Post-Pandemic World | It’s Time To Redesign Our World
Many prominent global healthcare experts have been warning us about the possible pandemic since the Ebola outbreak of 2014. Over the past 15 years, there has been no shortage of articles and white papers issuing dire warnings that the next global pandemic was only a matter of time. But we never seem to learn our lessons. Every time we face a global health emergency, we see it as one in a hundred years scenario. But the reality tells a different story.
If we look at the death chart of the 20th century, we can notice that 25 million died in world war 1 and 65 million died in world war 2. But apart from these two, there is another spike which is as big as the world war 2. It represents the Spanish flu that killed approximately 50 million people.
Medical historians tell us that there have been nine influenza pandemics in the past 300 years. So one in every 30 to 35 years or roughly three per century. But That trend is changing rapidly in the 21st century: first came SARS, then the swine flu, MERS, a new outbreak of Ebola, Zika, Dengue fever, and now COVID-19.
I have been working on this topic for the past two months. I studied scholarly journals, read more than 50 articles written by global health experts, and did an online course from Harvard University on preventing the next pandemic. I have mentioned all the sources, names of Academics, scholars, and global health experts at the end of the article. From why the 21st century is witnessing more outbreaks to making our world pandemic proof. From redesigning our cities to reforming the WHO. From developing a virus detecting sensor to building a surveillance mechanism. From facing the shortage of medical supplies and life-essential goods to making our global supply chains pandemic proof. From local politics to global diplomacy. Everything about creating a global healthcare system coming up.
Why this century is witnessing more and more outbreaks?
In the 21st century, epidemics are more likely to happen due to a number of reasons ranging from habitat destruction and climate change to global wildlife trade and interconnected cities everything seems to work in favor of pandemics. Urbanization, globalization and increased human consumption of animal proteins are driving the rise in epidemics significantly. If that is not enough modern transportation is making it easier for the infection to spread across countries quickly. In our global society, outbreaks of infectious diseases can move from a remote village to a major city on the other side of the world in under 36 hours. There is a clear link between the spread of viruses and the relationship between humans and the natural world. The difference between today and 100 years ago is that now we are dismantling the living world at an unprecedented rate.
Firstly We have got climate change, which is pushing animals to cooler areas like poles because animals want to get out of the heat. And that creates the opportunity for viruses and bacteria to get into new species and new areas that they were not in before. This Stress from climate change is making animals sick. As humans continue to expand into previously uninhabited areas, it is more likely that humans will come in contact with viruses that circulate in animals. In addition, due to deforestation and overfishing, pressure on animals has increased, and that is why the chances of animals getting sick have increased. Then we have Global wildlife trade. This trade is insane it is like moving animals around the world that can be potential carriers of viruses. There are over a million viruses like the novel coronavirus out there.
A research organization called Eco health alliance has found 500 different coronaviruses in bats alone, but it took them 10 years to do that work. So the bottom line is viruses are here to stay and we need to significantly transform our world to deal with them.
To effectively deal with the pandemic in future, we need to work on four key areas – Redesigning our cities, upgrading healthcare infrastructure, reforming pharmaceutical industry and finally fixing the WHO and improving the international collaboration. Let us talk about them one by one –
Public Infrastructure and Urban Spaces
Throughout the world, more and more people are migrating to cities. It is estimated that by 2050, 70% of all humans will live in cities. So, to efficiently deal with the pandemic it is essential to rethink our existing urban infrastructure. This new infrastructure is going to fundamentally change the way we conduct our public lives – because that is where these viruses mostly get transmitted from one person to another.
Our public life is closely related to places where a large number of people come together to perform a variety of tasks. The most important places where an average person visits most frequently are workplaces, Hospitals, Transportation facilities, Parks, restaurants, shopping centers, and religious places of worship. We spend 90% of our time indoors either at work or at home. So redesigning these indoor places should be the first task on our list – By using first principles thinking, let’s break down a city into its most fundamental components – Buildings, Transportation and Public places
Buildings have to be the secret weapon in the future to combat infectious diseases. Let us start with entering into a building. Some buildings are beginning to deploy temperature screening to identify people who might be ill. China and several other countries are currently measuring occupant’s temperatures prior to entering a building with the help of an infrared thermometer and utilizing thermal imaging. Typically, when people have a fever, they are at a very contagious point in their illness—with this technology, they can be made aware and directed to the appropriate avenues of testing and potentially quarantined if needed to minimize person-to-person transmission. Consider these screenings to be the new normal.
