The Covid-19 pandemic has left a deep and irreversible mark on the lives of entire populations across the planet and had serious and lasting economic and social repercussions. Compared with similar phenomena of the past, the Coronavirus SARS-CoV-2 stood out for its capacity to spread globally over a brief time span; this was facilitated by several of its own features but also, and above all, by the inter-connected nature of contemporary societies and the intensity and frequency of exchanges of goods and persons between countries and continents – in other words, by globalization.
Potentially pandemic infectious phenomena have quadrupled over the past sixty years and the number of epidemic outbreaks each year since 1980 has tripled. Covid-19 should not have been unexpected. Instead, only a few weeks before the appearance of the first cases of infection by this hitherto unknown pathogen, the Global Health Security Index reported that no country or national healthcare system was fully prepared to confront a catastrophic biological event of such proportions.
As the virus attacked one country after another in early 2020, every nation of the world and its healthcare system suffered unprecedented levels of stress, and government emergency responses were to a varying extent delayed, fragmented and disjointed. Likewise, international institutions were not always able to coordinate national authorities’ efforts to halt the spread of the virus and offer adequate treatment to patients affected by it.
Now, at more than two years since the onset of the pandemic, it is possible to draw some important lessons. Prominent among them are the centrality of health policies, the interdependence of national healthcare systems and, consequently, the need to establish a global health framework. This latter goal can only be achieved through the balanced development of healthcare in every area of the world, especially in those least developed.
Research into the causes of the pandemic have, moreover, foregrounded the close interdependence between humans, animals and the environment, along with the urgent need – in this highly inter-connected world – to integrate pivotal sectors such as security, defense, education and international cooperation, particularly in developing nations. To avoid epidemics becoming pandemics, it is critical to safeguard health in all sectors, cooperating at international multilateral level and using the One Health approach in drafting shared policies capable of reducing the risk of zoonoses.
Being better prepared
It was precisely this aspect that emerged most clearly: the value of preparedness in the field of public health emergencies, designing and implementing plans for responding to unexpected situations arising from an outbreak of unknown infections. To be effective however, preparedness cannot be limited to healthcare systems and operators but must also involve targeting citizens in the context of awareness raising projects and campaigns.
Investments in preparedness are much more cost effective and efficacious than healthcare responses, not least in terms of human lives. Indeed, Covid-19’s impact can be measured in increased direct mortality as well as in slowed or suspended healthcare services and increased indirect morbidity: a rise in alcohol and tobacco consumption, obesity and delayed screenings for oncological disease. In 2020, for instance, Italy saw breast, colon and cervical cancer screenings halved as compared with 2019 – late diagnoses that will translate in the coming years into higher mortality rates – not to mention the so-called “long Covid” phenomenon.
Management of a pandemic and preparedness itself must be founded on international collaboration guided by the key values of cooperation, solidarity and transparence – which includes sharing data and the ability to incorporate information deriving from the identification of alarm signals.
International collaboration is essential also for the production of medicines and vaccines. In the spirit of a procurement policy spurred by concern for national security and the market economy, multiple sources and a multipolar production system are key to increasing production capacity and preventing the emergence of shortages.
Positive signs for strategies aimed at confronting future crises have emerged at international level with the resumption of multilateralism; e.g. the United States’ re-entry into the WHO and the launch of negotiations for an international pandemic treaty within the WHO itself. The European Commission does not have the authority to impose binding health measures on individual states. Yet, from the very start of the pandemic, it demonstrated a good level of preparedness, e.g. ensuring vaccines for all 27 members contemporaneously and adopting a common means of certification. Moreover, it confirmed the commitment to counter future pandemics by activating measures such as strengthening the European Medicines Agency so as to facilitate and accelerate authorizations; boosting the Agency for Infectious Diseases in order to improve European surveillance and facilitate harmonized data collection and diagnostic methods; creating the permanent Health Emergency Preparedness and Response Authority (HERA) for a European vaccine research and development network in line with on the US model.
Advances in Italy
At national level, the 2022 Budget Law called for the creation of an anti-pandemic hub with an integrated, systematic approach aimed at the development of vaccines, monoclonal antibodies, pharmaceuticals and diagnostic strategies; the goal being to reduce dependence on other countries and contain the risk of shortages in essential medicines. The project envisages investments in research and development, technological transfers and capacities for clinical trials under emergency conditions. It also involves close interaction with other actors in the proper management of preparedness through the surveillance of infectious diseases for the purpose of identifying non-human and environmental reservoirs, and through the integration of data collection and management systems and the development of variant sequencing technologies. The results will be made available at international level.
In conclusion, the pandemic has foregrounded the urgency of strategies and instruments that allow for rapid, coordinated global responses to health emergencies. Yet, in order to produce positive results, the measures adopted require a global health governance that satisfies the criteria of inclusion and equality. Health can and must be a right enjoyed by all people, which means ensuring everyone in every nation full access to diagnosis, medicines, treatment and vaccines.
Only under these conditions will the efficient and effective confrontation of future pandemics be made possible, if and when they occur.