While our region remains in the midst of the COVID-19 crisis, it is not too early to draw several important lessons that can be used to better prepare for any future crisis. In line with the goals of this conference, the lessons discussed here will focus on the essential role regional and international cooperation is playing in the Pacific.
Transparent information exchange
Sharing information early on concerning events that may constitute a public health emergency is a fundamental first step for any effective response.
The International Health Regulation (IHR), adopted by WHO member countries in 2005, requires focal points in each member country to notify WHO about any event which may constitute a public health emergency of international concern within 24 hours of assessment. However, the COVID-19 pandemic has raised questions about the robustness of these notification requirements. There are examples even from within the Pacific of country reluctance and delayed reporting to WHO and to neighbour countries on diseases of regional concern. The reasons for caution are certainly understandable. Report too early and there are implications for a nation’s economy, reputation, tourism and more, for something which may turn out to be a false alarm; while reporting too late could result in a far worse disaster.
This reporting challenge becomes even more complicated when considering a pandemic declaration. The IHR requires consensus between the WHO Director-General and the reporting State Party, or in the absence of a consensus, an Emergency Committee to assist in making such a determination. Both of these options can take a considerable amount of time, and time is something in very short supply during the start of a pandemic.
A fast-track notification system between countries must be established both by strengthening the IHR and by implementing complementary warning systems regionally and sub-regionally. In the Pacific for example, we have the established Pacific Public Health Surveillance Network, which has already proven its value as a hub of trusted regional information and support for our COVID-19 response actions. This network is well-positioned to be expanded and strengthened as an early awareness and knowledge-sharing network.
Sharing information on the COVID-19 virus, its transmission, the interventions for managing the outbreak and infected patients, has been invaluable to researchers, public health officials and clinicians around the world and is why we have been able to develop vaccines so quickly. Successful management of future outbreaks will require trust, transparency, and robust information sharing and collaboration systems to support scientists and health professionals across the globe.
Early and effective border management
Early border closures have been one of the most effective measures in minimising incidences and even keeping some Pacific Island countries and territories (PICTs) free of COVID-19. The region’s medical systems were already under stress due to high rates of non-communicable diseases (NCDs) amongst Pacific populations and this, combined with a lack of specialized equipment and resources to deal with a pandemic, made an outbreak in the region a potential catastrophe.
By closing borders early, the Pacific has been able to create the space and time for vaccines to become available and as a result have been able to protect their most vulnerable populations. Border measures for managing this pandemic have not been limited to Pacific countries, as early closures also played an important role in New Zealand’s successful COVID-19 elimination strategy.
Following the border closures, many Pacific people found themselves stranded abroad and Pacific countries have been offering reciprocal support to repatriate citizens between countries. However, the challenge remains with Pacific citizens stranded in countries outside, and far from, the Pacific. This is something that will be addressed through wider cooperation.
In a world where there is so much social and economic interconnectivity, collective health risks cannot be managed in isolation. As many have highlighted, the best hope of containing any outbreaks are through co-ordinated international efforts to ensure the equitable distribution of vaccines.
An excellent example is the COVAX programme that is currently providing international cooperation in response to the pandemic. Though COVAX membership is optional, almost 200 countries have joined including China, the United States, all members of the EU and many low-income countries. The news is not all positive however, and stories of COVID-19 ‘vaccine nationalism’ impacting distribution and slowing global vaccination efforts are all too common. Both examples provide important lessons for international cooperation when it comes to handling future outbreaks.
Recognising the connection to climate change
Climate change is having a direct impact on health in the Pacific. Access to healthy food, safe drinking water and shelter is reducing, while the prevalence of infectious disease vectors (e.g., mosquitoes) is increasing. In addition, PICTs are especially vulnerable to the effects of climate change given community displacements and worsening living conditions due to increasing costal erosion. More intense cyclones and droughts have been registered in the Pacific resulting in failure of subsistence crops and coastal fisheries and increases to sea temperature have resulted in losses of coral reefs and mangroves. All these climate change-related challenges amplify existing health challenges in PICTs due to weak health systems and the high burden of infectious and non-communicable diseases.
By supporting PICTs in addressing health challenges posed by climate change, nations beyond the Pacific are also investing in finding solutions for their own future, as well as their global commitments towards universal development agreements such as the Sustainable Development Goals (SDGs).
With strong donor support from the international community, mitigating and addressing the effects of climate on health should become a core part of the development aid agenda.
Investing in primary health care
Pacific people are over-represented when it comes to both communicable and non-communicable diseases. The poorest performing Pacific countries have a life expectancy of less than 63 years and infant mortality of 57/1000 live births. Problems with quality, delivery and uptake of health services, education, water and sanitation and rapidly changing diets, are all taking a toll. Sadly, the health problems currently faced by PICTs are forecasted to be exacerbated by the ongoing climate change crisis in the region.
