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Public health systems: Design now to re-imagine

Five areas to redesign public health systems

The COVID-19 crisis reminds us how underprepared the world’s public health systems are to detect and respond to emerging infectious diseases. We must make smart investments now to simultaneously navigate COVID-19 and prepare for future pandemics.

The necessity of re-imagining public health systems

The COVID-19 pandemic has exposed overlooked weaknesses in the world’s infectiousdisease-surveillance and -response capabilities— weaknesses that have persisted in spite of the obvious harm they caused during prior outbreaks.
Many countries, including some thought to have strong response capabilities, failed to detect or respond decisively to the early signs of SARS CoV-2 outbreaks. That meant they started to fight the virus’s spread after transmission was well established. Once they did mobilize, some nations struggled to ramp up public communications, testing, contact tracing, critical-care capacity, andother systems for containing infectious diseases.
Ill-defined or overlapping roles at various levels of government or between the public and private sectors resulted in further setbacks. Overall, delayed countermoves worsened the death toll and economic damage.

Correcting those weaknesses won’t be easy

Government leaders remain focused on navigating the current crisis, but making smart investments now can both accelerate COVID-19 response and strengthen public-health systems to reduce the chance of future pandemics. Investments in public health and other public goods are sorely undervalued; investments in preventive measures, whose success is invisible, even more so. Many such investments would have to be made in countries that cannot afford them.

Nevertheless, now is the moment to act

The world has seen repeated instances of what former World Bank president Jim Kim has called a cycle of “panic, neglect, panic, neglect,” whereby the terror created by a disease outbreak recedes, attention shifts, and we let our vital outbreak-fighting mechanisms atrophy.
And while some are calling the COVID-19 crisis a 100-year event, we might come to see the current pandemic as a test run for a pandemic that arrives soon, with even more serious consequences.
Imagine a disease that transmits as readily as COVID-19 but kills 25 percent of those infected and disproportionately harms children.

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Business case for re-imagining public health systems

A case for strengthening the world’s pandemic response capacity at the global, national, and local levels is compelling. The economic disruption caused by the COVID-19 pandemic could cost between $9 trillion and $33 trillion—many times more than the projected cost of preventing future pandemics.

McKinsey has estimated that spending $70 billion to $120 billion over the next two years and $20 billion to $40 billion annually after that could substantially reduce the likelihood of future pandemics. These are high-level estimates with wide error ars. They do not include all the costs of strengthening health systems around the world. A comprehensive program of health-system strengthening at all levels would cost substantially more and also contribute to effective outbreak management. Our preliminary findings call for further investigation, but the overall message is clear: infectious diseases will continueto emerge, and a vigorous program of capacity building will prepare the world to respond better than we have so far to the COVID-19 pandemic.

5 areas for investing in public health systems

This article describes the five areas that such a program might cover:
building “always on” response systems,
strengthening mechanisms for detecting infectious diseases,
integrating efforts to prevent outbreaks,
developing healthcare systems thatcan handle surges while maintaining the provision of essential services, and
accelerating R&D for diagnostics, therapeutics, and vaccines.


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