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COVID-19 | 7 changes to expect in the global healthcare system

Global leadership has to realise that we are constantly under threat from similar outbreaks, and preparedness is the only shield we have

April 15, 2020 / 03:17 PM IST

Dr Philip Mathew

The COVID-19 outbreak is a watershed moment in the global healthcare landscape. Never before in human history has a disease caused so much economic and social upheaval simultaneously in so many countries. Some estimates project widespread job losses because of the lockdowns initiated due to the pandemic, and most countries are looking at a sharp recession.

The outbreak has laid bare the deficiencies in the public health system. Many countries had felt that they made an epidemiological transition from communicable to non-communicable diseases before the nineties; and went ahead and partially dismantled their capacity to deal with outbreaks of infections. The focus was to prevent infections from reaching their shores.

Reskilling Health Workers

However, now many advanced health systems find themselves in the middle of a rapidly escalating contagion, and the collective expertise to deal with such outbreaks is low. This will change in the post-pandemic period, and countries are going to re-skill their healthcare workers on outbreaks of infectious diseases. Existing health workers may have to undergo a training processes and professional education curricula will change for the better.


COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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The pandemic has also revealed the fragility of global health governance. Criticisms aside, the World Health Organization (WHO) has been doing a good job in advising governments and projecting a balanced view. That said, the WHO’s mandate is severely limited due to the very nature of its existence and its dependence on governments for funding.

Better Global Governance

Agencies such as the G-20 and the Organization for Economic Cooperation & Development (OECD) can complement the United Nations (UN) agencies through its reach and influence — though we are yet to see it during this epidemic. Even the protracted negotiations within the European Union (EU) and failure to support the member countries on time shows that we need a better co-ordinated global governance system for health issues.

It may be difficult to get the ball rolling in the immediate post-pandemic period due to policy instability in many high-income countries, but this outbreak will surely pave the way for a better governance process. It is likely to be broadly complementary to the WHO.

Strategic Stockpiles

During the Cold War and in the immediate aftermath of the 1973 oil shock, many countries maintained strategic stockpiles of essential goods and medical supplies. Some continued the practice, while most abandoned it. The United States maintains a modest stockpile while Finland continues to stock on a significant scale even now. Those countries which abandoned this practice pointed at the highly globalised world and the economic inefficiencies associated with maintaining large stocks. However, we are seeing the advantages of maintaining a strategic stockpile and this may become more evident when the outbreak evolves further.

world-after-covid-19-option3-revisedIt will take time for the supply chains to get normalised and we may see shortages of medicines. It is not clear if this is a feasible strategy for developing countries, but more governments will start the process of establishing strategic stockpiles. This may be even used as one of the tools to kick-start the economy in the short term.

Focus On Essential Supplies

A lot has been said about the need for the public sector to maintain control over pharmaceutical manufacturing. Most of the larger pharmaceutical firms are exiting the antibiotics vertical due to poor returns. There have been very little investments for Research and Development (R&D) of vaccines for neglected tropical diseases which still claim millions of lives.

Here there is a definite role for governments to intervene and ensure that essential medicines are not left to the vagaries of market forces. There are several options available, from contract manufacturing, publicly-owned production facilities, incentivising products, exploring innovative financing options for research and promoting not-for-profit agencies to manage production of essential medicines. I anticipate that there will be a large push towards greater public control of pharmaceutical production and medical equipment manufacturing.

Vaccines For All

Vaccine research has also suffered in the last few decades due to a chronic lack of funding where pharmaceutical giants and governments have shied away from putting significant money into its R&D. In many cases, vaccine research has been driven by funding from philanthropies.

Some virologists see the current outbreak as a warning sign and say that increasing environmental pressures can spawn more such viruses with human-to-human transmissibility. The money needed for vaccine research pales when compared to the global losses due to a pandemic, and this has now been proven beyond doubt. Therefore, governments may get proactive and money will flow into vaccine research. I hope that the global health community will also think about restrictive intellectual property regulations which may prevent economic access to vaccines in developing countries.

Bridging The Divide

Another change that we may see in the coming years is the bridging of the traditional north-south divide in global health practice. In the current pandemic, the developing countries have relied on techniques which are not similar to those practiced by high-income countries. Even in issuing treatment protocols or mandating ‘social distancing’ the countries of the global south have charted an independent course.

The term ‘decolonising global health’ is gaining currency across the world. I do not agree with the choice of terminology, but the idea behind such a move is valid. Developing countries will start investing in building their own public health capacity and this will be a systematic process over a long time. Capacity building is a long drawn out process, but it will finally pay off for everyone involved.

Universal Health Coverage

Lastly, we have seen that countries which lack an effective primary care system struggling to control the outbreak. The US, with all its financial prowess and well-managed hospital system, is still struggling with a large case load. The issues have been accentuated by the lack of access to healthcare, in the absence of a Universal Health Coverage (UHC) system.

Though the UHC has featured prominently in the ongoing presidential primaries, it has not yet captured the attention of the entire population. In the last decade, the UHC has been firmly placed in the global health agenda due to actions taken by UN General Assembly and the WHO. There is a larger consensus that the UHC has to be achieved through higher investments in health and a strong primary healthcare system. The world should move in this direction as equitable access to healthcare is the mainstay for improving the health of the society.

The global leadership has to realise that we are constantly under threat from similar outbreaks, and preparedness is the only shield we have. When such an outbreak happens, hindsight is a luxury that we cannot afford. Our healthcare system needs to undergo a drastic change to prevent the same mistakes from happening again.

Dr Philip Mathew is a physician and a public health researcher. Views are personal.

This is the fourth article in a multi-part series, World After COVID-19, which looks at the probable developments in various sectors: macro economy, trade, healthcare, agriculture, judiciary, international politics and sports.
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