Countries will need a more agile response to the next pandemic
Already there are calls for the United States and other countries to start taking steps to better prepare for the next pandemic by developing very detailed response plans at the local, state and federal levels. However, based on my experience helping set up CIC Health to rapidly scale up testing in multiple US states and mass vaccination sites in Massachusetts and working on large enterprise strategy and planning for nearly two decades, I have another point of view. While plans are obviously important, ones that are too prescriptive can lead you down the wrong path because you can never predict exactly what is going to happen. So, instead of trying to list every possible action in excruciating detail, it’s better to develop the ability to be nimble.
We can pull a page from the world of business strategy to explain why this is the case. Companies know that they must adapt their strategic approach to their strategic environment. Two important factors to consider are the level of predictability and the ability to shape the future. In environments where you can predict the future, winning players are often incumbents who can execute a plan that makes best use of their advantaged assets. In environments where you can reshape the future, winning players are usually innovators who can execute a visionary plan that disrupts the structure of an industry. However, in environments marked by high uncertainty and low ability to shape the future, the winners are not those with pre-existing plans, but those who are agile – who can quickly get out of starting blocks, change direction as they learn more and evolve rapidly. .
The United States’ response to the Covid-19 pandemic is an illustration of this. In 2019, following a multi-year effort, an international team of experts and researchers ranked the United States as number one among 195 countries in pandemic preparedness and gave it a perfect score for “emergency preparedness and response planning.” (They have since docked the United States by a few points but still gave them first place in their 2021 Global Health Security Index.) Obviously, the plans for the fight against the pandemic, considered excellent, were not enough. Why? First, while many predicts a pandemic, many key features were unpredictable. For example, the fact that infected people were contagious before showing symptoms meant that plans that relied on testing for symptoms were not going to work. Moreover, following such plans gave a false sense of security. Second, we had much less control than expected. For example, early warning systems did not work as expected.
The next pandemic could also be both unpredictable and difficult to control. The variety of plausible scenarios, ranging from zoonotic viruses to bioterrorism, is simply too vast. Meanwhile, trust between nations has eroded, with lingering concerns about the source of this virus, anger over travel restrictions and inequality in access to vaccines and essential supplies, which potentially makes it more difficult in some ways to coordinate a global response. So, faced with the likelihood that the next pandemic will have elements that are both unpredictable and difficult to control, the United States must turn to an approach that relies not on excruciatingly detailed plans, but on adaptive capacities in at least five key areas.
1. Redeployable Manufacturing
The United States must have manufacturing facilities that can be deployed quickly to produce critical items – not just factories that are “hot” (i.e. mothballed) and needs to be restarted. It also needs some that are actively used and can be exploited quickly. This is important for both advanced technologies, such as medicines, and low-cost basic items such as masks, swabs and syringes.
It’s not just having that ability that matters; the country also needs a set of principles for bringing these resources together and adjusting how they are deployed across the country as events unfold. A fragmented approach, with States in competition with each other as happened this time, is sub-optimal for everyone.
2. An expandable health workforce
One of the big challenges during a pandemic is that there is an increase in the need for public health and health care workers that far exceeds the demand in normal times. The United States must find ways to maintain the pandemic-related skills of this workforce.
Moreover, as the country faces a long-term shortage of doctors and nurses, it must find ways to reward and retain (and refresh) the pool of people who have been willing and able to pivot quickly into roles that increase the capacity of its clinical staff during pandemic-related surges. This could include a range of people, including school nurses, community health workers and emergency medical technicians (EMTs) who can be organized and trained as a “para-pandemic corps”.
3. Decentralized innovation
The United States must also do more to harness its innovation ecosystem. Sun Microsystems co-founder Bill Joy observed that “No matter who you are, most of the smartest people work for someone else.”
During the first months of the current pandemic, the Centers for Disease Control and Prevention (CDC) was solely responsible for developing the test for the virus that causes Covid-19. This centralization of a first stage of innovation resulted in a critical delay of several weeks. In contrast, South Korea was able to quickly develop and deploy high-quality tests because it focused on its medical industry innovate.
The United States must be ready to deploy quickly open innovation approaches that attract innovation talent from outside government to participate in the development of potential solutions.
4. Flexible regulation
While any innovation (vaccines, drugs, tests, devices, clinical protocols) used for prevention, diagnosis or treatment purposes must, of course, be subject to appropriate control of its effectiveness and safety, the United States should eliminate regulations that unnecessarily slow things down.
The Food and Drug Administration Emergency Use Authorization (EUA) eventually accelerated approvals for labs to test, but the EUA process also exposed a lot of bureaucracy that got in the way of common-sense process improvements. For example, the testing organization quickly realized that using pre-labeled tubes (instead of labeling the tubes after collecting patient samples) could save hours in turnaround time. tests, but making this simple change, which had nothing to do with the test itself, required modifying the EUA, a time-consuming exercise.
Another regulation that did more harm than good was one that required doctors to allow Covid-19 PCR tests for patients – a stipulation that prevented what Atul Gawande and I called insurance tests, frequent testing of asymptomatic workers and students as a way to keep our schools and workplaces open. This requirement added unnecessary cost, time and complexity.
A consequence of treating population-level pandemic testing the same way as traditional diagnostic testing was that the entire testing enterprise was burdened with the costly infrastructure (regulations, health IT, clinical resources) of symptomatic testing . Looking ahead, the United States needs to identify areas where regulations need to be rewritten so they don’t impede an agile response.
5. Better communications and coordination
The number failures of public communication during the pandemic are widely documented. These were particularly problematic given historical doubts about the federal government’s role in public health and widespread misinformation.
The main challenge is that people are looking for clear direction at the same time that data on the pandemic is being collected. So, as the science evolves, public health authorities need to be transparent about what they know and don’t know. This will create an environment in which changing guidance in response to changing information builds, rather than harms, the trust needed to gain broad support for public initiatives based on sound scientific evidence (e.g., for vaccinations tested).
Another prerequisite for an adaptive pandemic response is the establishment of mechanisms for the many relevant departments and agencies at the federal, state, and local levels to communicate effectively with each other and coordinate their actions. These include better systems for sharing information, know-how and concerns. This is perhaps the most difficult of these recommendations given the compartmentalization of these entities and the relatively high level of political polarization in the country.
The result: a faster and more efficient response
Ultimately, investments in building adaptive capacity in the areas of manufacturing, labor, innovation, regulation, and communication will put the United States in a good place. better positioned to respond to the next pandemic than this one. These abilities will be far more valuable than extremely detailed blueprints.
Some may argue that a better solution would be scenario planning to develop plans that cover many different uncertainties. I strongly support scenario planning, but not for the purpose of coming up with a variety of plans. I support doing them – and participating in war games and simulations – because such activities can help develop the skills the country needs to adapt.
Referring to the fog of war, Dwight D. Eisenhower, the Supreme Commander of the Allied Expeditionary Force in Europe during World War II and the 34th American President, said:Plans are worth nothing, but planning is essential.” Given the inevitable fog that will engulf the next pandemic, let’s make sure our planning doesn’t just result in plans, but helps build the capacity to be nimble to respond to whatever nature throws at us.