansa.gov.au/sites/default/files/legacy/pubs/rps/rps12_Supplementary_Information_Artificial_Sources.pdf">is halted</a>, too.</p>
<p>As per the World Health Organisation’s advice, <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters#uv">direct UVC exposure</a> should not be used to disinfect any areas of the skin. Studies are underway to identify particular UVCs that are safe for human cells and still worthwhile as germicides. </p>
<p>Far-UVC (wavelengths between 207-222 nanometres) <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138418">is promising</a> as it can’t cross physiological barriers, such as the dead outer layer of our skin, or the eye’s outer (tear film) layer.</p>
<p>Nonetheless, UVC still poses risks to our health since our skin and eyes can have cuts and micro-lesions. This would expose susceptible cells in our body to the damaging radiation.</p>
<h2>Can it kill COVID-19?</h2>
<p>Our knowledge of what constitutes “suitable” UVC emission is growing. This includes knowledge of the proper germicidal UVC wavelength that can be applied to surfaces, the amount of light that reaches the surface, and the exposure time needed to completely sterilise the viral particles. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112912/">Research</a> from 2002 confirmed UVC inactivated SARS (severe acute respiratory syndrome) after six minutes of exposure.</p>
<p>A <a href="https://www.medrxiv.org/content/10.1101/2020.06.05.20123463v1.full.pdf">more recent study</a> (while not peer-reviewed) has shown UVC-based disinfection is helpful for stopping the SARS-CoV-2 virus from replicating. However, this depended on how much of the virus was present and how much UVC exposure it received. </p>
<p>The study centred on the efficiency of UVC to inactivate and inhibit the virus at low, medium and high concentrations. It found the highest viral concentrations required quite high UVC dosage. </p>
<p><a href="https://www.medrxiv.org/content/10.1101/2020.04.02.20051409v1.full.pdf">Another study</a> looking at a different type of coronavirus (SARS-CoV-1) provided further evidence of the utility of UVC disinfection. The authors of this work suggest UV technology may be the solution to filling gaps in the supply of personal protective equipment such as masks.</p>
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Read more:
<a href="https://theconversation.com/what-is-a-virus-how-do-they-spread-how-do-they-make-us-sick-133437">What is a virus? How do they spread? How do they make us sick?</a>
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<h2>Overcoming major hurdles</h2>
<p>Apart from being carcinogenic, another limitation on using UVC is its poor penetration. It only allows surface-level sterilisation of microbes (such as viruses, bacteria and fungi) by impacting their genetic material. </p>
<p>That said, as the pandemic continues, the deployment of UVC sanitising technology across sectors could greatly contribute to our awareness of the risks presented by microbial pathogens. </p>
<p>The safe implementation of UVC-based measures could undoubtedly enhance public health and even biosecurity. Beyond the novel coronavirus, this arsenal has great potential to prevent costly impacts of future pandemics, too. </p>
<p>But, while enthusiasm is high, there are obvious risks of direct exposure to humans, with consequences ranging from serious burns to cancer. These will need to be carefully managed.</p><img src="https://counter.theconversation.com/content/142277/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Lotti Tajouri is a member of both Dubai Police Scientist Council and Dubai Future Council on Community Security (United Arab Emirates).</span></em></p><p class="fine-print"><em><span>Mariana Campos is affiliated with the Australian Plant Biosecurity Science Foundation.. </span></em></p><p class="fine-print"><em><span>Rashed Alghafri is affiliated with Dubai Police.
Rashed Alghafri is affiliated with Dubai Police Scientists Council.
Rashed Alghafri is affiliated with Dubai Future Council on Community Security.
</span></em></p><p class="fine-print"><em><span>Simon McKirdy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>UVC radiation is effective for disinfecting objects and surfaces. It could help manage the coronavirus pandemic and fill gaps in PPE supplies.Lotti Tajouri, Associate Professor, Genomics and Molecular Biology; Biomedical Sciences, Bond UniversityMariana Campos, Lecturer and Researcher, Harry Butler Institute, Murdoch UniversityRashed Alghafri, Honorary Adjunct Associate Professor, Health Sciences and Medicine, Bond UniversitySimon McKirdy, Professor of Biosecurity, Murdoch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1409232020-07-05T10:46:52Z2020-07-05T10:46:52ZFinding a place to pee during a pandemic or a protest shouldn’t be so hard<figure><img src="https://images.theconversation.com/files/344627/original/file-20200629-155312-rea637.jpg?ixlib=rb-1.1.0&rect=271%2C36%2C4617%2C3085&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Finding a washroom during either a pandemic or a protest within a pandemic is an issue about how free and accessible our urban spaces are. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>In early June in our home city of Guelph, Ont., <a href="https://www.guelphtoday.com/local-news/thousands-gather-in-downtown-guelph-for-black-lives-matter-protest-24-photos-2415299">thousands marched</a> to support the Black Lives Matter movement in the wake of George Floyd’s killing in the United States and the death of Regis Korchinski-Paquet in Toronto. But where did protesters who needed to use the washroom go? We don’t know. </p>
<p>Guelph, like many Canadian cities, had few open public washrooms in the first phase of the pandemic. The libraries, community centres and municipal buildings that house public washrooms were closed to the public (though as of late June there is some <a href="https://guelph.ca/2020/06/guelph-opening-outdoor-pools-splash-pads-washrooms-farmers-market-and-serviceguelph-with-covid-19-measures-in-place/">limited reopening in Guelph</a>.) </p>
<p>From May’s now-infamous <a href="https://www.thestar.com/news/canada/2020/05/23/dangerous-and-selfish-behaviour-a-day-after-mayor-medical-officer-urges-social-distancing-dozens-gather-at-trinity-bellwoods.html">impromptu summer party</a> in Toronto’s Trinity Bellwoods Park to Black Lives Matter protests in June, there are serious challenges when large groups of people gather during a pandemic. These gatherings magnify existing problems with urban public space.</p>
<p>At the Trinity Bellwoods party, <a href="https://dailyhive.com/toronto/tickets-issued-trinity-bellwoods-park-over-weekend-toronto-police">almost all tickets</a> issued were for public urination or defecation. As researchers at the University of Guelph who study public spaces, we were struck by the irony of handing out these tickets when public washrooms and businesses weren’t open. There was literally nowhere for people to go. Where we go when we really need to go is not something people like to talk or think about when they’re in public spaces.</p>
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<h2>Finding a public washroom</h2>
<p>Even in the best of times, public availability of washrooms is limited and often heavily restricted. <a href="https://www.ctvnews.ca/health/coronavirus/how-safe-is-using-a-public-restroom-during-a-pandemic-expert-weighs-in-1.4965907">Public health experts</a> say that public washrooms are no more dangerous than any other enclosed space for COVID-19, and <a href="https://www.theglobeandmail.com/canada/article-june-4-andre-picard-on-coronavirus-masks-testing-and-pandemic/">recommend leaving them open</a>. But the already limited public washrooms in many cities remain closed, with some exceptions. </p>
<p>Public space and public washrooms are two fundamental public goods. <a href="https://theconversation.com/washrooms-for-customers-only-peeing-with-dignity-in-the-city-112192">Research shows</a> people who need to use the washroom when they’re out and about in Toronto rely on the kindness of private business owners or the blind eye that their employees often turn. </p>
