“Pandemic preparedness of, by and for the people”

By Oanh Khuat and Mark P. Lagon

COVID-19 has inspired leaders with vision to champion pandemic preparedness. For instance, high-, middle- and low-income nations generously replenished the Global Fund to Fight AIDS, Tuberculosis and Malaria in fall of 2022 as a tested tool to overcome three deadly diseases and emerging pandemics. A pandemic treaty is under negotiation. A trust fund for pandemic preparedness has been set up at the World Bank. A UN General Assembly High-Level Meeting in September will address pandemic preparedness. But as COVID-19 subsides as a threat, there’s a significant danger the world will neglect pandemic preparedness, or at least neglect a people-centered approach to it.

We are Vietnamese and American partners in a project with others in Asia and Africa on how to effectively advocate for investments in health programs that engage all segments of the population. Given the human and economic cost of future pandemics – in light of HIV/AIDS, SARS, Ebola and COVID-19 — , this is an important insurance policy the world cannot afford to ignore.

First, technical solutions on their own will not fully prepare us for future pandemics. We need, cutting- edge, well-funded surveillance for health emergencies, improved diagnostic tools, laboratories and drugs for prevention and treatment. But being ready to respond effectively to outbreaks – and contain them — also means thinking about people. 

For instance, in Vietnam, within just one year of being available, 98.7% of adults and 93.8% of children from 12 years old had received at least 2 COVID-19 vaccine shots, eventually thwarting the COVID-19 threat and becoming one of the first countries in Southeast Asia to remove international travel restrictions. Without the participation of the population, this would not have been possible.    

The best way to prepare for future pandemics is to build strong, resilient health systems. COVID-19 taxed those health systems in all countries. Whatever their income level, countries with more solid and nimble health systems fared best. We also know that many countries, particularly in Africa, spent years successfully fighting AIDS, TB and malaria — halving combined mortality rates in 20 years — and had structures in place to help fend off the worst impacts of COVID-19.

Health systems are not solely national health ministries and bureaucracies, brick and mortal facilities or technology. Successful pandemic preparedness requires investment in people at many levels – including local communities, civic organizations and health workers. The role of the community in a pandemic is paramount to reach marginalized and minority populations – the poor, neglected, remote, persecuted, stigmatized. People with the understanding and trust of communities to which they belong are crucial program designers and implementers.

Take Vietnam, where between 2005 and 2022, AIDS mortality had been reduced by over 60% (from over 11,000 deaths in 2005 to 4,100 in 2022). This happened thanks to the fruitful partnership between Vietnam’s health system and communities of people living with and affected by HIV. The number of anti-retroviral (ARV) treatment clinics rose from just three to five in the early 2000s to 446 in the 2020s, facilitated by the growing community networks and organizations who encourage and help people to overcome social, psychological and other barriers to testing, and to access and adhere to treatment. When COVID-19 hit, the health and community systems both accelerated their efforts.

One can see this in the COVID-19 response. People living with or most vulnerable to HIV, including sex workers and people who use drugs, had the same level of very high vaccine coverage as the general population. This would not have been possible without the efforts of community systems to inform,  support and mobilize their members and of the health system to ensure that everyone is vaccinated. 

Recruiting and training a “field force” of millions of community health workers (often not doctors or even nurses) in the next decade will pay extraordinary dividends. While addressing current health priorities and challenges, that’s a standing force poised to tackle new pandemics quickly.

In response to a pandemic, medical procedures that require medical qualifications are essential but not adequate. Many interventions, which do not require medical training, need to be delivered to make the response effective. 

For example, accurate information, mobilization of different communities, distribution of and instruction about using disease prevention commodities, removing barriers to access medical services, as well as social, psychological and other critical support such as food security, are all best delivered by communities themselves.

Gender equity is critical to pandemic preparedness, as women account for 70% of the global health workforce. Too often their needs are neglected within health systems, which continue to be led mostly by men. Retaining women in healthcare systems requires concerted efforts to close the gender pay gap, which will elevate their status and decision-making authority, and ensure opportunities for professional advancement.

Putting people first involves not just health systems but a broader fabric of social protection. Food security and nutrition – including help to those who must support their families even during disease outbreaks —  insurance coverage, education and help to those caring for family members  are crucial. A holistic approach is actually the most prudent one.

The experience of COVID-19 in Vietnam shows how this approach can work. There were no reports of people suffering from  hunger despite months of strict lock-down. People living with HIV reported helping one another to prevent ARV treatment interruption. And with progress by 2022 there is no evidence of people left unvaccinated. This was due to organized community groups working alongside the government so no one was left behind. 

All these needs are highlighted in a recent report, Putting People at the Center of Pandemic Preparedness, based on input from affected populations, health professionals, researchers and officials in lower-, middle- and high income countries as well as international organizations.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, has proven that such priorities work. Requiring the inclusion of affected communities and civil society in its own decision-making board and in the projects it funds in implementing countries  has contributed to 50 million saved from the three epidemics in 20 years, and yet more from its COVID-19 assistance based on the very same requirements.

When the world comes together to discuss pandemic preparedness in treaty negotiations and an imminent High-Level Meeting at the UN General Assembly, it would do well to think about concrete and continuous ways each country can put people first, from vulnerable groups to health workers as everyday heroes. To paraphrase Abraham Lincoln, action over mere words consists of pandemic preparedness of the people, by the people, for the people.

Dr. Khuat Thi Hai Oanh is Founder and Executive Director of the Center for Support Community Development Initiatives (SCDI) a non-governmental organization in Vietnam. Dr. Khuat has worked closely with communities of marginalized populations and been actively involved in COVID-19 relief efforts and vaccine advocacy in Vietnam. Mark P. Lagon Chief Policy Officer of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria. They are partners in the Health Education Advocacy and Learning Series, a project of community voices for investment in equitable healthcare access globally.