Now after entering a building, having an adequate air quality is a must – Well-filtered air minimizes the risk of virus circulation. Newer technology is making it more cost-effective to make air much cleaner. UV-C light, for example, can eliminate viruses in air treatment systems while simultaneously making equipment last longer. Bringing fresh air into buildings is also important, as is improving ventilation outside in dense neighborhoods. If you have fresh air coming in, it will minimize the time that you are exposed to any virus. Future technologies will be able to do more—sensors that can detect viruses on surfaces in real time are in the initial phase of development. They can be used to warn building occupants or trigger air cleaning. Monitoring air quality and sensors that can detect viruses are the type of technologies, which can be administered externally. This will minimize the risk of infection and the need to wear masks or other protective equipment. We are starting to see this technology in some hospitals in the United States, but it should be considered as one of our first lines of defense in all buildings, with applications beyond healthcare environments.
Now if a virus is detected we need an efficient response system. One part of that might mean creating buildings that can quickly switch to a different use in the case of an epidemic or another type of disaster. To do that we would need medical staff available 24/7 in each building. But I think corporates and governments who own these buildings are unlikely to hire a full-time medical staff. Therefore, if a person is infected he should be transported quickly to nearby hospitals for treatment. So now we are coming out of buildings and entering into Public spaces and Transportation –
Transportation and Public Places
We need to redesign public spaces so that they can also work as logistics and treatment areas in cities for epidemics like this. Public transport systems are highly vulnerable to disease outbreaks, but they are also essential for daily mobility. During a health emergency, to help get essential workers and patients around quickly, cities need to revise traffic patterns and make more room for bikes and pedestrians. Around the world, calls to increase urban sidewalk space to allow for safer pedestrian use are getting louder.
In the near future, bus operators should be able to match the changes in demand. For that, they would need to closely monitor the changes in demand and control the departure frequencies accordingly. This would mean providing more buses when passengers are more and reducing the number of bus departures when demand is low. Then at the bus stations, in order to support social distancing – operators will have to focus on avoiding crowds gathering at bus stations, terminals, and stops. To create such a mechanism we need to combine two technologies – Automatic vehicle location and an efficient passenger information system.
Automatic Vehicle Location and Passenger Information center
Automatic Vehicle location tech integrated into the transit management system can be used to monitor and manage the public transport fleet in real-time. This system gives citywide control over every aspect of transport operations. In addition, Passenger counting devices and cameras can be installed in vehicles and at bus stops. By combining all this information, operators can gather crucial data to determine the demand and schedule departures accordingly. Passengers would also need to be informed about the changes in schedule and exact arrival and departure timings.
Operators can keep their passengers fully informed, simultaneously, and consistently across a wide range of channels with a passenger information system. Before traveling via the website and mobile apps, at the start of the journey with screens at stations and solar-powered digital bus stops, and during the journey on displays in the buses. This accurate real-time information will enable travelers to plan their trip and time their arrival using mobile apps. Data collected from these apps can again be used to determine demand. So, this system has the capacity to create an efficient ecosystem.
Airports and The Spread of Corona-virus
Now if you have been paying close attention to how coronavirus spread across countries you must have noticed that airports played a major role in spreading this virus. Cities with big airports are importing more cases than cities without airports. Today almost all the major cities are globally interconnected. So transforming our airports in a way so that they could efficiently detect, prevent, and respond to any such health emergency is important. At airports, security screening could be done differently so that passengers are not forced to wait together in crowded lines. New and upgraded airports are being designed to increase security-screening lanes and reduce pinch points in passenger flow. This, along with automated screening lanes, reduces passenger wait time, congestion, and person-to-person contact.
In another approach, Changi Airport recently shifted to contactless screening for returning citizens. Now returning Singaporeans at Changi Airport Terminal 4 no longer need to produce their passports to clear immigration. Travelers simply need to look at a scanner that will employ iris and facial recognition to verify their identity. The contactless immigration clearance is faster than the current passport-and-thumbprint system. A contactless system such as this can also be used to make payments at railways, bus stations, and airports. This will minimize contact between passenger and ticket inspectors. This can be done with the help of Mobile ticketing, smartcards, and EMV contactless payments. After dealing with buildings, public spaces, and transports independently, we also need to study how the overall physical design of a city affects its ability to respond to an epidemic?
