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The challenge of pandemic under-preparedness: the size of the problem, its impact and the best strategies for efficient health systems

Digital format, 13/05/2021, International Conference

The Covid-19 pandemic has ramped up the pressure on healthcare systems around the world, burdening already limited resources and existing capabilities. In order to ensure the quality and efficiency of services for all, healthcare systems need to build and improve their ability to be prepared for crises, while at the same time enhancing their essential primary functions. The discussion touched on the crucial aspects to be considered in making systems more efficient by reinforcing prevention. Also discussed were the proposals contained in the Policy Brief compiled by an international group coordinated by Aspen Institute Italia, in particular a 6-point action plan for the G20 aimed at enhancing global healthcare resilience through joint provision programs, policy harmonization and health education.

The main points that emerged from the discussion are as follows:

  • An initial issue concerned healthcare sector investment. If it is true that healthcare systems are in need of reform and reorganization, it is essential that the majority of financial resources be used for that purpose; increased investment in healthcare proximity, home assistance, telemedicine and the digitization of the healthcare system would ensure resiliency and preparedness for unexpected and unpredictable situations. An equal amount should be earmarked for the training of medical/healthcare personnel and the basic medical research that could ensure timely and effective responses. Therefore, work needs to be done on the current “hospital centricity” typical of developed countries that absorbs resources at the expense of the capacity to provide assistance, treatment and local responses, and that has proven insufficient in averting the spread of Covid cases and consequent hospitalization. Well-organized home assistance becomes key to lessening the pressure on hospitals, thereby ensuring proper treatment and assistance for everyone.


  • A second focus was on the concept of preparedness, i.e. the necessary sustained, lasting and constant commitment of policy makers to “prevent, prepare and manage pandemics”. One of the most important problems that the pandemic has highlighted is precisely healthcare systems’ ability to confront problems as they arise. The key elements to be implemented/perfected are supply, storage and rapid distribution of medicines and healthcare equipment by means of internationally shared data exchanges. No one is capable of confronting ever more global phenomena alone; thus, the pandemic has taught us that swift data exchanges can increase the effectiveness of prevention, preparation and strategy development for the care and treatment of the population. 


  • Greater international cooperation in sharing data, information and scientific discoveries is therefore indispensable, especially at the level of the G20, and it is hoped that those nations will eventually be willing to cede a portion of their sovereignty in exchange for greater stability and health crisis prevention. An equally crucial concern are the inequalities within and between countries. No one must be left behind, since the systemic risk posed by global crises has the potential to interrupt the delivery of health services, with the consequent severe impact on economic and social stability. Evidence shows that healthcare assistance services vary widely from one country to another, implying the need for a variety of models, types of agreements and levels of development; such agreements are also influenced by existing health threats and problems. In order to comply with the principles of the “One Health” concept, the central focus must be on people, along with efficiently administered universal medical coverage aimed at ensuring everyone adequate treatment and assistance. Health must come to be considered a public asset in all its aspects.


  • Health policies need harmonizing. Europe, for example, is assessing the proposal for a European Health Emergency Response Authority (HERA) as a possible model for ensuring coordination on healthcare preparation and response capacity, while at the same time respecting the authority and sovereignty of national authorities, for a unified European approach to global health. Indeed, this project could potentially constitute a prototype for G20 member countries.


  • Also proposed was a supranational body in support of the G20. The impact of this health crisis on economies has been considerable; the price to be paid will be high not only in terms of the real economy but also of government spending. The severe economic impact of Covid on the society has been a lesson in preparedness. A global health commission at the level of health and economy ministers could provide a legal, streamlined framework for global health crisis management.

In conclusion, an Italian Presidency proposal to the G20 underscored that resilient healthcare systems must be capable of providing good quality, effective primary treatment rooted in proximity and available to everyone (Universal Health Coverage) independent of prevailing budgetary constraints. Member countries were urged to cooperate increasingly on the supply and distribution of medical supplies, the harmonization of policies and their simultaneous monitoring, “horizon scanning” and education, with a view to improving preparedness for sudden and unexpected crises.