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Read more:
<a href="https://theconversation.com/washrooms-for-customers-only-peeing-with-dignity-in-the-city-112192">Washrooms for customers only: Peeing with dignity in the city</a>
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<p>Truly public spaces are those that are freely accessible to all. Public spaces that don’t have public washrooms are neither free nor accessible. Public spaces are diminished by poor investments in the amenities (like washrooms) that make being in public possible. Investing in washrooms, especially during a public health crisis, means paying people to clean them. </p>
<p>We don’t often see the burden that cleaning up public washrooms, and dealing with the occasional health crises that happen in them, <a href="https://theconversation.com/washrooms-for-customers-only-peeing-with-dignity-in-the-city-112192">puts on minimum wage workers</a>. Frontline workers in restaurants and grocery stores are being celebrated during the pandemic but not rewarded with <a href="https://www.bloomberg.com/news/articles/2020-06-12/a-supermarket-billionaire-steps-into-trouble-over-pandemic-wages">permanent wage increases</a> and job security.</p>
<p>As businesses open up again with tighter social distancing rules, it will be these same low-paid workers who keep businesses going and are tasked with protecting themselves and customers — all while enforcing unfamiliar rules. And while <a href="https://www.nytimes.com/2020/06/16/health/coronavirus-toilets-flushing.html">there’s a playful squeamishness</a> associated with public washrooms, they are nonetheless essential public service. </p>
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<img alt="" src="https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/344621/original/file-20200629-155353-in17bz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The work of cleaning public bathrooms often falls to minimum wage workers and during a pandemic, they have few protections and temporary pay increases.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>Free to pee, free to be</h2>
<p>Maintenance — specifically the hiring of well-paid city workers with appropriate protective gear — is a crucial part of making public washrooms work. During our research, we noticed that many of the Toronto’s park washrooms were closed at odd times, often pervasively. The insufficient maintenance and cleaning of these spaces means that they fall into disrepair and cannot be used, where they do exist.</p>
<p>Instead of stepping up maintenance, however, the city opted for bylaw enforcement patrols to encourage social distancing and make sure no one pees where they shouldn’t. Policing washroom use likely determines who feels able to show up at both parties and protests.</p>
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<img alt="" src="https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/344636/original/file-20200629-155345-4zeha8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Whether in public parks or during protests, washrooms must be free and accessible for all in order to make public spaces welcoming and safe.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Knowing that public washrooms are closed, people who need to frequently use the washroom might not participate in public gatherings because of a lack of access to these facilities. And the possibility of incurring a ticket for public urination may bring protesters in contact with law enforcement when, as the Black Lives Matter movement continues to highlight, encounters between <a href="https://www.thestar.com/news/gta/2020/05/28/autopsy-scheduled-for-toronto-woman-who-fell-24-storeys-from-high-park-building-with-police-present.html">Black</a> people and law enforcement can be fraught, and all-too-often, deadly. <a href="https://montreal.ctvnews.ca/quebec-watchdog-to-probe-fatal-rcmp-shooting-of-n-b-indigenous-man-1.4982770">Indigenous people</a> too are deeply familiar with this pattern.</p>
<p>A comprehensive system of open, accessible public washrooms should be part of how we think about reorganizing urban public spaces after the pandemic. We need to think about how people are excluded from public space because of the lack of public washrooms, how responsibility for maintaining existing limited resources fall to low-paid, often precarious workers, and how routine involvement with law enforcement is much more dangerous for some people. </p>
<p>The washroom dilemma requires more investment. Why? Because having more free and accessible public washrooms is not just the right thing to do, it’s the necessary thing to do.</p><img src="https://counter.theconversation.com/content/140923/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mervyn Horgan receives funding from the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Edith Wilson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Public washrooms are an essential service and the people who maintain them are essential workers. But what happens when a pandemic closes public bathrooms and a civil rights protest breaks out?Edith Wilson, Master's of Sociology, University of GuelphMervyn Horgan, Associate Professor of Sociology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1386882020-05-24T12:22:33Z2020-05-24T12:22:33ZWe need inquiries into why coronavirus is ravaging long-term care homes<figure><img src="https://images.theconversation.com/files/335193/original/file-20200514-77247-17jqcsz.jpg?ixlib=rb-1.1.0&rect=819%2C738%2C2651%2C1293&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wheelchairs sit behind Camilla Care in Mississauga, Ont., on May 12, 2020. Fifty residents from the long-term care home have died from COVID-19. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span></figcaption></figure><p>Ontario says it will establish a <a href="https://www.cbc.ca/news/canada/toronto/ontario-long-term-care-commission-1.5575035">commission</a> to study the handling of COVID-19 in the province’s long-term care sector.</p>
<p><a href="https://www.cbc.ca/news/canada/toronto/ontario-long-term-care-commission-1.5575035">More than 1,400</a> Ontario long-term care facility residents, and a number of staff, have died of COVID-19 over the past two months. They are among the <a href="https://www.thestar.com/politics/federal/2020/05/07/82-of-canadas-covid-19-deaths-have-been-in-long-term-care.html">more than 3,400 who have died in long-term care centres across the country</a>.</p>
<p>The announcement was greeted with <a href="https://www.thestar.com/opinion/editorials/2020/05/20/ontario-needs-a-real-public-inquiry-into-long-term-care.html">widespread criticism</a> because the province is not convening a formal judicial inquiry along the lines of those that examined the far less deadly <a href="http://www.archives.gov.on.ca/en/e_records/walkerton/index.html">2000 Walkerton</a> drinking water disaster and <a href="http://www.archives.gov.on.ca/en/e_records/sars/report/index.html">the 2003 SARS</a> outbreak. </p>
<p>Rather, the commission is yet to be defined and seems more likely to be an informal process. Premier Doug Ford <a href="https://www.orilliamatters.com/local-news/watch-ford-says-not-time-for-full-long-term-care-inquiry-while-people-are-dying-2361616">emphatically ruled out a formal inquiry</a>, saying that it would take too long to produce recommendations for reforms of the sector.</p>
<h2>Less than stellar response</h2>
<p>At the federal level, the situation is only slightly less confusing. While Canada <a href="https://www.macleans.ca/society/health/coronavirus-deaths-these-charts-show-how-canada-compares-with-the-world/">has managed COVID-19 better</a> than the United States, the United Kingdom, Italy and Spain, its response has nonetheless been less than stellar. <a href="https://www.folio.ca/how-covid-19-overwhelmed-canadas-long-term-care-system/">Long-term care</a> along with food processing, specifically <a href="https://www.cbc.ca/news/canada/calgary/alberta-covid-19-outbreak-brooks-speed-of-spread-1.5552359">meat-packing</a>, are critical points of vulnerability.</p>
