Lesson: How to avoid next outbreak… and the next

The last three months have been the longest public health roller-coaster that the world has ever seen in recent times. The emergence of Covid-19 and the viciousness with which it pronounced itself was a rude reminder that we are not done with infectious diseases yet.

Following the discovery of penicillin early in the 20th century and the elimination of small pox in 1980, there came a period of complacence regarding infectious diseases as the global community shifted its focus on elimination of these diseases. However, the last few decades have demonstrated that infectious diseases and especially viral diseases are here with us and may be becoming more lethal.

That is why we need to use the outbreak of Covid-19 as a turning point in our engagement with emerging and re-merging infectious diseases.

It’s quite evident from the events of the last three months that Covid-19 has re-engineered not only our public health system but also our social and political processes and interactions. Never before is the world afraid of massive social meltdown like now. Governments around the world are scrambling, under resource constraints, to manage the epidemic and forestall economic catastrophe. And still we remain hopeful that our global efforts will bear fruit to enable us move on with our lives.

Technical expertise

Here in Kenya, government efforts are commendable, grounded on superior technical expertise and buttressed by committed political leadership. As we begin to adjust to life in which Covid-19 defines us, it’s time to reflect on how we could better be prepared to deal with the next pandemic.

As we do this, we have to bear in mind that that Covid-19 or any other respiratory epidemic would take the form of either seasonal outbreaks, occurring only during certain months of the year, or peter out to small outbreaks occurring every couple of years. Alternatively, they could take the current form of a larger international outbreak. What is obvious is that there shall be another outbreak - the only uncertainly is its time and magnitude.

Although not much is known about it, the 1968 Hong Kong Pandemic (although less lethal than the 1918 Spanish Flu and the current Covid-19), went on to become seasonal and continues to be a leading cause of illness and hospitalisation worldwide. It is therefore not inconceivable that Covid-19 could turn into a deadly virus that wreaks havoc periodically. That is why we have to lay the groundwork for the next epidemic now!

First, we have learnt sufficient lessons from the current response. One such lesson is that you cannot separate health emergencies from universal health coverage (UHC). Indeed, investing in preparedness for health emergencies acts as an insurance against unforeseen risks to UHC.

The onward march towards UHC has been stifled as resources are preferentially shifted towards Covid-19. Just like one insures a car for about five per cent of the its value, it would not be imprudent to invest approximately five per cent of the health budget in disease preparedness and these investments should prioritise disease surveillance, county-level prepositioning of requisite health commodities and community response. We therefore need a detailed documentation of our current response, including its weaknesses, so as to build a lasting template for future strategies.

Vaccine

From a global perspective, and even as we work on a vaccine, we need to further define the transmissibility of this virus to better prepare ourselves for any future outbreaks. The controversy on whether it is airborne or not lingers. We need to understand Covid-19 risk profiles better and especially what led to explosive epidemics in Italy and Brazil.

Do people without symptoms actually spread the virus? How often and how quickly does the virus change its genetic code? Will there ever be a vaccine or masks shall become the unexpected Covid-19 vaccine?

All these require deliberate scientific collaborations with the best research centres in the world. Kenya, in particular, would need to partner with the University of Washington’s Health Metrics and Evaluation team, which already has invested in building capacity in Kenya, to develop models to predict when Covid-19 would strike next and how large it is anticipated to be. As the old adage goes, forewarned is forearmed!

As we prepare for future incidences, we have to fully embrace technology. Korea, for example, was successful both during the Middle East Respiratory Virus Syndrome (MERS) outbreak of 2005 but also with the current Covid-19 because they were able to deploy information technology at the earliest opportunity. Through smart application of phone geo-location data, credit card transaction data as well as artificial intelligence, they were able to pass information faster, do contact-tracing more efficiently and even classify infected patients based on severity of their symptoms.

Kenya has the best technology expertise and resources in Africa and can easily adapt the Korean model for this and other outbreaks. Indeed, we must foster collaboration between Safaricom and Korea Telecom as there are probably the most innovative public health telecom companies in the world.

Our lives are inevitably and irreversibly changed. Wearing masks may become our new way of life. While this may be disconcerting and may appear culturally counter-intuitive, it is conceivable that there might be a section of Kenyans who would consider wearing masks as a necessary evil. To the extent that the proportion of Kenyans wearing masks continuously reaches a critical mass, we may be able to reap its benefits in terms of reduced possibility of future Covid-19 outbreaks and those of other respiratory ailments.

Regardless of the strategic approach to prevent another pandemic, we cannot ignore history and the lessons we have learnt along the way. Our future will be secured with better preparedness secured by increased resources and optimal use of technology. [Dr Cherutich, is a public health expert and researcher]