Physical Design of A City
Better physical design can be helpful in reducing population density and hence reducing crowds where viruses can easily spread. More holistic approaches to making cities healthy can also affect future epidemics by making it less likely that people get sick, and more likely that they avoid the most serious consequences. As one example, architects should start adding more outdoor space to their designs, even in super-tall buildings. A large percentage of Americans are vitamin D deficient, and some studies have linked higher vitamin D levels to a reduced risk of acute respiratory tract infection. Access to outdoor space can eliminate this risk of Vitamin D deficiency because we get it from the sunlight.
Similarly, easy access to parks encourages people to exercise and spend time outside. Parks also reduce air pollution. Polluted air is linked to health problems such as asthma, high blood pressure, and diabetes, all of which are associated with a higher risk for patients with the new coronavirus. Some potential changes in cities could be relatively simple. Deploying temporary handwashing stations or portable sinks at retail stores, banks, restaurants, bus stops, and almost all transportation facilities (Public transit Hub).
Digital Infrastructure of Cities
we need to upgrade the digital infrastructure of our cities by deploying citywide surveillance and effectively collecting and managing urban data. Surveillance is an essential foundation for monitoring and evaluating any disease process, and is especially critical when new disease agents appear. Already today, coronavirus has led to intensified use of digital infrastructure in our cities. South Korea is on the list of worst corona-affected countries. Yet it has posted some of the lowest mortality rates by effectively using a series of technological innovations – including, controversially, the mapping and publication of infected patients’ movements.
In China, authorities have enlisted the help of tech firms such as Alibaba and Tencent to track the spread of Covid-19 and are using “big data” analysis to predict where transmission clusters will emerge next. These corporations have introduced a feature on their mobile apps that assigns a colored QR code representing the health of residents. On these apps Users need to fill out an online form where they report their ID number, their travel history and any symptoms they might have that suggest an illness, such as fever or a heavy cough. After filling out the questionnaire, users receive a color-based QR-code on their mobile phones that indicates their health status. Red code suggests to remain quarantined for 14 days, yellow code for 7 and so on. Similar techniques are also being used in populous countries like India. One important lesson that Governments learned in fighting coronavirus is that, the “smart cities” are much safer cities from a public health perspective. Therefore, we can expect greater efforts to digitally capture and record our behavior in urban areas.
Who will control the surveillance system?
This question will become a topic debate in the near future. I have nothing against surveillance, but it’s very important who is doing it? who’s getting the data and how they are using that data. I mean, surveillance can always go both ways, not just government monitoring citizens but also citizens monitoring governments. Otherwise, we would face a tough situation when the government starts collecting enormous amounts of private information while its own decision-making process remains non-transparent. Parliament, Citizens and the media should also be able to closely monitor Government’s actions.
Modern planning and civil engineering were born out of the mid-19th century development of sanitation in response to the spread of malaria and cholera in cities. In the 21st century Digital infrastructure might be the sanitation of our time.Unknown
Now the next step must be to improve co-ordination between the transportation – Surveillance system and Healthcare facilities to get things done quickly. Now that we have arrived at healthcare – we all know that our current global healthcare system is incapable of handling a pandemic like this.
Coronavirus pandemic has shown us that the healthcare systems of rich and poor countries alike are not efficient in dealing with such a crisis. Firstly, it cannot recognize or predict such an outbreak in advance. Secondly, even after realizing that there is a health emergency, it is incapable of handling it. In poor countries, people do not have access to adequate healthcare and in rich ones like America healthcare is too expensive. To fix such a structurally broken healthcare system we have two options- Either we keep working on our existing emergency only system which gets activated only during the emergency or we create an everyday system that can monitor and recognize an emergency in advance and then effectively respond to it. So, how can we build such a system?
If you feel sick, where do you go first? –
If you live in a developed country you go to your local physician – In poor countries you have to visit a local community health worker. That must be our starting point. Local clinicians and health-workers must be appropriately trained to at least detect a new type of viral infection. For that, they need access to good testing facilities and they must be able to tap into the surveillance mechanism to report cases. If testing facilities are not available, they at least need to raise suspicion over a possible outbreak. This can act as an early warning system.
If a local doctor or a community health worker notices that, a person is suffering from a new type of infection and many others in that same community are showing the same symptoms. That is the right time for them to raise the alarm. In the first step, they should report cases to a higher authority by using an online disease surveillance mechanism. Secondly, they must advise infected patients to self-quarantine. Now this local response system and infrastructure must work efficiently within a broader national healthcare infrastructure of a country and vice versa.
