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    By Dana Burduja and Anna Lynch

    It has to be faced: There will be another pandemic—it’s just inevitable. But the natural tendency among decision makers is to act as though it will never happen. That’s because preparation is costly and may not pay off for a long time. We have to ensure that policymakers back preparedness now, while the impact of COVID-19 is still fresh and before the onset of wishful forgetting.

    COVID-19 is not yet gone, of course. We can look forward to the end of the pandemic, but the disease will remain with us, perhaps becoming endemic. Still, its impact has been profound on life, society and the economy. If we want to ensure that the next pandemic may have less of an epochal and catastrophic effect, scientists and policymakers need to come together to prepare for a new and different kind of pandemic. We can’t foresee exactly what kind of disease may strike, but we have learnt lessons during this pandemic that can be applied to our planning for the future—now.

    Some of this preparedness is generic, rather than specific to the disease—whatever it may be—that next ravages the world. One major lesson we have learnt is that surveillance of infectious diseases and the level of research into them had been dwindling. The more attractive areas of scientific research have been focused on the very real threats posed by conditions such as heart disease and cancer. The pandemic allows us to point to the crucial importance of research into infectious diseases—particularly how a pandemic progresses, vital diagnostic tools and potential treatments or vaccines. Most of all, the understanding on a political level of the potential economic and societal impact of a pandemic is significant.

    Political leaders must take responsibility for the risks posed by pandemic preparedness. They must give more weight to—and restructure—the aspects of the scientific community that have not functioned optimally during the COVID-19 pandemic, including behemoth structures such as the World Health Organization, where processes and functions have been shown to be outdated or outpaced.

    Global collaboration for pandemic preparedness

    Increased financing for pandemic preparedness is a difficult thing to sell to political leaders, because it provides zero return in the short- and medium-term. Nonetheless, it comes with a huge economic impact when the pandemic eventually strikes. To play that long game requires a lot of political commitment.

    That’s particularly true when investment in health systems is generally low. Even rich countries fall below the 7% to 10% of gross domestic product that is typically aimed at, so that universal health coverage targets can be met by 2030. To take some of that money and spend it on preventative measures is complicated. Preparedness needs strong political support. We can only hope that the abyss into which politicians stared during the COVID-19 pandemic will encourage them to spend now for a big return during the next pandemic.

    The pandemic stressed international collaboration, especially during the early stages of the lockdowns in spring 2020. Political leaders now need to instil a true will to collaborate, globally. Because pandemics have an impact all around the world. With travelling, supply chains and access to information now truly global, collaboration must be closer on reliable information sharing, best practice, data sharing, research, distribution of medical supplies (such as protective equipment) and vaccines, including donations to poorer countries. That kind of cooperation doesn’t necessarily come easily in current world politics, but it’s crucial.

    A library of vaccines

    What might this international cooperation mean in concrete terms?

    Once the genome of COVID-19 was published, it took established researchers no more than three months to design the formula for the vaccine. (Testing and production took longer.) Some of those same researchers now say that, with sufficient funding, they could design formulas for the most common pandemic threats of the future, using the new technologies developed for COVID-19.

    This, according to the Coalition for Epidemic Preparedness and Innovations (CEPI), would require €3.5 billion of investment, just for the design phase. Without this kind of research, CEPI warns of the possible mutation of far more lethal viruses, such as Middle East Respiratory Syndrome, so that they might take on the highly transmissible qualities of COVID-19. That combination, according to CEPI, could be “civilisation-shattering.” CEPI proposes research to create a “library of vaccines,” as well as financing for manufacturing and distribution infrastructure. Certainly, this is something world leaders ought to agree upon, joining public investment with private sector resources, so that this research can be globally available when the next pandemic hits.

    Nonetheless , it’s unlikely that we will see a major shift in research funding from the higher profile areas of cardiology and oncology towards infectious diseases in the short term. The COVID-19 vaccines came from little-known companies, such as BioNTech, the German firm backed by the European Investment Bank that was the first to have its vaccine approved, and from long-term research projects, like the University of Oxford team whose work lead to the AstraZeneca vaccine. It wasn’t the result of big research programmes by the biggest industrial players, many of which had long exited the area of infectious disease R&D in favour of more profitable ventures.

