“The world needs to prepare for pandemics in the same serious way it prepares for war. This should absolutely be a priority. There's no need to panic. We don't have to hoard cans of spaghetti or go down to the basement. But we need to get going because time is not on our side. In fact, if there's one positive thing that can come out of the Ebola epidemic, it's that it can serve as an early warning, a wake-up call. If we start now, we can be ready for the next pandemic.”
These words were spoken six years ago by Bill Gates, a champion of vaccines and global health equality, in the midst of the outbreak of Ebola in Africa. Ebola happened in Africa and went unnoticed especially, by the developed world. It took around four years even to develop a vaccine. But now that we are living through an actual pandemic, we realise how prescient these words have been. Yet, the entire world was woefully underprepared for a contagion of this magnitude.
Incidentally, Contagion, a movie from 2011, forecast the present Coronavirus pandemic with uncanny precision. Not only Bill Gates, but also many scientists and the World Health Organization (WHO) itself had warned of a “Disease X” that could potentially wipe out much of humanity. Luckily for us, the Coronavirus disease now known as Covid-19 has a much lower mortality rate when compared to previous Coronavirus diseases such as MERS and SARS. Nonetheless, it has claimed 2.3 million lives worldwide, at least half of which could have been prevented if the world was a little more ready to confront a disease of this magnitude.
Around 107 million people around the world have been infected. This would seem to be a blip in terms of the world population of eight billion, but one just has to look at the damage caused in socio-economic terms to countries both rich and poor to understand the enormity of the challenge. In any case, the pandemic is showing no signs of slowing down, with more transmissible and potentially more lethal variants of the virus cropping up in several countries.
This will continue as long as ‘vaccine nationalism’ and ‘vaccine hoarding’ continue, on the part of the developed world. Some Western countries have ordered enough vaccines to inoculate their populations 10 times over.
They have ‘locked in’ orders that could have gone to developing countries. This could negate the massive victory mankind has gained by developing several effective vaccines in less than one year. Health experts and policy planners often repeat the phrase ‘no one is safe until everyone is safe’ with regard to Covid-19.
The Organisation for Economic Cooperation and Development (OECD) has estimated that the global economy will suffer a US$ 9.2 trillion loss as a result of vaccine nationalism, with developed countries poised to absorb as much as US$ 5 trillion from that loss. Thus it is in their economic interest to pave the way for a more equitable distribution of vaccines around the world.
Moving on from the vaccine debate, the world needs ‘Universal Health Coverage’ (UHC) whereby people in all countries have equitable access to health care. Sri Lanka is one of the few developing countries with UHC. Its free immunisation program is a great success and the country has eliminated some diseases such as malaria even without a vaccine being available. Sri Lanka is ready to immunise the majority of its population (except schoolchildren and pregnant women) against Covid-19 by May this year. Sri Lanka could well become the first developing country to achieve this feat. It was also the first developing country to have a network of State-run Quarantine Centres.
Even so, there are lessons that we can learn from the pandemic and shortcomings that we have to address. Our quarantine laws are more than a century old and in the light of certain lessons we have learned, the time is right to update them to reflect modern needs.
This is unlikely to be the last pandemic, given that millions of Coronaviruses are residing in bats and other animals. It is only a matter of time before another zoonotic (animal to human) virus transmission takes place and the next time, it could be even more lethal than Covid-19. It is thus important to revamp our entire health system to face a bigger pandemic.
Several shortcomings were also noticed with regard to medical equipment. It goes without saying that we need more ICU beds and isolation wards where pandemic patients can be more securely treated. We also need to boost the manufacturing capacity for PPE (Personal Protective Equipment), which will also help save foreign exchange.
It was also somewhat shocking to learn that the country has only two ECMO (Extra Corporeal Membrane Oxygenation) life support machines, which are basically advanced heart-lung machines that carry out the functions of these organs outside the body. Dr. Gayan Danthanarayana, who succumbed to Covid-19, underwent the ECMO procedure at the Karapitiya Teaching Hospital (the other machine is at the Lady Ridgeway Hospital, Colombo) and his father, himself a doctor, has begun a fundraising campaign to purchase more ECMO machines, which cost from US$ 150,000 to US$ 500,000 depending on the manufacturer and complexity.
Health planners should make a careful assessment of such essential needs and suggest that funds be allocated in the next Budget for purchasing the same. There is no need to wait till the next time – now is the time to take stock, address any lacunae and keep our health system ready for any challenge.