After reporting cases, they must get assistance as quickly and efficiently as possible because these viruses are highly contagious. A COVID-19 patient can infect more than 400 people in 30 days if preventive measures such as lockdown and social distancing are not implemented. To contain the spread of virus efficient response matters a lot. For a well-coordinated response against an outbreak private and public sector, both need to work with each other within a single outbreak response mechanism. Now that we have tried to envision a local level system that might prove to be instrumental in fighting future pandemics. It is time to think about redesigning our hospitals – because once an outbreak is detected, you need better hospitals to treat the infected. The hospital at Rush University in Chicago is an ideal model to look up to for some inspiration. It has an ambulance bay that is designed to be closed off, so that patients can be safely evaluated there before entering the hospital. Inside, it has negative pressure zones that limit the spread of the virus. They can be turned on in multiple areas in case of emergency. We can also transform hospital rooms. For example, if someone suddenly becomes very, very sick we should be able to immediately turn [acute care] room into a critical care unit i.e. ICU room. By doing this we eliminate the need of transporting a patient from the general hospital ward to ICU. These architectural changes may take some time. Meanwhile, Governments need to make themselves able to conduct rapid testing once an outbreak is detected.
Governments can reach out to private healthcare facilities to identify potential volunteers for clinical trials and testing. Testing methods can also be improved to minimize the contact between the infected and healthcare workers. The self-swab developed by the Seattle Coronavirus Assessment Network, is the best example. It allows patients to take a sample themselves without possibly exposing a health worker. I hope this and other innovations in testing are scaled up across the globe soon. Until now, we talked about redesigning our cities and upgrading our healthcare infrastructure. But all of this would be useless if we don’t find cures for these infectious diseases within a short span of time.
One of the main technical challenges for developing vaccines is to improve on the old ways of manufacturing proteins, which are just too slow for responding to an epidemic. We need to build a system that can develop safe and effective vaccines and antivirals, get them approved, and deliver billions of doses within a few months of the discovery of a fast-moving pathogen. For that, we need to use a data-based approach to developing treatments and vaccines. For antivirals, there will need to be an organized system to screen existing treatments and candidate molecules in a swift and standardized manner. Another technical challenge involves constructs based on nucleic acids. These constructs can be produced within hours after a virus’s genome has been sequenced; now we need to find ways to mass-produce them at a large scale. To make all this possible industries and governments need to work together. Public-private partnerships can overcome technical, diplomatic and budgetary obstacles more easily and quickly.Then there is the question of funding. Governments will have to spend billions of dollars on pharmaceutical research and on improving the system of regulatory approvals.
Why does this require government funding—can’t the private sector solve this on its own?
Pandemic products are extraordinarily high-risk investments, and pharmaceutical companies will need public funding to de-risk their work and speed things up. Finally, world governments and industries will need to come to an agreement over – Who gets the vaccines and medicines first? During a pandemic, vaccines and antivirals should not simply be simply sold to the highest bidder. Once we have a safe and effective treatment, we will need to ensure that the first doses go to the people who need them the most.
Developing A Vaccine in only half the battle
After discovering a treatment, the next challenge is to make it affordable and accessible to everyone. And this notion of access to everyone has a lot to do with the local infrastructure and delivery system of a country. You can have biomedical technology to develop a vaccine but to deliver those medicines you need to have the infrastructure, resources, and a robust delivery system on the ground. Poor countries don’t have all of that. But why should the rich countries care about it? More on that in a minute. So how to get the medical supplies to the poorest and the most underdeveloped regions? Is a gigantic social, economic, and policy question. We tend to think of scientific solutions, social policies, and infrastructure issues separately. But instead, they all need to be integrated into a global healthcare system. And this is where our last factor comes in The global response where a lot needs to be done.
– From encouraging countries to be collaborative to reforming the world health organization – We need a well-coordinated global response to pandemics. Just like how the local healthcare infrastructure of a country needs to work efficiently within a national healthcare system. Similarly, the national healthcare infrastructure of a country should fit in well into the global healthcare system. That is the only way to speed things up in the face of crisis. This global healthcare system needs to ensure that every country has an adequate healthcare system. Now many would say why the rich countries would pay for building the infrastructure in poor countries. Because that is what exactly happened during the Ebola outbreak. Some politicians from rich countries said that Ebola is a disease of poverty why should we care about it. That was an act of self-preservation. Those people who think in this way need to understand one thing – We live in an interconnected global world – our cities are interconnected and our economies are interdependent. Any local outbreak can give rise to a global problem. To make the international community more collaborative we need to address 3 issues.
