In May 2021, The Independent Panel for Pandemic Preparedness and Response presented its final report on the response to the COVID-19 pandemic to the World Health Organization. A significant lesson from the report is that standard EHSQ practices could have improved the COVID-19 response, reinforcing the importance of organizational learning and system preparedness.
The report, titled COVID-19: Make it the Last Pandemic, aims to provide insights into how the world responded to the fast-moving pandemic in its early stages, as well as how to learn the important lessons that can mitigate the impact of future health crises. While the report contains many frustrating and heart-breaking insights, EHSQ professionals will probably recognize some familiar themes. This summary will provide some examples of important elements of the COVID-19 response and the lessons we can learn from them.
Summary of the Impact of COVID-19
The report describes COVID-19 as the 21st century’s Chernobyl moment: “…not because a disease outbreak is like a nuclear accident, but because it has shown so clearly the gravity of the threat to our health and well-being.” The list of impacts the pandemic has had around the world is shocking:
- 164 million people have been infected, with almost 3.4 million deaths (as of May 17, 2021).
- 17,000 health care workers have died from COVID-19.
- The world economy is expected to lose $22 trillion between 2020-2025, which is the most significant economic crisis since the Second World War.
- At the highest point of the pandemic in 2020, 90% of schoolchildren were out of school.
- In some parts of the world, 10 million girls are at increased risk of early marriage because of the economic and social impact of the pandemic.
- Services providing support to people experiencing gender-based violence have seen a five-fold increase in demand for services.
- 115-125 million people have become extremely impoverished.
Why Was the Pandemic So Bad?
The report does not shy away from casting blame for the terrible impact of the pandemic, stating: “Current institutions, public and private, failed to protect people from a devastating pandemic. Without change, they will not prevent a future one.”
While the World Health Organization declared the novel coronavirus a Public Health Emergency of International Concern (PHEIC) on January 30, 2021, the panel determined that there was sufficient evidence to make this declaration when the WHO Emergency Committee met on January 22. The eight-day delay meant that governments lost crucial time responding to the crisis. Further, this inspired many governments to take a “wait and see” approach to the pandemic, which gave the coronavirus ample time to spread further across the globe.
The panel also found that the alert system for global pandemics is not equipped to respond at a speed that was proportionate to the spread of the virus. Perhaps most significantly, many national governments lacked preparedness plans that had support from the highest national leadership, and the metrics used to determine their levels of preparedness did not reflect the complexity of their national context. For example, the United States ranked the highest in its aggregate score on the Global Health Security Index. However, within that ranking are very low scores for access to universal health care and public confidence in government. Many nations that seemed prepared on paper buckled under the stress of a real-life emergency.
The Perspective from EHSQ
EHSQ practitioners will recognize the importance of stress-testing complex response systems with drills and simulations, as well as the importance of managing the risk of anticipating only low-impact events instead of high-impact/low-probability events like pandemics and natural disasters. Learning the lessons from past incidents and drills is a crucial component of the organizational learning required to respond to emergency situations like pandemics.
The concept of Plan-Do-Check-Act is built on the premise that the system must be constantly tested, observed and modified to facilitate continuous improvement and meet the challenge of changing conditions. According to the panel, nations around the world failed to understand fundamental principles that every EHSQ practitioner should implicitly understand, such as the importance of leadership support for the system, coordination across different organizations and informed decision-making. Some research suggests that the knowledge derived from previous experience of real-life crises can go a long way to mitigating other shortcomings, such as lack of technology and infrastructure.
At the beginning of the pandemic, many health experts feared the impact of the coronavirus on Sub-Saharan Africa because of the lack of sophisticated health infrastructure compared to that of Western nations. However, compared with the infection and mortality rate in the United States and the United Kingdom, Africa has fared remarkably well. According to researchers, while the lack of critical technology and testing was undoubtedly a serious constraint, many African nations had significant experience with Ebola, Tuberculosis and HIV epidemics, which meant that healthcare practitioners had significant real-world learning and understanding of the path the pandemic was likely to follow and were able to implement high-impact safety measures.
While future research will help to clarify this, it seems that, at least for now, human knowledge formed by real-world experience has allowed many African health organizations to respond to the COVID-19 pandemic with results that are at least commensurate with, if not better than, those of Western nations whose high technology infrastructure was not enough to overcome failures of leadership and resiliency.
What we learn from the failed response to the COVID-19 pandemic will, hopefully, save lives by making nations and organizations more resilient in response to future pandemics. It should also remind EHSQ practitioners of the critical importance of engaging in continuous improvement of systems to ensure they can meet high-impact/low-probability events when they inevitably arise.