<p>COVID-19’s impact has raised major questions about pandemic <a href="https://www.cbc.ca/news/canada/saskatchewan/ppe-import-china-shortage-1.5552426">preparedness</a> and the resiliency of critical, globalized <a href="https://www.thestar.com/politics/political-opinion/2020/04/07/covid-19-provides-a-stark-reminder-that-in-donald-trumps-world-global-trade-leaves-canada-vulnerable.html">supply chains</a>. </p>
<p>There’s also a question of whether Canada should have taken reactive, risk-based approaches to public health threats rather than a more proactive, <a href="https://nursesunions.ca/position-statement-on-covid-19/">precautionary</a> stance. There are more questions still about travel restrictions in the early stages of the pandemic, co-ordination among the federal government, provinces and local health agencies, issues around data and <a href="https://globalnews.ca/news/6825938/coronavirus-incomplete-data-pandemic-modelling-scientists/">information access</a> for the public, and the role of the Public Health Agency of Canada, which is itself a legacy of the SARS outbreak.</p>
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<a href="https://theconversation.com/coronavirus-another-chance-to-transform-the-global-food-trade-136561">Coronavirus: Another chance to transform the global food trade</a>
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<p>So far the federal government has been ambiguous about plans for a review of Canada’s overall response to the pandemic. They have referred to the need for a “<a href="https://www.citynews1130.com/2020/05/12/federal-government-to-look-at-long-term-care-reforms/">national conversation</a>” regarding the situation in the long-term care sector, but few specifics on what that might involve. </p>
<p>The <a href="https://www.ckom.com/2020/05/19/new-auditor-general-says-office-narrowing-focus-on-federal-covid-19-programs/">Auditor General announced</a> her intention to review the federal government’s preparedness for the pandemic. Various internal and parliamentary reviews are likely to occur as well.</p>
<h2>Falling short of what’s required</h2>
<p>While these steps, including Ontario’s proposed commission, are better than nothing, they fall far short of the comprehensive review that’s necessary.</p>
<p>The current situation has similarities to another recent disaster — the 2013 <a href="https://thecanadianencyclopedia.ca/en/article/lac-megantic-rail-disaster">Lac-Mégantic</a> train derailment and fire in which 47 innocent people were killed.</p>
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Read more:
<a href="https://theconversation.com/disasters-foretold-boeing-737-max-8-and-lac-megantic-130760">Disasters foretold: Boeing 737 Max 8 and Lac-Mégantic</a>
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</em>
</p>
<hr>
<p>In the aftermath of the accident, there was no formal inquiry at either the federal or provincial levels. But there were civil lawsuits and criminal trials as well as a <a href="https://sei.info.yorku.ca/files/2012/12/Case-for-public-Inquiry-into-the-LacMegantic-Disaster-September-22-2017.pdf?x46177">series of investigations</a> and reports: the Transportation Safety Board, the Auditor General, the House of Commons Standing Committee on Transportation and the Québec Coroner’s Office. </p>
<p>Although extensive, the overall findings were fragmented. They failed to provide a comprehensive picture of the actions and decisions, both immediate and systemic, leading up to the disaster. </p>
<p>Key people involved in the disaster never testified in public. None of the investigations and reviews had complete access to all of the relevant information and documents.</p>
<h2>COVID-19 dwarfs other public health disasters</h2>
<p>The scale of the impact of the COVID-19 pandemic in Canada already dwarfs most previous <a href="https://www.thecanadianencyclopedia.ca/en/article/pandemic">public health disasters</a> in modern Canadian history. The situation requires a much more comprehensive review and response than appears to be emerging at the federal level.</p>
<p>A formal public inquiry would be the best way to investigate these questions. Inquiries cannot bring criminal or civil indictments but they can compel senior officials, politicians and senior executives to testify under oath and be cross-examined, and confidential documents from public and private sources can be accessed. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335199/original/file-20200514-77267-1qreg00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health-care workers use a sheet to obscure a person on a stretcher being placed in an unmarked van outside the Laurier Manor in Ottawa, a long-term care facility experiencing an outbreak of COVID-19, on April 26, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>As such, an inquiry is likely the best tool for establishing as full and complete an understanding as possible about what went wrong in Canada’s response to COVID-19. This is essential to ensuring that the same mistakes are avoided in the future.</p>
<p>Independent inquiries can serve another critical purpose that other mechanisms cannot: they can help survivors and the families of victims in their grieving and healing processes.</p>
<p>The act of establishing an inquiry is itself a public acknowledgement of the significance of the events and the losses that have occurred. </p>
<h2>Anti-inquiry forces</h2>
<p>As was the case with <a href="https://sei.info.yorku.ca/files/2012/12/Case-for-public-Inquiry-into-the-LacMegantic-Disaster-September-22-2017.pdf?x46177">Lac-Mégantic</a>, powerful forces will likely be aligned against inquiries, either federal or provincial, into the handling of the COVID-19 pandemic. </p>
<p>Care-home operators and government agencies that were supposed be overseeing their operations, for example, as well political officials past and present who may be concerned that blame will fall on them for whatever failures may be identified, will all have reasons to strongly resist formal inquiries.</p>
<p>Yet, these are the very reasons why formal inquiries are so essential. Inquiries operate outside of normal government structures. This is especially important when, as is the case with COVID-19, there is a need to examine the performance of existing agencies and policies. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/336778/original/file-20200521-102632-auu59t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Rest In Peace card and flowers are shown outside a long-term care home in Montréal in April 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>The formalized inquiry process is far less vulnerable to internal or external lobbying by the interests and agencies whose performance is under review. An inquiry may also have much greater freedom to engage with new ideas and perspectives than may be possible within existing governmental processes. </p>
<p>Public confidence in inquiries is closely related to their degree of independence from government, in combination with their investigative powers to get to the bottom of a problem.</p>
<p>An inquiry at the federal level will need to co-ordinate with provincial reviews. Separate formal inquiries are clearly needed in Ontario and Québec on the specific question of what went wrong in the long-term care sector, the epicentres of the pandemic in both provinces.</p>
<p>In a world that remains highly globalized, COVID-19 will not be last pandemic Canada faces. It is critically important that we have as complete an understanding as possible of what went wrong this time and what can be done better next time — because there will almost certainly be a next time.</p><img src="https://counter.theconversation.com/content/138688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Campbell receives funding from SSHRC. He is involved in two SSHRC research grants. He does not receive any apart from travel and accommodation expenses for meetings.
