The COVID 19 pandemic has once again triggered a debate among the global scientific community and policymakers on the significance of multinationals collaborations and response actions to fight pandemics such as COVID 19 and more such pandemics in future. Dr Sarthak Das, CEO Asia Pacific Leaders Malaria Alliance (APLMA), draws some inferences from past experiences and shares insights on how nations can work together to initiate a global health restoration plan in conversation with Raelene Kambli
We have had learnings from the HIV epidemic, Malaria epidemic, Ebola and other influenza outbreaks, why haven’t we yet devised a global strategy or developed a response action group that can help?
We have multilateral institutions, international alliances, and organisations that can and do help with strategy, financing and action. As a critical body that provides normative guidance to countries, there is, of course, the World Health Organization (WHO). Key actors – from the spectrum of the UN bodies such as UNICEF to the Global Fund to fight TB, AIDS, and Malaria, Gates Foundation to organisations focused on timely crisis response delivery such as Medicines Sans Frontiers. But we have to recognise that countering the infectious threats you mention involves three things:
- Sharing of data across borders on what does and does not work in terms of diagnostic tools, drugs, and other health system interventions
- A toolbox of evidence-based practice that countries can access
- most importantly interventions tailored to a regional country or subnational context that draw from 1&2. So as much as some may want there to be a “one response action group” the reality of delivery of any given intervention must be adapted to the local setting. There are certainly examples, like HIV, where globally we have done a much better job at coordination there are always implementation approaches that will look wholly different say both within and across continents and regions
How can we develop a co-operative, transparent, science-based and coordinated global response to future pandemics?
One strategy is to encourage health diplomacy as a skill set in our public health training and among professionals. Translating data effectively for senior government officials in a compelling, forthright, and simple manner is a distinct skill. The ability of governments to work together in health crises is heavily reliant upon our scientists who can do this effectively. There are so many wonderful examples of this with public health officials in action across the world in our current crisis. Unfortunately, we are also seeing that this has its limitations especially when leaders are not compelled by science. An additional important step is for leaders in all spheres to be willing to admit what they don’t know, where the gaps in knowledge still are rather than making projections or pronouncements in haste. But in the end, it comes down to Government leadership recognising that we are one world, only as strong as the weakest link and letting that serve as a foundation to open communication and coordination.
How can a global response effort help in strengthening coordination and collaboration between countries?
A global response effort requires a sense of shared responsibility for handling public health challenges that allow the pooling of international resources for the greatest possible global and local impact.
For such an effort to be successful, reliable and shareable locally generated data is the foundation of a global response. Global data is only as good as local. After all its an aggregate of inputs. Data-integrity at a sub-national level is critical and when we strengthen primary healthcare systems we improve the ability to produce high-quality data that can be used to make good decisions. Surveillance is obviously also key, and we should be ensuring that front line health workers and the primary systems they operate in are equipped with tools tailored to their needs.
Data infrastructure aside, a stronger shared responsibility can come from further strengthening regional bodies like ASEAN. A good example of cooperation is from the Greater Mekong Subregion (GMS) to fight drug-resistant malaria, where Thailand, Cambodia, Vietnam, Myanmar, and Laos have seen a precipitous decline in both vivax and falciparum malaria. These countries are confronting the challenge head-on by working together to focus on communities of migrant populations and forest dwellers who are highly mobile across their borders.
How global resources are pooled is another important consideration when assessing global to local impact. The end-users, local and regional stakeholders, must have the opportunity to feedback on what works well and what doesn’t to effectively direct resource distribution.
How crucial are multilateral institutions to our collective health, prosperity, and security?
They are vital and provide some of the only vehicles for us to collaborate across borders in a systematic manner. Otherwise, we run the risk of being engulfed by social media, inaccuracies in information sharing, and furthering misperception and the false notion that communicable disease threats respect political borders.
There are five major challenges that need to be mitigated namely: The health challenge, the financial challenge, the information challenge, prevention challenge and the economic challenge. How can a global alliance response group go about fixing it?
Broadly speaking there are three areas that may be worth focusing on:
- by listening, in particular to the most vulnerable populations and regions for they are disproportionately affected by health threats,
- ensuring that health data are rooted in local generated evidence and knowledge, and taking a transdisciplinary approach to problems
- ensuring any global alliance focused on a particular problem conducts analysis and generates solutions by working in multidisciplinary teams to understand root causes and tackling them in an integrated manner in terms of policy reform. For example, if we think about childhood malnutrition as a problem it will be as important to engage sectors such as agriculture, education, and finance in addition to the paediatrician studying stunting and brain development.
What will be the road map to develop such multilateral organisation that incorporates global health restoration in the sustainable development plan for the next decade?
One very important aspect of promoting global health restoration is the inversion of capacity building, which is to ensure we have representation in both quality and quantity from the core regions that bear the most burden of public health challenges. The present-day global health agenda and roadmap for any multi-lateral organisation must be ensuring a well-balanced representation from local and national levels. Only then can leadership be best-informed by inputs from experts who have deep local knowledge and experience of central health issues in the relevant public health settings.
Sustained capacity building across all levels of health systems, particularly local levels, will be the most critical component for achieving public health and development goals. Tailored, sub-national efforts that prioritise local level capacity building, emphasise local immersion, and advance epidemiological methods and local-to-national data capture will be of the greatest benefit.