New BMJ Collection Commissioned By Independent Panel Takes Deep Dive Into Global And National Responses

Landmark series of COVID-19 peer-reviewed articles provides unparalleled overview of global and national successes and challenges

Nine-paper series commissioned by the Independent Panel and published as a British Medical Journal collection provides a roadmap to end this pandemic and thwart future health threats

29 November 2022 - London Today an esteemed peer-reviewed journal publishes a collection of Independent Panel-commissioned articles, that show how and why the world and individual countries succeeded or failed against COVID-19. The collection points to solutions that can end COVID-19 and make it the last pandemic of such devastation.

The British Medical Journal collection, entitled Covid-19 preparedness and response: Implications for future pandemics, presents a series of articles that delve deep to unravel the complexities of the pandemic responses of 28 countries representing all income levels.

The series also includes an analysis and endorsement of the recommendations of the Independent Panel for Pandemic Preparedness and Response, including an account of the strengths and challenges of the Access to COVID-19 Tools Accelerator (ACT-A).

“We believe these studies, based on real-time data and analysis, can have a practical impact on the plans and actions required to bring COVID-19 to an end as fast as possible, and critically, to help guide global agencies and countries to reform systems and prepare for a new pandemic threat,” said Dr. Kamran Abbasi, Executive Editor of the British Medical Journal.

“In May, The Independent Panel for Pandemic Preparedness and Response distilled untold thousands of hours of research into a concise report. We are proud to publish much of the evidence that underlies their report and essential package of recommendations,” said Dr. Abbasi.

Global actions, including reform of ACT-A
The series is headlined by a lead joint editorial authored by Her Excellency Ellen Johnson Sirleaf and the Right Honourable Helen Clark, who co-chaired The Independent Panel.

They review the progress against the package of recommendations made in the Panel’s main report in May, and find that six months later there is some reason for optimism, but note “the world is still dangerously unprepared for when the next pandemic threat emerges.”

Two articles go on to examine the key package of recommendations the Panel made in May. One makes a clear case for a reset of international systems for pandemic preparedness and response, and underscores the need for the combination of measures recommended by the Panel including leader-level commitment, finance, equitable access to global public goods, new legal instruments, and a stronger WHO.

An article focussed largely on ACT-A highlights how global efforts have been unsuccessful in providing equitable access to COVID-19 vaccines, therapeutics and diagnostics, and that a core underlying issue is lack of a shared vision to consider these tools a global health commons.

In order to succeed, authors argue that “future systems should be reshaped to ensure equitable access is considered from design through to manufacturing and procurement processes.” This should include agreements around technology transfer and intellectual property licensing, regional trial networks, inclusive governance, and substantial predictable funding.

Factors for national success
Six of the articles extrapolate from an unprecedented global study of 28 countries of all income levels, and their varied responses to the spread of COVID-19. More than 40 researchers from around the world combed through country information, conducted numerous interviews, and validated their results with global experts.

“We found that the most successful national responses happened in countries where the President or Prime Minister took charge, and coordinated a response across all relevant sectors,” said Dr. Helena Legido-Quigley, Associate Professor at the Saw Swee Hock School of Public Health, National University of Singapore and the London School of Hygiene and Tropical Medicine and senior author and coordinator of the series.

"The classic approach to ‘leadership’ was also upended. Government members and those involved in national responses highly valued empathy in leadership and recognised that putting communities at the centre of responses is a key to secure public health and national economies.”

The series examines several facets of national response including the challenge of narratives that falsely dichotomise and thereby polarise debates; qualitative factors including leadership, trust, social cohesion and culture; the importance of investment in public health, in communication and community engagement; and the drivers, complexities and uncertainties leaders face and must overcome.

A clear framework to make sense of a complex ecosystem
“A pandemic threat emerges in a complex ecosystem that is different from country to country - and is shaped by pre-existing factors such as demographics, economics and political institutions; the nature of the pathogen itself and where it thrives; and the way governments are equipped and decide to manage the threat,” said Victoria Haldane, a lead author, based at the University of Toronto.

“Nations must recognize that the pandemic reflects our collective neglect of the social, political, economic, ecological, and cultural determinants of health and well-being. Thus, to ensure pandemic preparedness and response, countries should take immediate action to move beyond piecemeal and inequitable approaches.”

Initial response sets the future trajectory
The authors also examined the strategies countries followed at the outset of spread of COVID-19 and found a correlation between those choices and the way a pandemic evolves.

“We found that the approach and strategy used in the initial response - whether aggressive containment or mitigation - has a bearing on the trajectory of the pandemic through the first and into the second year,” said Dr. Anne-Sophie Jung, Research Fellow at the London School of Hygiene and Tropical Medicine and a lead author.

“When a next health threat emerges, making the right strategic choices early will not only make the difference between life and death, but will shape how taxing and for how long a pandemic continues.”

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