The Lack Of Trust
In many countries around the world, people have stopped trusting the healthcare system. In poor countries, people are concerned about the lack of quality and in rich countries; people are concerned about healthcare expenses. That is why during epidemics in poor and developing countries we see people not reporting illness and fleeing the hospital isolation wards and in rich ones like America, we see people worrying about healthcare expenses. During the epidemics, this lack of trust grows even stronger. This is because of something called the disease control only paradigm, which focuses more on isolating patients and stopping the spread of virus, but pays very little attention to providing them treatment and care. During the Ebola outbreak of 2014, West African nations used this same disease control only paradigm to deal with the epidemic. They walled of areas, shut down clinical institutions, and isolated suspected and confirmed case. That’s it… very little efforts were made to provide treatment and care.
Of course, these countries lacked the resources. They did not have enough health workers and medical equipment’s etc. But if these things are missing they can be brought in if international community acts efficiently. After all West African countries like Guinea, Sierra Leone and Liberia are not places that are cut off from the rest of the world. Thy have been connected to the global economy for 500 years. The upper Guinea coast has been a site of extraction of stuff like Gold, Ivory and Diamond. So it is not about getting stuff in an out. It is about two things – lack of political will and weak global response. If we can extract gold and diamonds so efficiently why we fail to supply essential healthcare stuff. If people are not treated with dignity and respect. If they don’t get high quality care. And if we are forcing people to make medical decisions based on cost. How can we expect them to respect and trust the healthcare system? If we don’t fix this then during an epidemic people are more likely to run away from the healthcare system, making it the worst global nightmare. It is impossible to fight an epidemic if people are afraid to go to the doctor. So the bottom line is we need to address this lack of trust.
Global Digital Infrastructure
We already have talked about the need for surveillance mechanism at the local and national levels. But the data collected using this mechanism needs to be shared with the global community. Even if an outbreak occurs in the remotest regions of the world, it still must be reported to the global community in real-time. That will enable a faster global response. As of now the best example we can look at is Johns Hopkins’s CSSE aggregator of information. It splashes together data sources from WHO, NHS, and so on. Many national governments’ “official” numbers lag, so there’s better information by aggregating different sources of information. This information aggregator however is confined to display the numbers of infected and the dead. To fight future pandemics we need collaborative efforts on a much broader level. We must be able to share data related to healthcare, pharmaceuticals, and scientific research. To build such mechanisms and to drive innovations we would need to establish good public-private partnerships. We will need to figure out ways to get instant approvals from Governments to share that information with the global community. And that is tricky because most countries are not comfortable sharing data with others. We have seen time and again that countries even show reluctance in reporting outbreaks. All countries need to detect, assess, notify, and report events as quickly as possible. All of this must be well thought of and agreed upon in advance.
World City Network
We also need to consider the possibility of creating a data-sharing network between all the major cities of the world. Such networks already exist today – such as Metropolis.org. They are enabling urban voices to be heard collectively on the global stage while organizing local action against challenges like the climate crisis. These networks have built strong relationships between mayors and are already showing themselves agile enough in providing a collective response to global health emergencies like covid-19. During the Health emergency, local authorities have to make decisions quickly to protect their citizens. But in order to act they need to be well informed, they need to have access to adequate information. This is where such global city networks can prove useful. They can foster collaboration and give decision-makers access to timely information, knowledge, strategies, and actionable plans implemented by governments around the globe. With the help of Volunteers and Various NGO coupled with technology, these networks can also be helpful in mapping the informal urban areas such as tightly packed slums because that is where the viruses can spread quickly. To create such networks Research institutions, civil society, and NGOs must proactively participate and contribute. This global city networks can be designed to meet an emergent crisis without totally losing sight of the continuing ones. The next thing we need to fix at the global and local level are supply chains.
How can we make our supply chains pandemic proof?
The business of moving goods from their point of origin to their destination anywhere on Earth is no small task, and the risks seem to be growing. In the era of globalization, we can now buy products manufactured in faraway countries from our local stores. What makes it possible – The International Supply Chains?
