Writing for STAT in January 2023 Dr Jerome Kim warned that the world was not learning from pandemic experience. He identified 4 key areas of concern: diagnostics, vaccine supply, vaccination, and leadership. The latter, he argues, is the “broadest and most intractable”. From HIV/AIDS to COVID-19, to the recent Ebola outbreak in Uganda, Dr Kim is concerned that the global attitude is in a “sluggish, reactive mode”.
“We are in an age of epidemics and pandemics.”
Due to a combination of factors, such as “ease of global travel” and climate change, Dr Kim states that the “risk of infectious disease outbreaks is increasing with no end in sight”. Perhaps to those of us fortunate to have been ignorant of previous outbreaks, COVID-19 “put an exclamation point” on the series of “contagions” that others have been experiencing.
We might expect that, after these waves of infection, the approach to pandemics would be one of preparation and pre-emption. However, for Dr Kim, we have 4 gaps in our mindset.
The 4 gaps
Dr Kim suggests that the 4 areas for concern are diagnostics, vaccine supply, vaccination, and leadership. These “highlight the international community’s failures”. In his view, the first 3 are “straightforward technical and funding propositions”, and we know that he and his organisation are working to promote progress here. The fourth, leadership, is “most intractable”.
“If you don’t know who has a disease or how many people have it, then no one is motivated to take preventative measures or use a vaccine, especially not in the face of global misinformation campaigns”.
Dr Kim highlights the US’ response to COVID-19, where “experts agree” that the “government’s caseload numbers underestimate” the reality. Thus, the population feels “no urgency” to get boosters.
“If a country is not manufacturing its own vaccines and is dependent on other countries for them, it may not be able to secure enough vaccine to quash an outbreak”.
Once again, Dr Kim’s example focuses on COVID-19, when wealthy countries obtained “more doses than they actually needed”, leaving “less-fortunate” countries lacking. Manufacturing, he suggests, is concentrated in the US, Europe, India, and China, and “vaccine nationalism laws” enable countries of manufacture to “appropriate vaccines intended for other countries”.
“Even if the first two gaps are fixed, but the solutions do not reach large parts of the world, then nothing has really been fixed”.
Dr Kim identifies a “deeper and more inherent” issue here. This involves “weak health systems, complex logistics, and vaccine hesitancy”.
The “biggest” gap to be “bridged”.
The WHO global COVAX scheme involves a variety of organisations, Dr Kim states. CEPI develops vaccines that Gavi purchases, and WHO tracks. “No one entity is accountable for results”.
“And there is no agency with the political muscle, funding, agility, and experience to implement at pandemic speed – or to ensure that the world is prepared for whatever comes next.”
The vaccination efforts we saw in COVID-19 were the first in which “humanity attempted to vaccinate everyone, everywhere, all at once”. Although so many people have received at least one dose, the rate is uneven across the globe.
“The world needs leadership that can enforce a more equitable and timely distribution of vaccines.”
Despite COVAX being phased out, Dr Kim believes the “role it should have played remains unfilled”.
“Infectious diseases do not respect national borders.”
What, then, does Dr Kim propose we do to face them in the future? In his article, he emphasises the need for a Global Health Security Council. This would be “public-private partnership empowered, funded, and accountable, to ensure global pandemic preparedness and response”. This would be like the UN Security Council, but “without obstructing veto power”. In ordinary (non-pandemic) time, the organisation could “plan exercises and training specific to anticipated requirements”.
“The question isn’t whether this can be figured out before the next global contagion arrives. Instead, the question is: How many contagions will it take before the world finally stops tolerating preventable deaths on a massive scale?”
To read Dr Kim’s full piece click here. For our exclusive interview with Dr Kim from a previous event click here. We look forward to hearing more from Dr Kim at the World Vaccine Congress in Washington in April. Join us by purchasing your tickets today.