    Vaccine development for COVID-19 was also unprecedentedly swift. This was partially because regulatory authorities put in place exceptional measures to enable companies to submit scientific data as and when available, thereby expediting the regulatory review process. But this also meant that they put a lot of their other work on hold to focus on the vaccines. Many companies did the same, prioritising COVID-19 research over other programmes, with collaboration between pharmaceutical firms at a level we have never seen before.

    But medicines or vaccines generally take 10 or 12 years to develop. There’s a risk that, if we take our eye off the ball, attention—and research money—will move elsewhere, as soon as COVID-19 becomes an unpleasant memory.

    EU support for pandemic preparedness

    The public sector is key to funding at that early stage of drug development. It’s also at the final delivery end, too.

    When a pandemic strikes, the hospital sector will inevitably deal with the most severe cases. That proved to be a huge pressure on most of the health sectors in the European Union or outside. In line with European Commission policies and principles, the European Investment Bank supports equity of access to quality and affordable healthcare. That means investment to reshape the system, to ensure better and more equitable access to healthcare resources, mostly through modern technologies.

    There’s no financial return on these investments, but there is a huge economic benefit. The pandemic highlighted how important it is to have a health sector that’s well prepared, not just for the health of citizens, but also for the health of the economy in which they live and work.

    The European Investment Bank has been prominent in supporting the purchase of more ventilators, mobile hospital units and mobile intensive care units. But we can’t train staff overnight. There has been for a while a desperate need for investment in the training of nurses, doctors and support staff over a period of years. The pandemic just revealed the significant gaps.

    And a need for modern technology to reduce the workload of medical staff. That’s why we financed projects that encouraged telemedicine, the training and retraining of medical workers, and facilities that would develop a flexible approach to providing medical care. 

    The European Investment Bank supports equity of access to quality and affordable healthcare…mostly through modern technologies.

    Hospitals reconfigured

    A very simple example reflects what we can do to ready hospitals for the next pandemic.

    Most of the hospitals whose construction we finance are designed with special areas that, in case of an emergency, can be turned into isolation areas, as well as having a maximum of one or two patient beds per room. In a hospital along these lines, it’s much easier to treat COVID-19 patients in the same facility as non-COVID-19 patients, expanding the COVID-19 dedicated area as needed. Compare that to older facilities, where the large, inflexible spaces forced hospitals to treat COVID-19 patients, to the exclusion of other patients. That reduced the system’s capacity to treat chronic patients with other medical conditions. It also meant that medical staff needed to be separated within the facility. We’re preparing some new eligibility criteria for our projects that will incorporate this type of flexibility, alongside preparedness and resilience components.

    We’re also financing primary healthcare centres in the community, so that a lot of basic health delivery can come without the involvement of a hospital. We have backed primary healthcare centres in Ireland and Austria. The patient will experience more of a community feeling. Instead of visiting a general practitioner and then running around the system to get the rest of the services that they need, they will get a one-stop shop. The centre can solve most medical issues up to the level of specialist care.

    Integrated primary healthcare centres also lean a lot on education, public health and prevention, as well as treatment. They will be physically present in the community with extended working hours, with staff from different specialities and will possibly be digitally integrated with the rest of the health system and perhaps the patients themselves.

    Beyond digital borders

    Another layer of complication, in the European Union, at least, is that health systems are still the complete responsibility of the individual member states.

    There are guiding policies and principles for health policy priorities within the European Union, but delivery, financing, organization—including access and use of personal data for medical purposes—is in the hands of each country. The ideal situation for pandemic preparedness would be a unique patient identifier (topped up with basic medical information) that, at the EU level, can be interchangeable among different countries. The COVID certificate or passport is the right move forward, piloting how information can be shared across the European Union without digital borders. It could be the beginning of something bigger, leading perhaps to the sharing of patient files and information.

    Ultimately, communication about science is central to all these levels of preparedness, because it creates political consensus—around valid scientific data, information and analysis—and acceptance of all the necessary measures among the public. There needs to be a clear channel of communication between scientists and political leaders, so that policy decisions are made on the basis of real information, not fake news and disinformation. Without that, any amount of good planning could still leave us all at risk of the next pandemic. In every sense, we must ensure that no one behaves as though COVID-19 didn’t happen.

    Dana Burduja is senior health economist and Anna Lynch is a senior life sciences specialist in the life sciences and health division at the European Investment Bank.