I am a member of the national office steering committee of the Canadian Centre for Policy Alternatives. I am a board member of the Rideau Institute for international affairs. </span></em></p><p class="fine-print"><em><span>Mark Winfield receives funding from the Social Sciences and Humanities Research Council, the Natural Sciences and Engineering Research Council, and the George Cedric Metcalf Foundation. </span></em></p><p class="fine-print"><em><span>Pat Armstrong receives funding from SSHRC and CIHR.</span></em></p>The extraordinary scope and scale of the COVID-19 disaster at Canada’s long-term care centres would seem to warrant a public inquiry. But there are no guarantees there will actually be one.Bruce Campbell, Adjunct professor, Faculty of Environmental Studies, York University, CanadaMark Winfield, Professor of Environmental Studies, York University, CanadaPat Armstrong, Distinguished Research Professor of Sociology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1365352020-05-05T10:58:37Z2020-05-05T10:58:37ZCoronavirus is a failure of global governance – now the world needs a radical transformation<figure><img src="https://images.theconversation.com/files/332398/original/file-20200504-83751-1w7u44r.jpg?ixlib=rb-1.1.0&rect=224%2C233%2C5766%2C3754&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We're all in this together. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/planet-earth-face-mask-protect-world-1669328053">By Paopano/Shutterstock</a></span></figcaption></figure><p>World leaders have pledged €7.4 billion (£6.4 billion) in a digital fundraiser as part of <a href="https://www.dw.com/en/world-leaders-pledge-74-billion-for-european-commissions-coronavirus-vaccine-fundraising-conference/a-53322501">a new “international alliance”</a> to fight COVID-19. Assembled political leaders declared their support for the World Health Organization (WHO), which will <a href="https://global-response.europa.eu/about_en">receive some of the funds</a> alongside other organisations working on vaccine and treatment development.</p>
<p>Conspicuously absent so far from this new alliance, which was driven by the European Commission, was the US. This follows <a href="https://www.bbc.co.uk/news/world-us-canada-52289056">President Donald Trump’s</a> decision in April to halt funding for the WHO, claiming that the organisation covered up the spread of the coronavirus in collusion with the Chinese government.</p>
<p>Trump’s decision is a major blow, given that the US is the WHO’s largest single funder. At a time when the WHO is desperately <a href="https://www.un.org/en/un-coronavirus-communications-team/funding-fight-against-covid-19-world%E2%80%99s-poorest-countries">trying to raise a US$2 billion (£1.6 billion)</a> global humanitarian response fund to assist the world’s poorest countries, it spells disaster.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/world-health-organization-what-does-it-spend-its-money-on-136544">World Health Organization: what does it spend its money on?</a>
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</em>
</p>
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<p>COVID-19 reminds us of the dangers posed by global systemic risks to the protection and safeguarding of human life – the first duty of any state – in our ever more global civilisation. It also exposes a basic contradiction between an enormously complex planetary ecosystem and our still dominant form of political organisation: a fragmented system of sovereign states. </p>
<p>The American architect and theorist <a href="https://www.abebooks.co.uk/book-search/title/critical-path/author/buckminster-fuller/">Buckminster Fuller</a> captured this mismatch almost 40 years ago:</p>
<blockquote>
<p>We have today, in fact, 150 supreme admirals and only one ship – Spaceship Earth. We have the 150 admirals in their 150 staterooms each trying to run their respective stateroom as if it were a separate ship. We have the starboard side admirals’ league trying to sink the port side admirals’ league. If either is successful in careening the ship to drown the ‘enemy’ side, the whole ship will be lost.</p>
</blockquote>
<p>Emerging evidence of successful protection of life in places as diverse as <a href="https://www.theatlantic.com/politics/archive/2020/04/jacinda-ardern-new-zealand-leadership-coronavirus/610237/">New Zealand</a>, <a href="https://www.independent.co.uk/news/world/asia/uk-coronavirus-south-korea-deaths-cases-flatten-curve-how-a9457941.html">South Korea</a>, <a href="https://www.theguardian.com/world/2020/apr/17/test-trace-lessons-hong-kong-avoiding-coronavirus-lockdown">Hong Kong</a>, <a href="https://theconversation.com/vietnam-has-reported-no-coronavirus-deaths-how-136646">Vietnam</a>, and the Indian state of <a href="https://www.bbc.co.uk/news/world-asia-india-52283748">Kerala</a>, speaks to the enduring importance of “command and control” state capacity in delivering fundamental public goods, especially in times of crisis. Meanwhile, experts are rightly scrutinising the <a href="https://www.thefullbrexit.com/covid19-state-failure">alarming lack of preparedness</a> in some of the world’s wealthiest countries.</p>
<p>But despite the importance of national capacity, there remains a key role for global strategy in health governance. And that’s why the failings of the WHO are such cause for concern. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-governments-knew-a-pandemic-was-a-threat-heres-why-they-werent-better-prepared-136857">Coronavirus: governments knew a pandemic was a threat – here's why they weren't better prepared</a>
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<h2>Funding shortfall</h2>
<p>A <a href="https://cmr.asm.org/content/cmr/20/4/660.full.pdf">2007 study</a> by scientists in Hong Kong predicted the reemergence of a SARS-like coronavirus from bat meat, the <a href="https://www.nytimes.com/reuters/2020/04/21/world/europe/21reuters-health-coronavirus-who-virus.html">likely source</a> of COVID-19. If an epidemic was predictable then a pandemic was preventable and the WHO should have played a central role in the detection and avoidance of a COVID-19 pandemic in the critical window of January 2020.</p>
<p>It’s estimated US$3.4 billion a year <a href="https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1663118">is needed</a> to fund “global functions” of WHO pandemic preparedness. However, WHO global pandemic preparedness funds have <a href="https://www.tandfonline.com/doi/full/10.1080/23288604.2019.1663646">fallen woefully short</a> of this target, even following the 2014 Ebola epidemic. </p>
<p>Wealthy governments have long been resistant to <a href="https://www.cornellpress.cornell.edu/book/9780801450655/the-world-health-organization-between-north-and-south/#bookTabs=1">redistributive demands</a> by developing countries and have left the WHO chronically funded as a result. There has also been a desire by Western governments to prioritise health sector loans, with strings attached, through <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30202-9/fulltext">the World Bank</a>. Countries have never given the WHO the requisite independence, powers or resources required to fulfil its mission to ensure “the attainment by all peoples of the highest possible level of health”.</p>