A typical supply chain not only includes the manufacturers and suppliers, but also transporters, warehouses, retailers, and customers themselves. During a health emergency like coronavirus, if your local Grocery stores are running out of essential goods and don’t seem to see supply coming – it is a supply chain problem. If medical stores are running out of medicines – it is a supply chain problem. And if hospitals are not being able to get enough medical supplies, PPE kits, and medical instruments – it is a supply chain problem. Now you know why it is important to solve this supply chain disruption. 3.
For centuries, countries mostly sent finished goods abroad: olives from Italy; wine from Spain; furs from Canada; and later on, cars from Germany; and sewing machines, printing presses, and cash registers from the United States. But now we are in the era of multi-country manufacturing – We get the raw material from one country, manufacture components in another one, and assemble all of those components to create devices like laptops or smartphones in a third country. These multi-country manufacturing processes have made our global supply chains much more complicated. When a component is produced exclusively in one country or one region, or in some cases, even in one factory, businesses around the world can suddenly find themselves without vital inputs. For example at the time of writing this script, our world is in the middle of Coronavirus pandemic and Disruptions in the production of medical supplies are already evident in the countries around the world. Hospitals and health-care workers are at the risk of being infected by the virus because masks and protective equipment are not available, in large part because most are made in China. Maybe pharmaceuticals will be next. Sure, factories all around the world churn out pills, ointments, and syrups. But many of the active ingredients in antibiotics, painkillers, insulin, antidepressants, and other medicines come from China. If shipments of these items are delayed because of the coronavirus, the health of tens of millions of people could suffer. That is just one example out of many. So what can we do? We cannot replace the entire existing manufacturing infrastructure with the new one. It will completely dismantle our international supply chains. However, we can use new effective ways of managing and handling the supply chains. So that when the next pandemic hits us hard, we will not run out of life-essential goods and medical supplies. To make supply chains pandemic proof we have three options –First and the basic one – Having large inventories
1. Large Inventories
The multi-country manufacturing we talked about became possible due to two things – Free trade policies in global markets and due to the advances in transportation, technology, and communication. Because of them, Shipping costs plummeted and suppliers managed to keep the supply coming without much disruption. On the other hand, inside the factories, corporations started using sophisticated software sensors and artificial intelligence to speed things up along the assembly lines. Now parts or components can arrive immediately before they are inserted into cars, MRI machines, and computers. From getting the supply of raw materials and components to assembling them – everything became so fast that corporations just did not give much importance to having goods stocked inside their inventories. These lean manufacturing techniques, which seek to reduce inventories, workers, idle moments, and mistakes are not useful in times of crisis. They leave companies in a short supply of products and suppliers when supply chains are disrupted.
In many corporations due to coronavirus, inventories have fallen from enough to last weeks to enough to last days and in some cases, enough to last just hours. Therefore, Industries must make themselves able to get components from multiple places and multiple suppliers. They should be prepared to pay more for backup options and to keep larger inventories on hand. Even the governments should consider building strategic stockpiles not only of petroleum and medical equipment but of other critical resources, such as the minerals that are used for manufacturing advanced technologies. And to find out where exactly a country or a corporation gets all of its supplies it needs to invest in mapping the supply chains. And that is our second option.
2. Supply Chain Mapping
Supply chain mapping is the process of engaging across companies and suppliers to document the exact source of every material, every process, and every shipment involved in bringing goods or products to the market. If corporations are well aware of the exact locations and shipping routes of their suppliers then it becomes easy for them to find alternative options in the time of crisis. Despite numerous supply-chain upheavals inflicted by disasters in the past decade — including the eruption of a volcano in Iceland, the Japanese earthquake and tsunami, Thailand floods, and Hurricanes Maria and Harvey — most companies still found themselves unprepared for the Covid-19 pandemic. Even a month after the first COVID-19 patient was reported, many companies were still in data collection and assessment mode. They were manually trying to identify which of their suppliers had a site in the specific locked-down regions of China.
But if companies start investing in supply chain mapping. They will have better visibility into the structure of their supply chains. Instead of scrambling at the last minute, they will have a lot of information at their fingertips within minutes of potential disruption. They will know exactly which suppliers, sites, parts, and products are at risk. That will allow them to put themselves first in line to secure constrained inventory and capacity at alternate sites. Even after knowing the importance of supply chain mapping many companies were unprepared because the mapping process is expensive and it needs a lot of human capital. To solve that we have a third option – Blockchain and Location intelligence.
