Saturday, January 18, 2020

JHCHS, The Gates Foundation & WEF: 7 Pandemic Preparedness Recommendations In A Joint Call to Action



Just 90 days ago, a naturally occuring novel coronavirus sparking an epidemic was a fictional scenario used by Johns Hopkins Center For Health Security (JHCHS) - in concert with the World Economic Forum and the Bill & Melinda Gates Foundation - in a half-day table top pandemic exercise (#Event201) hosted in New York City.
JHCHS Pandemic Table Top Exercise (EVENT 201) Videos Now Available Online

The JHCHS #Event201 (Fictional) CAPS Pandemic Scenario
Johns Hopkins Pandemic Table Top Exercise (EVENT 201)
While an influenza pandemic is generally considered the most likely scenario, other viruses - particularly coronaviruses - are viewed as potential contenders as well. And unlike with influenza - the most studied of all respiratory viruses - we don't have dedicated antivirals, or the expectation of producing an emergency vaccine in a timely fashion with coronaviruses.
Despite vigorous research - 17 years after SARS, and nearly 8 years after MERS-CoV emerged in the Middle East - we still don't have an approved vaccine against either virus, and we'd have to get very lucky to see one in less than a year.
Even a relatively mild coronavirus could produce a significant impact (assuming it were spreading efficiently), given the lack of an effective armamentarium against it.
While it remains to be seen if our current 2019-nCoV has `legs' or the virulence needed to become a significant global threat, the reality is - if not now - another pandemic will happen someday.
If you haven't already viewed the Event 201 exercise, I highly recommend it. And if that doesn't satiate your thirst for pandemic tabletop exercises, you can binge watch all of the videos from 2018's day-long CLADE X pandemic tabletop exercise as well.

Yesterday, JHCHS, The Gates Foundation, and the WEF released the following press release, outlining the steps need to be taken to prepare for the next pandemic.

The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation Call for Public-Private Cooperation for Pandemic Preparedness and Response
Organizations release 7 recommendations in a joint call to action
Download a full description of each recommendation and the call to action (PDF)
January 17, 2020 - The next severe pandemic will not only cause great illness and loss of life but could also trigger major cascading economic and societal consequences that could contribute greatly to global impact and suffering. Efforts to prevent such consequences or respond to them as they unfold will require unprecedented levels of collaboration between governments, international organizations, and the private sector.
The Event 201 pandemic exercise, conducted on October 18, 2019 co-hosted by the Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation, vividly demonstrated a number of these important gaps in pandemic preparedness as well as some of the elements of the solutions between the public and private sectors that will be needed to fill them.
The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation jointly propose the following:
  • Governments, international organizations, and businesses should plan now for how essential corporate capabilities will be utilized during a large-scale pandemic.
  • Industry, national governments, and international organizations should work together to enhance internationally held stockpiles of medical countermeasures (MCMs) to enable rapid and equitable distribution during a severe pandemic.
  • Countries, international organizations, and global transportation companies should work together to maintain travel and trade during severe pandemics.
  • Governments should provide more resources and support for the development and surge manufacturing of vaccines, therapeutics, and diagnostics that will be needed during a severe pandemic.
  • Global business should recognize the economic burden of pandemics and fight for stronger preparedness.
  • International organizations should prioritize reducing economic impacts of epidemics and pandemics.
  • Governments and the private sector should assign a greater priority to developing methods to combat mis- and disinformation prior to the next pandemic response.
A full description of each recommendation and the call to action is available on the Event 201 website, along with videos of the pandemic exercise.
Over the past three years we've seen a renewed push for global pandemic preparedness, including:
CDC: 2018 Interim Guidance On Allocating & Targeting Pandemic Influenza Vaccine
WHO: Global EOC Pandemic Flu Exercise (GEOCX)
CDC/HHS Community Pandemic Mitigation Plan - 2017
ECDC: Guide To Revising The Influenza Pandemic Preparedness Plan
But the reality is, the world is far from ready to deal with a severe pandemic, as many countries have put pandemic planning on the back burner; gambling that the next pandemic will not occur anytime soon (or at least not on their watch).
In an attempt to gauge the world's pandemic readiness, in 2018 the World Health Organization sent out a 2 part questionnaire to 194 member states, and the results were published in June 2019 (see WHO: Survey Of Pandemic Preparedness In Member States).
Sadly, just over half (n=104, or 54%) of member states responded. And of those, only 92 stated they had a national pandemic plan. Nearly half (48%) of those plans were created prior to the 2009 pandemic, and have not been updated since.
Worse, only 40% of the responding countries have tested their pandemic preparedness plans - through simulated exercises - in the past 5 years.
Even among high and upper-middle income nations, pandemic planning is described as `far from optimal' - which becomes even more sobering when you realize these grades are based on self-reporting.  
There is clearly a lot of work yet to be done, and an unknown amount of time remaining in which to do it.  We dawdle at our own, considerable, risk. 
Although the following quote is from roughly 14 years ago it is just as true today as it was in 2006:
“Everything you say in advance of a pandemic seems alarmist. Anything you’ve done after it starts is inadequate."- Michael Leavitt, Former Secretary of HHS