<h2>Few effective tools</h2>
<p>To <a href="https://www.bbc.co.uk/news/health-52299820">seasoned WHO observers</a>, its deferential posture towards China (and governments of all shades) reflects its reliance on states cooperating with it. The WHO has no powers to compel information-sharing or enforce pandemic preparedness. Former director-generals, such as Gro Harlem Brundtland or Halfdan Mahler, willing to confront powerful interests, have <a href="https://www.chathamhouse.org/sites/default/files/publications/research/2013-02-01-role-world-health-organization-international-system-clift.pdf">faced stiff resistance</a>. </p>
<p>As with the UN’s <a href="https://www.cambridge.org/core/journals/american-journal-of-international-law/article/what-works-in-human-rights-institutions/C24517FEA634993D5AB4488B19E42746">human rights</a> and <a href="https://www.mitpressjournals.org/doi/abs/10.1162/glep.2010.10.1.30">climate change</a> agencies, the WHO finds itself embattled – at the mercy of obstructive member states and saddled with dwindling resources. It enjoys few effective tools to directly monitor outbreaks of infectious disease, coordinate pandemic planning, allocate resources to those countries most in need, or ensure effective preparedness implementation at country-level.</p>
<p>The WHO should serve a vital global function, mitigating against the risk of states becoming overwhelmed. In turn, it could reduce the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26883181">destructive impact</a> unmanaged economic globalisation has had on public health systems, many of which have been left ill-prepared to deal with COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-prepare-for-a-pandemic-137116">How to prepare for a pandemic</a>
</strong>
</em>
</p>
<hr>
<h2>A fix is needed</h2>
<p>The WHO is essential, but it is broken. We will almost certainly confront even more daunting challenges on our interconnected, globalised planet. COVID-19 is a global catastrophe, but recovery is not in question. The same cannot be said for other <a href="https://global.oup.com/academic/product/global-catastrophic-risks-9780199606504?cc=gb&lang=en&">global risks facing the world</a>, including the possibility of much deadlier pandemics. </p>
<p>A sober reckoning with this predicament demands a radical transformation in how we design and manage authoritative health governance both domestically and at a global scale. Political economist Elinor Ostrom’s work on cultivating global solidarity through <a href="https://www.sciencedirect.com/science/article/abs/pii/S0959378010000634">“polycentric governance”</a> – fostering collective action between those who make decisions in contexts of competition, conflict resolution, cooperation, and social learning – provides important coordinates for such an endeavour.</p>
<p>Whether or not existing global governance configurations such as the UN and the WHO can be repurposed to address systemic global risks is an open question. This is not simply a call for more funding to the WHO or other intergovernmental bodies. Its dysfunctions are symptomatic of a broken global political system. </p>
<p>For many, global-scale system reform may appear <a href="https://www.newstatesman.com/international/2020/04/why-crisis-turning-point-history">untenable</a>, for others, undesirable. But what if – as <a href="https://press.princeton.edu/books/hardcover/9780691180441/on-the-future">expert observers</a> increasingly agree – nothing less is going to be enough? Why, if we can imagine <a href="http://nymag.com/intelligencer/2017/07/climate-change-earth-too-hot-for-humans.html">existential climate catastrophe</a>, can we not imagine a different role for the nation state? Rather than countries competing with one another, we should remember we are agents of the global whole working on behalf of all inhabitants on Spaceship Earth.</p><img src="https://counter.theconversation.com/content/136535/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tom Pegram does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Coronavirus shows just how much the world needs a new system of global governance to address systemic risks.Tom Pegram, Associate Professor in Global Governance and Deputy Director of UCL Global Governance Institute, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1334682020-03-11T20:04:39Z2020-03-11T20:04:39ZCoronavirus control measures aren’t pointless – just slowing down the pandemic could save millions of lives<figure><img src="https://images.theconversation.com/files/319981/original/file-20200311-168563-qa3j4i.jpg?ixlib=rb-1.1.0&rect=299%2C284%2C4715%2C3110&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The point is to make sure hospitals have space for those who get sick.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/empty-hospital-beds-in-hospital-royalty-free-image/135539226">Ariel Skelley/DigitalVision via Getty Images</a></span></figcaption></figure><p>Anywhere from 20% to 60% of the adults around the world may be infected with the new coronavirus SARS-CoV-2, the virus that causes the disease COVID-19. <a href="https://www.hsph.harvard.edu/news/hsph-in-the-news/the-latest-on-the-coronavirus/">That’s the estimate</a> from leading epidemiological experts on communicable disease dynamics. Even the best-case scenario using those numbers means nearly 40,000,000 adults will be infected in the United States alone. </p>
<p>Some people may start to feel fatalistic in the face of those kinds of statistics. There are no vaccines and no specific treatments for people who get sick. What’s the point of fighting something that’s bound to happen anyway? Why not just let the epidemic run its course?</p>
<p>But public health officials and medical professionals have been <a href="https://www.npr.org/sections/health-shots/2020/03/11/814460233/coronavirus-1-000-cases-now-in-u-s-and-it-s-going-to-get-worse-fauci-says?">advocating for rapid and decisive efforts</a> to reduce the transmission of SARS-CoV-2 as much and as early as possible.</p>
<p>The goal is to “flatten the curve.” Rather than letting the virus quickly rampage through the population and burn itself out fast, the idea is to spread all those infections out over a longer period of time.</p>
<figure>
<img src="https://cdn.theconversation.com/static_files/files/890/Flatten_the_curve1.gif?1583941324">
<figcaption><span class="caption">Flattening the curve is another way of saying buying more time.</span></figcaption>
</figure>
<p>Yes, it would potentially prolong the epidemic. But in doing so, public health agencies and the health care infrastructure <a href="https://doi.org/10.1016/S0140-6736(20)30567-5">gain invaluable time to respond to the crisis</a>.</p>
<p>Most importantly, “flattening the curve” provides an opportunity to significantly reduce deaths from COVID-19.</p>
<p>On the steep rise of the epidemic curve, especially <a href="https://www.politico.com/news/2020/03/10/coronavirus-testing-lab-materials-shortage-125212">when testing capacity is lacking</a>, there is a tremendous burden on health care providers – many of whom will fall ill themselves and be forced to self-isolate, becoming unable to provide care for those in need. At the same time, there is immense pressure placed on health care facilities where <a href="http://nrs.harvard.edu/urn-3:HUL.InstRepos:42599304">demand for patient care will outpace capacity</a> – things like the number of hospital beds, ventilators and so on – for a significant amount of time.</p>