3. Block-chain and Location Intelligence
Making use of blockchain and location intelligence technologies will allow supply chain managers to better identify risk and respond early when a pending supply disruption arises. Geospatial and location intelligence (LI) technologies can help pinpoint the flow of both primary and alternate materials. We are in an era where every movement leaves a digital footprint behind. Already today, countries around the world are using advanced location technologies to monitor the movements of individuals to assess vulnerabilities and hotspots. Several governments are using location information of individuals using mobile data, and this has helped them to predict and control the spread of the coronavirus within and across populations.
We can extend this digital tracer to every good, commodity, or exchange that touches the global supply chain. For example to solve the short supply of PPE kits. In the future – By using location intelligence we can examine its supply chain which involves raw materials, industrial chemicals, and shipping routes that touch dozens of countries in nearly every continent. With the help of location intelligence Corporations can have all this information handy. Then comes the blockchain technology, which can be used to track and secure orders and deliveries, and also to respond to existing or predicted supply chain threats transparently and efficiently. I do not claim to be an expert supply chain manager. However, I tried my best to present you with all the future possibilities.
Until now you guys must have realized the importance of international cooperation. We talked about various countries coming together, sharing surveillance and scientific research data, and also reporting outbreaks with 100% transparency and accuracy. Such a perfect global healthcare system that can not only handle the unexpected but also predict the unexpected, cannot function without proper co-ordination. It needs a central coordinating agency to lead. To get countries to co-operate we need clearly defined rules and regulations and to see if every country is fallowing them we need a strong institution. Wait for a second; we already have such an institution with its clearly defined rules and regulations. The only problem is it is not strong enough.
Reforming The World Health Organization
Historically WHO has dealt successfully with the number of infectious diseases like smallpox, HIV aids, and SARS. The WHO was created to manage the cross border spread of disease. It has the responsibility of leading the global framework for dealing with infectious outbreaks. W.H.O has laid down the set rules to follow in the form of International Health regulations.t is an instrument of international law that aims to a) assist countries to work together to save lives and livelihoods endangered by the international spread of diseases and other health risks and b) avoid unnecessary interference with international trade and travel.
Do Countries Respect International Health Regulations?
Do they act according to this so-called International Law? The answer is Big No. Only Less than 50% of the WHO member states have adequate healthcare systems that fit well into WHO global standards and norms. Since 2008, several prominent academics and global health experts have been criticizing the WHO’s weak and slow response to epidemics. It happened during Ebola and happened again during COVID-19. Human-to-human transmission of Covid-19 was detected as early as December. The Chinese government did not immediately share the virus’ genome with the international community for at least a full week afterwards. Then WHO took two whole months to finally call it a pandemic. That is too slow.
If the slow response was not enough some countries did not take COVID-19 seriously even after it was declared a pandemic. WHO had a hard time convincing its 194 member nations to follow it’s guidance. On 11 March, the day Tedros declared the coronavirus a pandemic, he spoke darkly of “alarming levels of inaction” from many countries.
Donald Trump Vs The WHO
The US president has charged the WHO with “severely mismanaging and covering up the outbreak.” For the first time, a leader of a prominent developed country has threatened to punish WHO by halting the funding to WHO. WHO started as an institution proactively handling health emergencies but in the past decade became an institution acting merely as technical support. Why?
There is a simple reason for this- WHO has a lot of heavy responsibilities but has very little power and authority. Unlike international bodies such as the World Trade Organization, the WHO, cannot bind or sanction its members. Its annual operating budget is about $2bn in 2019. This budget is smaller than that of many university hospitals and is distributed among a variety of public health and research projects. The WHO “has been drained of power and resources. Its coordinating authority and capacity have become weak and its ability to direct an international response to a life-threatening epidemic is non-existent. So the bottom line is we need to empower the WHO.
Gro Harlem Brundtland and SARS Epidemic
In 2003, the world witnessed how efficient a strong and authoritative WHO can be? In all the reports, journals, blogs I read, and interviews of experts I watched. One name keeps popping up – Gro Harlem Brundtland. She is considered as the most efficient and authoritative director-general WHO has ever had. Brundtland believed that international bodies like WHO should be prepared to lead when necessary, rather than being bossed around by powerful nations.