In recognition of this challenge, Pacific health ministers adopted the Healthy Islands vision in 1995, providing an overarching framework for health development in the region. The Healthy Islands initiative is the Pacific version of a ‘settings approach’ which calls for the creation of supportive environments with a focus on settings for health.
A recent review of the Healthy Islands initiative found some improvements in Pacific health indicators since its adoption but unfortunately also showed increasing health inequality between the Pacific and the rest of the world. Implementation of the Healthy Islands approach was patchy, under-resourced and unsustainable. Communicable, maternal and child health challenges in the Pacific persist alongside unprecedented levels of NCDs, inadequate levels of health finance and too few skilled health workers as the major impediments to health development.
In response to the findings of the review, Pacific health ministers called for the revitalisation of the Healthy Islands vision and primary health care. Drawing on international evidence, PICTs agreed that primary health care (PHC) should be the starting point for Healthy Islands and Universal Health Care (UHC). PHC can help provide an early warning system when disease outbreaks emerge, respond to crises that arise and is also the most equitable and efficient way to ensure UHC and cope with many of the social and health challenges across the Pacific.
Managing NCD risks
NCDs remain the leading cause of death in PICTs, accounting for up to 75% of all mortalities. NCDs are also a driver of premature deaths with a high proportion of fatalities occurring in people below the age of 60. Premature death, disability, and reduced productivity from NCDs pose a heavy burden on governments, communities and families. This creates a human, social and economic crisis and makes it challenging for the Pacific to achieve its Healthy Islands vision or its SDG commitments. Childhood obesity is also a serious concern in the Pacific due to unhealthy diets and behaviours factors. As this young generation ages, they will face a greater risk of NCDs and further reduced life expectancy. A complex backdrop of globalisation, rapid economic growth, and behaviour practices in the Pacific have fundamentally changed regional diets for the worse.
There is an urgent need for people to avoid unhealthy behaviours and products, and to practice healthier ones. However, convincing the public of this need for change is a monumental and extremely complex challenge requiring consideration of the environmental context, life course dimensions, and whole of society approach to make relevant healthy lifestyles, diets and activities available and popular.
Globally the most successful interventions have been through regulations and taxation, creating incentives for healthy choices and putting up disincentives for unhealthy options. Investing in safe sidewalks and bike paths, creating public parks, promoting home gardens and local farmers can all have a positive impact. Increased taxation and better information on the dangers of behaviours like smoking have also made a significant contribution. But globalisation, weak regulations, subsidies and attractive marketing, often make unhealthy foods and activities cheap and accessible.
We have seen some significant progress in this area from developed nations, where for example, smoking rates are collapsing and overall cholesterol levels are falling. Often though the result has been a reallocation of unhealthy products to the developing world, which is not always well equipped to counter the pressures of this influx, has limited resources to improve its infrastructure and little experience developing the regulations required to protect its people. The Pacific is suffering today from this trend, but it is not alone. If we truly want to manage the risks that NCDs pose to the world’s population, we must take a global approach to our actions.
If there is a common thread that connects these lessons, it is the need for cooperation and coordination at every level of crisis response. From the initial warning systems, to border management, vaccine distribution and the investment in public health - the potential for success is exponentially increased when nations, regions and the international community are working as one. The transparent, and rapid exchange of ideas and experiences can be the glue that holds together our efforts in preparing, managing and recovering from a health crisis, while its absence can be the gap that turns a global health crisis into a global health catastrophe.
Often with COVID-19 we hear statements along the lines of ‘who could have predicted’, but the truth is that while the specifics of COVID-19 were not predicted, the inevitability of a global health crisis should not have come as a surprise to anyone. It is not the first, nor will it be the last one to impact our lives. COVID-19 is a warning, and a lesson for both the Pacific and the world. Let’s work together to make the changes and the investments we need, so when the next crisis hits, we are ready.
Dr Stuart Minchin, is currently the Director-General/CEO of Noumea, the largest intergovernmental organisation in the Pacific. The Pacific Community (SPC) is a science and technology for development organisation owned by the 26 Member countries and territories in the Pacific region. SPC’s 650 staff deliver services and scientific advice to the Pacific across the domains of Oceans, Islands and People, and has deep expertise in food security, water resources, fisheries, disasters, energy, maritime, health, statistics, education, human rights, social development and natural resources.
Stuart was previously Chief of the Environmental Geoscience Division of Geoscience Australia. He has an extensive background in the management and modelling of environmental data and the online delivery of data, modelling and reporting tools for improved natural resource management. Stuart has represented Australia in key international forums and was Australia’s Principal Delegate to both the UN Global Geospatial Information Management Group of Experts (UNGGIM) and the Intergovernmental Group on Earth Observations (GEO). He also currently serves on the Editorial Board of the international Journal “Ecological Indicators”.
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