<p>So yes, even if every person on Earth eventually comes down with COVID-19, there are real benefits to making sure it doesn’t all happen in the next few weeks.</p>
<p>How, then, can people “flatten the curve” via reducing transmission of the coronavirus? At present, with many regions of the United States and other countries seeing community members spreading COVID-19 locally, the world has entered a phase of mitigation to complement efforts to contain its spread.</p>
<p>As a result, we’re left with an old but quite effective strategy: <a href="https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html">social distancing</a>. It means staying out of close contact in crowded public places, avoiding mass gatherings and maintaining space – approximately six feet – between yourself and others when possible.</p>
<p>Social distancing requires changes in how people work, live and interact with each other. It may require canceling or avoiding big events, limiting nonessential travel and rescheduling conferences. Traditional classroom instruction may have to move to online delivery – already happening in some colleges and universities, though less easy to do for K-12 schools.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319978/original/file-20200311-116270-1kwcdrf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Social distancing means things like games being played in stadiums empty of fans.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/France-Brazil-Canada-Soccer/3dac0a55eea646cb9a4fb89186adfb71/1/0">AP Photo/Michel Spingler</a></span>
</figcaption>
</figure>
<p>To be clear, social distancing comes with a substantial economic cost as people aren’t engaged in the same work and life activities that fuel the economy as they were just a month or two ago. As a result, public health and government officials are faced with balancing the public health push to “flatten the curve” with desires to minimize the impact on the economy.</p>
<p>As the COVID-19 pandemic unfolds, public health experts across the world are collecting data and communicating information as fast as possible in an attempt to provide health care providers, research laboratories, public health agencies and policymakers with the knowledge they need to respond to the emerging threat. In the meantime, one of the most important things individuals can do for our collective public health is to <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen">listen to the experts</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html">follow their advice</a>.</p>
<p>World Health Organization Director-General Tedros Adhanom recently commented that “We need to remember that <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---9-march-2020">with decisive, early action, we can slow down the virus</a> and prevent infections.” We’re not going to stamp out COVID-19. But by not just throwing up our hands and giving up, people can help address the crisis early, preventing COVID-19 from overwhelming the health care system’s capacity to respond effectively.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/133468/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew McQueen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Best-case estimates suggest 40 million American adults may come down with COVID-19. But an epidemiologist explains why now is not the time to just give up.Matthew McQueen, Director, Public Health Program and Associate Professor of Integrative Physiology, University of Colorado BoulderLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1309832020-02-03T13:51:47Z2020-02-03T13:51:47ZThe Trump administration has made the US less ready for infectious disease outbreaks like coronavirus<figure><img src="https://images.theconversation.com/files/313137/original/file-20200131-41503-fzedsh.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C2653%2C2279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Colorized scanning electron micrograph of filamentous Ebola virus particles (blue) budding from an infected cell (yellow-green). </span> <span class="attribution"><a class="source" href="https://flic.kr/p/o15Y5n">NIAID</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>As coronavirus continues to spread, the Trump administration has <a href="https://www.hhs.gov/about/news/2020/01/31/secretary-azar-declares-public-health-emergency-us-2019-novel-coronavirus.html">declared a public health emergency</a> and imposed <a href="https://www.wsj.com/articles/u-k-reports-first-coronavirus-cases-as-china-allies-limit-ties-11580467046">quarantines and travel restrictions</a>. However, over the past three years the administration has weakened the offices in charge of preparing for and preventing this kind of outbreak.</p>
<p>Two years ago, Microsoft founder and philanthropist Bill Gates warned that the world should be “preparing for a pandemic in the same serious way it prepares for war”. Gates, whose foundation has <a href="https://docs.gatesfoundation.org/documents/global-health-program-overview.pdf">invested heavily in global health</a>, suggested staging <a href="https://www.facebook.com/TheNewEnglandJournalofMedicine/videos/10155849069743462/">simulations, war games and preparedness exercises</a> to simulate how diseases could spread and to identify the best response.</p>
<p>The Trump administration has done exactly the opposite: It has slashed funding for the federal <a href="https://www.cdc.gov/">Centers for Disease Control and Prevention</a> and its infectious disease research. For fiscal year 2020, Trump proposed <a href="https://www.cdc.gov/budget/documents/fy2020/cdc-overview-factsheet.pdf">cutting the CDC budget by US$1.3 billion</a>, <a href="https://www.cdc.gov/budget/fy2020/congressional-justification.html">nearly 20% below the 2019 level</a>. </p>
<p>As a <a href="https://scholar.google.com/citations?user=WFylm2wAAAAJ&hl=en">specialist in budgeting</a>, I recognize that there are many claims on public resources. But when it comes to public health, I believe it is vital to invest early in prevention. Starving the CDC of critical funding will make it far harder for the government to react quickly to a public health emergency. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=371&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=371&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313132/original/file-20200131-41503-13sdjdg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=371&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As of Jan. 31, 2020, cases of 2019-nCoV had been confirmed in China and 25 other countries.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html#map">CDC</a></span>
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<h2>Cutting funds and staff</h2>
<p>Every year since taking office, Trump has asked for deep cuts into research on emerging diseases – including the CDC’s small center on <a href="https://www.cdc.gov/onehealth/basics/zoonotic-diseases.html">emerging and “zoonotic” infectious diseases</a> that jump the species barrier from animals to humans. The new coronavirus is just the latest example of these threats. </p>
