Misinformation in the Era of Pandemics

Of all the long-term consequences of the COVID-19 pandemic, one that will have far-reaching and long-term health impact is the worrying rise in anti-vaccine sentiment. We know that COVID has had a dramatic impact on vaccine confidence, but that faltering confidence is unfortunately not limited to the COVID vaccine. New research and data show that misinformation and distrust surrounding the COVID vaccine has spilled over to other routine vaccines, such as measles, resulting in decreasing vaccination rates and increasing the risk of outbreaks. At the root of this trend is a pervasive and increasingly powerful engine of misinformation.

Vaccine misinformation is not new, but COVID has made it more mainstream and profitable. In the U.S., the archetype of the original anti-vaxxer was a parent opting for a more “natural” lifestyle for their children, but since the politicization of vaccines, the movement has gained traction, particularly among white conservatives. Anti-vaccine Google searches have also increased during the pandemic, peaking after various WHO announcements. Support for getting a COVID vaccine varies by region — 74.8% in West and Central Africa and 97.2% in Asia Pacific region — while vaccine confidence in the U.S. has decreased by 20% since the COVID-19 pandemic began. According to NPR, “articles connecting vaccines and death have been among the most highly engaged with content online this year.” And, what is fueling this surge in anti-vaccine misinformation? Profit. The anti-vaccine industry boasts annual revenues of at least US$36 million, according to the Center for Countering Digital Hate.

These days, many people including parents rely on the internet for medical information, but the facts are not the only thing they are finding. Studies show that “using the internet and social media as a source was associated with vaccine hesitancy.” In one study, 45% of parents who relied on the internet for vaccine information were vaccine hesitant, and parents who rely on the internet for vaccine information were significantly associated with vaccine hesitancy.

What does this mean for global health? 

  • In the short term, we are seeing more outbreaks of preventable diseases and thus more preventable deaths. Measles cases in January and February of 2022 surged 79% worldwide compared to the same time last year. 
  • Long term, this trend points to severe consequences. Outbreaks of measles or polio would divert staff and funds away from other health crises and be very expensive, with vaccine-preventable diseases posing an economic burden of US$9 billion in 2015 alone. Rather than focusing on R&D for new treatments or emerging diseases, we will be diverting funds to solve outbreaks that were preventable in the first place, wasting valuable time and resources.  

So what can we do to stop this wave of vaccine misinformation? Vaccine misinformation and hesitancy varies by community, so responses must be tailored and specific

  • To learn more about who is funding vaccine misinformation efforts and how governments are responding, check out the Center for Countering Digital Hate.
  • You can sign their petition calling on major technology companies to take action and remove vaccine misinformation along with superspreaders from their sites. 
  • For more information on vaccine education efforts, check out our resource hub on vaccine education.

In our global society and communications landscape, we cannot ignore the rising tide of health misinformation. Just like a virus, what starts with misinformation about one disease in one community, can quickly evolve to infect other communities around the world.

 

G20 health Ministers’ Meeting — What Happened? What’s Next?

DESPITE PROMISING STATEMENTS OF COOPERATION, VERY LITTLE WAS AGREED UPON DURING THE G20 HEALTH MINISTERS’ MEETING AND WHAT COMES NEXT TO TURN COMMITMENTS INTO ACTION REMAINS UNCLEAR. 

In advance of the two-day gathering of Health Ministers from the Group of Twenty (G20) in Rome, Italy’s health minister Roberto Speranza, holding the G20 presidency this year, said the event was an occasion to strengthen international relations and work for fairer COVID-19 vaccine distribution.

While the G20 Health Ministers’ declaration contains encouraging messages of strong multilateral cooperation to end the pandemic and enhance timely, equitable, and global access to safe, affordable, and effective COVID-19 vaccines, therapeutics and diagnostics, very little was agreed in terms of concrete steps needed to turn these promises into a reality.

Here are some of our main take-aways:

“Pact” on achieving vaccine equity

Countries committed themselves in the so-called “Rome Pact” to providing the entire world population with access to COVID-19 vaccines. Speaking after the meeting, Italian Health Minister Speranza told journalists, “if we leave part of the world without vaccines, we risk new variants which will hurt all of us.” He promised that efforts would be strengthened bilaterally and through international platforms starting from COVAX.

We welcome the Ministers’ commitment to continue their efforts to meet the World Health Organization’s (WHO) goal to vaccinate at least 40% of the world’s population by the end of 2021 and continue to support collaborative initiatives, such as the Access to COVID-19 Tools Accelerator (ACT-A) and COVAX as well as important global research and innovation initiatives as the Coalition for Epidemic Preparedness Innovations (CEPI). We still have a long way to go — the WHO Director-General has said that while 5 billion vaccines have been administered worldwide, almost 75 percent of these doses have been administered in just 10 countries.

