It does not take a pandemic for governments to develop a public health cadre to deliver healthcare, because clearly there is a need, says Dr Soumya Swaminathan, until recently the World Health Organization’s (WHO) Chief Scientist.
The WHO recently downgraded Covid-19 and Mpox (monkey pox) from being a global health “emergency”. But addressing the ongoing World Health Assembly, WHO chief Dr Tedros Adhanom Ghebreyesus cautioned, “When the next pandemic comes knocking — and it will — we must be ready to answer decisively, collectively and equitably.”
Against this backdrop, Swaminathan speaks to businessline’s Pulse on learnings from the last three years, including the need for skilled human resources and a research blue print to tailor responses for disease outbreaks.
“Every State needs to build a public health cadre,” she said, of the multi disciplinary crew that would comprise doctors, nurses, entomologists, data scientists and others with different skills, working together. “The public health cadre does not wait for the next pandemic,” she says, pointing to the recent Anthrax outbreak as an example, that was not picked up despite animals being sick and dying.
“We talk of One health, this is what it means, a public health cadre would also have veterinarians,” she said, since people in rural areas live in close contact with their animals, and given the concern of zoonotic diseases. Swaminathan is presently Chairperson, MS Swaminathan Research Foundation (MSSRF).
Blue print
She calls for a research and development blue-print in line with the country’s public health needs, diagnostics, treatment, etc. “We don’t need to wait for the next pandemic, we have diseases today that affect people for which we don’t have the tools. We don’t have vaccines for dengue, chikungunya. We don’t have a point-of-care test for many diseases so there are things that industry could be asked to work on,” she points out. The blue print should also outline response to an outbreak — “it could be an epidemic or localised outbreak, but we know the way to bring these things under control if you have an effective diagnostic test, an effective vaccine and treatment,” says Swaminathan. Pointing to threats like Nipah, viral encephalitis, she says, even localised outbreaks kill, so if there are counter measures, it would help prepare for the big one when it happens.
‘Continue collaborations’
Reflecting on the early days of the pandemic, Swaminathan says, the world was not prepared. High-income countries that generally have good health systems, were in fact badly hit. Whereas some low income countries that had built up their public health cadre and community health workers, did better, she points out. Several international committees were instituted to plug deficiencies and facilitate collaborations to improve access to drugs, diagnostics and vaccines, among others.
“The pandemic is not over, Covid has not gone away, people are still going to get sick, people are still going to need drugs and diagnostics… we are going to need products in the future… so it’s going to be important that they still remain accessible and affordable to people,” she says, calling for collaborations that were inked during the pandemic to continue. WHO’s Covax facility may be gradually phased out, but the delivery partnerships put in place for low income economies will continue in some form, she adds.
India’s drug and vaccine makers were part of several international collaborations involving Covid-19 linked therapies — AstraZeneca and Novavax had collaborations with India’s Serum Institute, while companies like Gilead, Merck and Pfizer formalised multiple alliances directly or through the Medicines Patent Pool, on their respective antivirals—Remdesivir, Molnupiravir and Paxlovid.
Track adverse effects
Several therapies were fast tracked and introduced into the system during the crisis. International public health voices are now calling for greater scrutiny of the scientific data and possible side-effects. For instance, some European countries did not give the AstraZeneca vaccine in some age groups due to clotting concerns. But the same vaccine through an alliance with Serum Institute was the mainstay in India.
Explaining this, Swaminathan said, Europe had multiple options and they could afford to go with mRNA vaccines, given its claims of high efficacy. For majority of low and middle income countries, there was really no other option. That said, she calls for the review of these adverse event cases.
Further, the former Chief Scientist points out that WHO continually did risk benefit analysis, and throughout the pandemic it said vaccines were safe and effective and the side-effects were minimal. In fact, they had disagreed with Europe’s decision, but every country has its own standards, safety reviews etc, she said, on one issue that will see much deliberation, well beyond this pandemic.