<p>The CDC’s program focuses on infectious diseases ranging from foodborne illnesses to anthrax and Ebola. It manages laboratory, epidemiologic, analytic and prevention programs, and collaborates with state and local health departments, other federal government agencies, industry and foreign ministries of health. </p>
<p>In 2018, Trump tried to <a href="https://www.hhs.gov/about/budget/fy2018/budget-in-brief/cdc/index.html">cut $65 million</a> from this budget – a 10% reduction. In 2019, he sought a 19% reduction. For 2020, he proposed to cut federal spending on emerging infectious and zoonotic diseases <a href="https://www.cdc.gov/budget/fy2020/congressional-justification.html">by 20%</a>. This would mean spending $100 million less in 2020 to study how such diseases infect humans than the U.S. did just two years ago. </p>
<p>Congress reinstated most of this funding, with bipartisan support. But the overall level of appropriations for relevant CDC programs is still <a href="https://www.hhs.gov/about/budget/fy2018%5B/budget-in-brief/cdc/index.html">10% below what the U.S. spent in 2016</a>, adjusting for inflation. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/oLeDTXnaGkw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr. James Wilson, who led the team that provided warning of the 2009 H1N1 influenza pandemic, describes the need for global infectious disease forecasting.</span></figcaption>
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<p>Even worse, in 2018 the administration <a href="https://www.washingtonpost.com/news/to-your-health/wp/2018/05/10/top-white-house-official-in-charge-of-pandemic-response-exits-abruptly/">disbanded its own global health security team</a>, which was supposed to make the U.S. more resilient to the threat of epidemics. This unfortunate decision was part of a reorganization that former national security adviser John Bolton carried out shortly after arriving at the White House. </p>
<p>Bolton eliminated the National Security Council’s global health security and biodefense directorate, and reshuffled its team of world-class infectious disease experts. In response, two highly respected leaders in the field – <a href="https://www.theatlantic.com/health/archive/2018/05/white-house-loses-global-health-security-lead-as-a-new-ebola-outbreak-hits/560195/">Rear Admiral Tim Ziemer</a>, the NSC’s senior director for global health security and biodefense, and <a href="https://www.washingtonpost.com/politics/white-house-homeland-security-adviser-resigns-amid-continued-turnover-in-trump-administration/2018/04/10/15db518a-3ccb-11e8-a7d1-e4efec6389f0_story.html">Homeland Security adviser Tom Bossert</a> – left the White House. </p>
<p>Under Presidents George W. Bush and Barack Obama, Ziemer had served as the U.S. point person for a coordinated global anti-malaria campaign that helped reduce deaths from the disease by 60% over 15 years. In 2016 he estimated that funding initiatives to reduce malaria generated a <a href="https://news.harvard.edu/gazette/story/2016/02/politics-biggest-threat-to-malaria-effort/">36 to 1 return on investment</a> because it averted so many deaths and debilitating illnesses. </p>
<p>In 2018 Ziemer was instrumental in fighting the <a href="https://www.usaid.gov/news-information/congressional-testimony/jun-4-2019-rear-admiral-tim-ziemer-aa-dcha-ebola">reemergence of Ebola</a> in the Democratic Republic of Congo, traveling there and working with public health officials to reduce the spread of the dreaded disease. </p>
<h2>A clear and present danger</h2>
<p>There is no wall high enough to keep virulent pathogens from crossing national borders, and when they emerge there is a potential for widespread illness and death. Containing the first major Ebola epidemic in 2014-2016, which <a href="https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html">killed 11,000 people in West Africa</a>, required an enormous global effort. Only 11 patients were treated for Ebola in the U.S., but that was because President Obama took the threat seriously, appointing an “<a href="https://www.washingtonpost.com/news/post-politics/wp/2014/10/17/obama-taps-ron-klain-as-ebola-czar/">Ebola czar</a>” to coordinate U.S. preparedness and assistance. </p>
<p>Now that the White House has evicted the NSC’s global health security experts, it is not clear who in the Trump administration will be responsible for coordinating U.S. efforts in the event of a global pandemic. </p>
<p>The new coronavirus that emerged in Wuhan, China, has already <a href="https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed-cases.html#map">spread to 25 countries</a>. The CDC has confirmed that <a href="https://www.cdc.gov/media/releases/2020/p0130-coronavirus-spread.html">person-to-person transmission has occurred</a> in the U.S. It will take a large-scale effort to contain this outbreak, and battling the virus requires money. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313142/original/file-20200131-41527-dpdvvs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Dr. Nancy Sullivan of NIH’s National Institute of Allergy and Infectious Diseases briefs President Barack Obama on Ebola research, Dec. 2, 2014.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/qhYKXG">NIH</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Although the Gates Foundation and other charities give away <a href="https://www.healthcareglobal.com/top-10/healthcare-charities">billions of dollars to promote public health</a>, such gifts are no substitute for the kind of specific, targeted scientific research into emerging diseases that the CDC and <a href="https://www.niaid.nih.gov/news-events/niaid-officials-discuss-novel-coronavirus-recently-emerged-china">other federal agencies</a> are uniquely designed to conduct. Fighting epidemics also requires planning to prepare and coordinate with hospitals, medical professionals, pharmacies, airlines, local government and the general public, which also requires funding.</p>
<p>President Trump recently signed a <a href="https://www.cnbc.com/2019/12/21/trump-signs-738-billion-defense-bill.html">$738 billion dollar defense budget</a> – the highest level since World War II. It creates a new <a href="https://www.military.com/space-force">Space Force</a> and funds research into dozens of remotely possible military threats. Relative to defense spending, the $6.5 billion CDC budget is tiny. But as I see it, deadly global pandemics and emerging biological and viral threats pose an equal or greater threat to our national security. </p>
