Policy and planning for large epidemics and pandemics - challenges and lessons learned from COVID-19

Abstract

Purpose of review: The COVID-19 pandemic is a global catastrophe that has led to untold suffering and death. Many previously identified policy challenges in planning for large epidemics and pandemics have been brought to the fore, and new ones have emerged. Here, we review key policy challenges and lessons learned from the COVID-19 pandemic in order to be better prepared for the future.

Recent findings: The most important challenges facing policymakers include financing outbreak preparedness and response in a complex political environment with limited resources, coordinating response efforts among a growing and diverse range of national and international actors, accurately assessing national outbreak preparedness, addressing the shortfall in the global health workforce, building surge capacity of both human and material resources, balancing investments in public health and curative services, building capacity for outbreak-related research and development, and reinforcing measures for infection prevention and control.

Summary: In recent years, numerous epidemics and pandemics have caused not only considerable loss of life, but billions of dollars of economic loss. The COVID-19 pandemic served as a wake-up call and led to the implementation of relevant policies and countermeasures. Nevertheless, many questions remain and much work to be done. Wise policies and approaches for outbreak control exist but will require the political will to implement them.

Box 1

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FIGURE 1

Cumulative proportion of the population vaccinated with at least one dose by income group, 2021.

FIGURE 2

The Sturgis Motorcycle Rally, pictured here in 2018, is held every year in Sturgis, South Dakota (population 6,958). The August 2020 rally was the biggest gathering of people during the pandemic in the US to date, and possibly globally, and was held at a time when the US was reporting approximately 50,000 new COVID-19 cases a day. Although the majority of Sturgis residents did not support the event, with commercial interests at play, local leaders gave the go-ahead. Masks and social distancing were recommended, but not required, and were subsequently ignored by many attendees. Subsequent epidemiologic analysis revealed that at least 649 COVID-19 cases and one death in 10 US states could be connected to the rally, although the actual figures were probably higher, since many attendees refused to cooperate with health authorities [38]. Cell phone data showed that 61% of US counties had been visited by a Sturgis Rally attendee, creating a travel hub comparable to a major US city, with analyses estimating that the rally generated public health costs of approximately $12.2 billion [39], although the study's methodology have been questioned. South Dakota governor Kristi Noem deemed the analysis ‘fiction’ and an ‘attack on those who exercised their personal freedom to attend Sturgis’. The rally serves as an example of how deep-rooted social, cultural, economic, political and ethical influences can affect disease control in the absence of robust legal safeguards to protect public health. Photo credit: 125509667/Motorcycle Rally © Phillip Lowe | Dreamstime.com.