No, Covid-19 had nothing to do with Event 201 on 18 October 2019 in New York City. Yet it turned out to be an ominous herald. The Johns Hopkins Center for Health Security had hosted the high-level pandemic exercise in partnership with the World Economic Forum and the Bill and Melinda Gates Foundation. In attendance were global public health leaders.
Summarizing the event’s goal of asking vital questions, renowned infectious disease specialist Judy Stone wrote in the Forbes, “What will happen when an unexpectedly virulent flu, or SARS, or Disease X—any other rapidly spreading viral infections—spreads globally causing a pandemic? How prepared are we? What do we need to do to be ready?”
Soon after, the coronavirus epidemic started in Wuhan of Hubei province in China and quickly spread across the world. As Stone suggested, the old public health systems in both the developed and developing worlds seemed unprepared, hinting at the need for an overhaul with a new kind of long-term planning.
Nepal’s former Health Minister Gagan Kumar Thapa says a change in mindset is vital. “The 2015 earthquake taught us that we were short on long-term disaster planning and in dealing with health issues in such cases.” Thapa thus proposed a Mass Causality Center under the ministry, which would be operated with the help of security agencies. The proposal was forwarded to the finance ministry. “But nothing happened thereafter,” Thapa laments. “Such a center could have simultaneously treated thousands of patients.”
He also points out that the other essential during a pandemic is the capability of testing “thousands of suspected people quickly”, which should thus be our “long-term strategy.”
The coronavirus has exposed the weaknesses of health systems of the US and other powerful European countries. As short-term measures, they are rushing to build temporary hospitals and testing facilities. But most of these facilities have either been built too late or are overwhelmed. Nepal’s existing hospitals are also desperately short of ICU beds and ventilators. Nor have there been nearly enough tests to detect the presence of Covid-19 among the broader population. Broadening testing is also crucial in stopping the spread of the virus, as China and South Korea have recently shown.
More than that, there is a need for greater investment to build a robust public health system capable of dealing with pandemics. Dr. Sushil Nath Pyakurel, former Director General of Department of Health Services under the Ministry of Health and Population, says there have been several policy recommendations. “We had suggested setting up regional testing labs, to no avail,” Pyakurel says.
“It’s a tragedy that samples collected from Dhangadi and Biratnagar need to be brought to Kathmandu for tests, in what is a tardy process,” adds Pyakurel, who has also served as the chief specialist at the Ministry of Health and Population.
Pyakurel suggests the establishment of a Center for Disease Control (CDC) and its expansion in all seven provinces without delay. “We see such entities in countries like the US and India. They can conduct researches on how to deal with new viruses like corona, train healthcare workers, and inform the public,” he says.
Similarly, security agencies like Nepal Army, Nepal Police, and Armed Police Forces can be trained to prevent, detect and respond to infectious disease emergencies. Right now the security forces have their own hospitals but they have only limited capability and are in no position to handle the corona pandemic. “We have a coordinating mechanism called Health Emergency Operative Center under the Ministry of Health, a combined body of Nepal Army, police forces, the Home ministry, the Rotary club, and Red Cross. It can be activated during a pandemic,” Pyakurel says.
Indices of failure
According to the Global Health Security Index published in October 2019, none of the 195 countries in it, including developed ones, were well prepared for a pandemic. Nepal ranked 111th in the index prepared by The Economist Intelligence Unit in cooperation with the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security.
In South Asia, India, Bhutan, and Pakistan are better positioned to deal with pandemics than the other five countries in the region. Although the GHSI ranking puts Nepal in a ‘more prepared’ category in ‘maintaining health security’, the country lags in ‘detection and reporting’. The report indicates that Nepal’s laboratories, real-time surveillance and reporting, and epidemiology workforce are unprepared to tackle pandemics. Government officials say when there are outbreaks of infectious diseases like Zika and Ebola, there is some discussion on how to deal with them. Yet a collective long-term plan to handle pandemics is sorely missing.
Dr. Anup Subedi, an infectious disease physician, says dealing with pandemics is more difficult in a federal system with its fragmented and decentralized health systems. “There is a need for close coordination among federal, provincial and federal governments during pandemics,” he says, adding Nepal’s government agencies work in ad hoc manner and reactively during a crisis. “We need comprehensive measures to deal with pandemics. We also have capable manpower but the state has been unable to tap their talent.”
Due to phenomena like climate change, urbanization and globalization, more pandemics are likely in the days ahead. The Ebola in West Africa earlier this decade prompted many countries to take steps to fight large-scale epidemics but when the outbreak was controlled, their preparations were shelved too. As a long-term measure, Prime Minister KP Sharma Oli has instructed the Ministry of Health to start the process of building a separate hospital to deal with pandemics.
Common corona course
What can regional organizations do to tackle such pandemics? The successful video conference among the heads of SAARC member states suggests such regional organizations can chalk out a common strategy to fight such pandemics. Former Foreign Secretary Madhu Raman Acharya says SAARC and BIMSTEC can play a vital role in controlling pandemics both in the short and long runs.
“As a short-term measure, there could be a proper exchange of information on the virus among the countries. Both SAARC and BIMSTEC have millions in unspent money. This can be used to buy test kits, arrange for protective equipment and other logistics, and distribute them across the region,” says Acharya. “Those organizations should prepare a long-term regional strategy to build new institutions and revitalize old mechanisms.”
Now the countries are sealing their borders and canceling flights unilaterally, leaving many people stranded. Acharya reckons “perhaps organizations like SAARC and BIMSTEC can help bridge this communication gap as well.”