<p>As climate change warms the Earth, thousands of <a href="http://www.bbc.com/earth/story/20170504-there-are-diseases-hidden-in-ice-and-they-are-waking-up">long-frozen dormant diseases are defrosting</a>. And the World Health Organization reports that 75% of all emerging pathogens over the past decade are zoonotic diseases, <a href="https://www.who.int/neglected_diseases/diseases/zoonoses/en/">most of which are understudied</a>. As Bill Gates <a href="https://www.gatesnotes.com/Health/Shattuck-Lecture">warned in 2018</a>, “If history has taught us anything, it’s that there will be another deadly global pandemic.” I believe the U.S. must allocate more resources to research, detection and global prevention and communication efforts, not less.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/130983/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Linda J. Bilmes does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Trump administration has cut funding for infectious disease research and reduced high-level staffing for global health security, leaving the nation less prepared for major outbreaks.Linda J. Bilmes, Daniel Patrick Moynihan Senior Lecturer in Public Policy and Public Finance, Harvard Kennedy SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1155942019-04-18T23:01:47Z2019-04-18T23:01:47ZHow the UK is leading the world on flu research, ready to kick in quickly when the next pandemic hits<figure><img src="https://images.theconversation.com/files/269927/original/file-20190418-28103-zkqj6q.jpg?ixlib=rb-1.1.0&rect=50%2C70%2C4198%2C2497&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The new approach to keep research ready to go could be useful for other health emergencies, including other infectious diseases.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The next influenza pandemic is a case of when, rather than if. In the last major influenza pandemic in 2009, 201,200 people worldwide died.</p>
<p>The UK is now leading the world in how it prepares for such outbreaks, thanks to an innovative network of health research studies being kept in “hibernation”, ready to be activated the moment an outbreak strikes.</p>
<p>The approach is a more efficient alternative to the <a href="https://www.dc.nihr.ac.uk/highlights/pandemic-flu/about-the-research.htm">previous practice</a> in the UK. It involved waiting for a pandemic to hit before instigating studies that then struggle to get up to speed quickly enough.</p>
<p>The new approach holds promise elsewhere in the world as well as for other health emergencies, including other infectious diseases and chemical, biological and radiation incidents.</p>
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<strong>
Read more:
<a href="https://theconversation.com/we-cant-predict-how-bad-this-years-flu-season-will-be-but-heres-what-we-know-so-far-115303">We can't predict how bad this year's flu season will be but here's what we know so far</a>
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<h2>Pandemic flu preparedness</h2>
<p>We outline the development and benefits of the hibernated studies in an <a href="https://ees.elsevier.com/thelancetid/authorProductionTaskAssignments.asp?fn=authorProdTaskAssignments&currentpage=1">article published today</a>. </p>
<p>This initiative followed the UK’s experience during the most recent flu pandemic, the 2009 A/H1N1 strain, commonly known as “<a href="https://www.sciencedaily.com/releases/2016/06/160627160935.htm">swine flu</a>”. It caused at least 3,700 deaths in the UK and 201,200 worldwide. It was a variant of the “Spanish flu” strain that killed over 50 million people globally in 1918.</p>
<p>In 2009, the National Institute of Health Research (<a href="https://www.nihr.ac.uk/">NIHR</a>) rapidly sponsored and activated studies to inform clinical and public health responses to the outbreak. Even with accelerated processes, some were completed too late to have a significant impact. Some studies suffered from inherent delays in calling for proposals and in assessing, funding and setting up subsequent projects, including obtaining relevant ethical and regulatory approvals.</p>
<h2>Research ready to go when needed</h2>
<p>Major research networks in other countries shared the experience. In 2012, the NHIR set up a suite of studies to be maintained in a state of readiness for activation in the event of another flu pandemic. The eight studies include key care and public health aspects of a flu pandemic, including surveillance, vaccination, triage and clinical management.</p>
<p>One study is to develop rapid turnaround flu phone surveys to monitor behaviour across the general population and identify ways to better communicate public health advice. Another is to advance real-time modelling of flu epidemics and provide a tool to monitor and predict the development of an ongoing pandemic.</p>
<p>The <a href="https://ees.elsevier.com/thelancetid/l.asp?i=134757&l=BY82OTRW">study I lead</a>, the <a href="https://njl-admin.nihr.ac.uk/document/download/2002765">EAVE</a> project, aims to build a reporting platform that will determine how effective new vaccines or antiviral drugs are once a new flu pandemic is underway.</p>
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<strong>
Read more:
<a href="https://theconversation.com/whens-the-best-time-to-get-your-flu-shot-114978">When's the best time to get your flu shot?</a>
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<h2>Fostering collaboration</h2>
<p>After seven years, these studies are now mature and, we believe, illustrate the value of the potential for rapid research, as well as clinical and public health response, in a future flu pandemic.</p>
<p>Hibernation has raised a number of issues, reflecting the need to keep stakeholders (including policy makers and those hosting the research) engaged and to keep studies up to date in terms of research regulations, scientific and social changes, and technological advances. </p>
<p>One of the network’s benefits is the spirit of cooperation. All too often researchers are in competition when trying to answer research questions in an emergency situation. The research <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561545/">response to the 2014 Ebola outbreak</a> in West Africa was late and then inappropriately competitive. This resulted in several underpowered and unsuccessful studies. In contrast, the UK model allows for advance funding and planning of complementary studies, system testing and developing a collaborative network of researchers. </p>
<p>The challenge ahead is for commercially funded studies not to compete for scarce resources and to fit within this framework to ensure the highest quality studies are conducted most expediently. With this in mind, now might be the time for an international register of planned pandemic and emerging infection studies with agreements about collaboration.</p><img src="https://counter.theconversation.com/content/115594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lead UK research institutions in the network are the University of Oxford, University of Cambridge, University of Edinburgh, King’s College London, University College London, London School of Hygiene and Tropical Medicine, University of Sheffield, University of Liverpool and Nottingham University Hospitals NHS Trust
Colin Simpson receives funding from: National Institute for Health Research (UK), National Environment Research Council (UK), Health Foundation (UK), Chief Scientist Office Scotland, Medical Research Council (UK), Asthma UK, Innovate UK, H2020 (EU) and Health Research Council (NZ). </span></em></p>All too often, researchers around the world act in competition when trying to answer research questions in an emergency situation, such as outbreaks of the flu. The UK is trialling a new approach.Colin Simpson, Professor of Population Health, Te Herenga Waka — Victoria University of WellingtonLicensed as Creative Commons – attribution, no derivatives.