A synopsis

On July 13, 2020 McKinsey & Company has published an interesting article titled ‘Not the last pandemic: Investing now to reimagine public-health systems’, which can be found here. It aims to help reduce the chance of future pandemics by suggesting an investment to change health care systems.

Essentially, the article estimated that the economic disruption caused by COVID-19 could cost between $9-$33 trillion. In order to reduce the likelihood of future pandemics, a substantial investment of $70-$120 billion in the next two years and $20-$40 billion annually thereafter would be required. These investments would come from donor countries and spending would be focussed on poor / developing countries. Using the investments, five shifts in healthcare systems below aresuggested:

• Outbreak responsiveness–this is so called the ‘Always on’ systems
• Effective detection capacity–by strengthening the mechanisms to detect infectious diseases at all levels
• Targeted interventions–an integrated epidemic prevention agenda should be built in the health care systems
• Healthcare capacity–ability to divert healthcare quickly without lessening core services
• Renaissance in infectious disease R&D

Initial thoughts

The wake of COVID-19 pandemic has hit us all hard and left many lessons to learn. What we do not know is when the next global pandemic will be but what we do know is there will be the next one and more to come.

This article offers steps so that we can be prepared for the next pandemic and avoid not only deaths but also economic impact. The five shifts in healthcare systems present a highly welcoming holistic view for future pandemics–a much needed suggestion of how best we can reduce the chance of the next global devastation. The ‘Always on’ systems and partnerships that can rapidly scale up during pandemics will and should no longer be an option. The investment for future will be inevitable and amore effective spending will certainly improve the outlook of the global health.

Rethinking of the spending focus

Before we agree in the details that a significant investment is required in low-to-middle income countries for surveillance purpose, however, one should look at history of the worst pandemics.Many infectious diseases were not originated in low-or middle-income countries. Although a few e.g. Flu and COVID-19 could be traced back from Hong Kong and China subsequently, today with many technological advances, China is no longer seen as a poor country. Therefore, investing in more surveillance may not necessarily equate to the control of disease spreading. It is rather a pre-approved procedure and swift containment of the disease that would be required.

Implication of future R&D

We also need to review the current standard procedure of R&D. If COVID-19 vaccination can be tested and made available in 18 months after the outbreak, we should indeed re-imagine how we can adopt and standardize the speedy process to improve R&D for other important disease areas such as cancer and heart diseases that have killed many more population than COVID-19, not merelyR&D for new infectious diseases.

Final thoughts

Whilst it is agreeable that the risk reduction of new pandemics is a great way to move forward, we should not leave any stone unturned and the investment needs to be practical, wise and carefully studied. In reality, it is simply not about the low-to-middle in come countries. COVID-19 has proven that clearly it is rather the rich countries that have taken a deeper fall. If it is about the speed of a new infectious disease discovery (and so-called surveillance), these rich countries had a fair warning prior to the first case in their local communities. Thus, before we agree on the details, there are many remaining questions that could further clarify the issues and help us make the right decision:

• Why did the rich countries such as USA and those in the EU have much deeper hit by COVID-19 compared to the low-mid income countries like South Korea and Thailand?
• Is it about understanding how to contain the disease and when to make that call?
• What is the priority of the politicians, people’s lives or economy?
• How do we balance between these two?
• What is the role of WHO and can they unite country leaders to agree on timely containment?
• And importantly, how can we better educate ourselves and change the way we live so that we can prevent a new disease in the first place?