Brundtland pushed the WHO to use its local contacts, diplomatic channels, and the emerging internet to locate potential outbreaks, all of which made the organization less reliant on national governments for information. Within just a few years, this strategy proved its worth. In November 2002, when the Chinese government became aware of the first cases of a novel respiratory disease, later named Sars, it failed to alert the WHO. But, as part of Brundtland’s new approach, WHO staff were monitoring Chinese medical message boards and news media anyway and were already aware of it. Although the WHO had no formal powers to monitor and criticize its members, Brundtland was not shy about doing so anyway. She even publicly called out China for withholding information, claiming that the outbreak might have been contained “if the WHO had been able to help at an earlier stage. Immediately after that, China fell in line and shared its data with the WHO
Then In March 2003, as the disease spread more – reaching Hong Kong, Vietnam, and then Canada – for the first time in its history, the WHO issued advice against traveling to affected areas. Before then, the decision to advise on travel had always been left up to member states. Despite having no formal powers to ground planes, the measures worked. “Passengers and flights dropped dramatically as soon as the WHO issued the recommendations,”. The WHO’s response to SARS was considered a huge success. Fewer than 1,000 people worldwide died of the disease, despite it reaching a total of 26 countries. The pandemic was defeated not with vaccines or medicines, but with NPIs, “non-pharmaceutical interventions” such as travel warnings, tracking, testing and isolating cases, and a huge information-gathering operation across multiple countries. All of this became possible because the WHO was willing to wield authority that it had, in a sense, created simply by speaking it into existence. Brundtland did things the WHO had no authority doing. She just did them. That’s the kind of WHO we need today. It should be able to lead everyone while responding to pandemics and health emergencies.
Failure of International Health Regulations
After successfully handling SARS, in a bid to formalize its role WHO drew up a new version of the international health regulations which is the same version we have today. It stated that during an emergency, countries are expected to take the lead from the WHO’s guidelines and report any deviations to the organization. But there was one major loophole – There was no mention of consequences if countries don’t comply. The document could not give the WHO real power and authority. The WHO cannot every time use authority the way Brundtland did to handle sars. It needs to enhance compliance. It needs to encourage countries to comply – To solve this we first need to study the reasons why countries hesitate to report outbreaks.
Why Countries Hesitate To Report Outbreaks?
Countries hesitate because they fear sanctions and unnecessary trade and travel restrictions. In the Ebola crisis, at least 40 countries inforced restrictive measures on west African countries which affected their trade and economic activities. Airlines refused to fly into the region during and even after the Ebola crisis was over. The region became isolated and even sending medical help became difficult. All of this was an unnecessary punishment for countries that were already in the middle of a crisis. In the past, we have also observed China’s lack of transparency during the SARS epidemic in 2003 and Indonesia’s reluctance to share information regarding the H5N1 virus because of these same concerns.
What Can We Do To Enhance Compliance?
If we want countries to report cases with 100% transparency, we need to make sure that reporting countries do not suffer. The WHO must balance transparency and the early reporting of suspicious events with the need to protect the interests of the reporting country. So to keep the balance between the authoritative measures and compliance we need the number of incentives and disincentives in place. To encourage governments to report earlier, financing bodies like the world bank must come forward to provide financial support to deal with the emergency as well as to compensate for at least some of the economic losses that would be expected. Now if countries don’t comply – there must be consequences. The WHO must play an important role in publicly calling out countries that are not respecting the WHO guidance. One of the mistakes WHO has been making is allowing the political decisions at the local level to get into the way of implementing the strategy. This situation presents a very difficult question – How do you respect the sovereignty of a country while doing all these things getting data, not allowing local politics, provide supply chains, and essential healthcare systems? This is a question even I could not find the answer to – but the global community needs to find answers to these questions as quickly as possible.
International Health Workforce
Finally, the world needs a well-trained, well-funded, and accountable International Health Workforce. Just like how NATO and the UN have their military forces. The WHO needs an army of health workers ready to deploy in case of an emergency. We need a medical reserve corps – lots of experts ready to go. We need to pair medical with the military to take advantage of the military’s ability to move fast, do logistics, and secure areas efficiently.
All of the things we talked about would require a large amount of money. But the cost of inaction is higher than the cost of action. Already today Coronavirus is costing the world more than a 1 trillion dollar. We have everything at our disposal – Money, advances in technology, and biology but these tools need to be systematically incorporated into the global healthcare system.