Most high-income countries have bought significantly more doses than needed to cover domestic vaccination needs. We need these countries to donate at least 1 billion vaccine doses as soon as possible, and 2 billion doses by the end of 2021, if this goal is to be achieved. We welcome Germany’s announcement on the sidelines of the meeting to make 100 million vaccine doses available for the international inoculation campaign before the end of the year, and call on others to swiftly follow suit.

Financing for pandemic preparedness and response

According to the Health Ministers’ declaration, proposals on sustainable financing to strengthen future pandemic preparedness and response are being drafted to be presented at the G20 Joint Finance and Health Ministers’ meeting in October. Immediate and multi-year funding commitments for the pandemic response in low- and middle-income countries (LMICs) must match the scope and urgency of the need. We must urgently establish a financing mechanism to channel and direct the additional funding required for the current pandemic response to where it is most needed, and to jumpstart funding for preparedness for emerging pandemic threats. Read more on the call for a new global financing mechanism that provides robust and sustained investments in pandemic prevention, preparedness, and response in this policy brief.

One Health approach

On a positive note, there was agreement on adopting a ‘One Health’ approach in responding to future health emergencies, i.e., recognizing that human, animal, and environmental health are interlinked and determinant of our wellbeing. According to the Ministers’ declaration, the WHO, World Organisation for Animal Health (OIE), Food and Agriculture Organization (FAO), and UN Environment Programme (UNEP) are to work on a joint work plan on ‘One Health’ to improve prevention, monitoring, detection, control, and containment of zoonotic disease outbreaks.

Vaccine education

There is an abundance of great research, information, and approaches to vaccine education, yet efforts to address vaccine hesitancy and build vaccine confidence can be fragmented and siloed. Catalyzing vaccine confidence requires action across the world by diverse stakeholders, active inclusion, and feedback loops with local implementers. Therefore we welcome the ministerial declaration’s emphasis on the need to promote vaccine confidence “by implementing the most effective, culturally appropriate, and science-based public communication and listening strategies tailored to the context of communities at the local level, to combating misinformation and disinformation, and instilling trust in public institutions and experts.”

Implications for the G20 Leaders’ Summit

The G20 Health Ministers’ meeting was one of the last G20 ministerial gatherings before the Leaders’ Summit in Rome on 30 and 31 October. We urgently need strengthened global leadership and accountability; and expect the next joint Health and Finance ministerial and the G20 Leaders’ Summit at the end of October to produce solid commitments on the following issues:

  1. Building strong political leadership for the global COVID-19 response by setting out a fully-costed Global COVID-19 Response Roadmap with specific time-bound commitments to help drive us to the end of the pandemic — full details are defined in our Framework for a Global Action Plan for COVID-19 Response;
  2. Sharing doses at scale and donating entire production slots where feasible, to accelerate global immunity, starting with the donation of excess doses as soon as possible;
  3. Delivering meaningful finance at scale to tackle the global pandemic, including looking to free up as much as possible of the IMF’s US$650B in Special Drawing Rights (SDRs) to low-income countries and to contribute to funding the global COVID-19 response.

We wholeheartedly agree with Minister Speranza when he calls the vaccine a ‘key to freedom’. But we urgently need leaders to focus on ensuring that this ‘key’ is accessible to everyone, not only those in G20 countries.

Why Smooth Vaccine Rollout And Social Proof are Key to COVID-19 Acceptance and Trust

Note: Policy recommendations to decision makers available here

Since the world began to entertain viable vaccines as a real prospect in the fight against COVID-19, we have been confronting the challenge of vaccine hesitancy and navigating what is required to address this challenge. While recent surveys show that vaccination intent has been on the rise globally, increasing hopes that the world will be able to turn the tide on the pandemic relatively soon, the dynamic nature of this pandemic shows that vaccination intent and trust correlates to vaccine access, management of vaccine rollout, and social proof.

The challenge of vaccine hesitancy to end the pandemic
Vaccine hesitancy remains a looming threat to the successful rollout of vaccines and the prospect of ending the COVID-19 pandemic globally. The “anti-vax industry” is well-financed and organized, and determined to spread doubt as to the safety and efficacy of COVID-19 vaccines. A study by Imperial College found that hesitancy around COVID-19 vaccines could lead to thousands of extra deaths. The study, from March 2021, compares current levels of hesitancy compared to the ideal level of uptake. The potential risk is particularly acute in countries like France, where vaccination intent is among the lowest. France could see 8.7 times more deaths in 2021/22 than it would under the ideal level of uptake. This compares to just 1.3 times more in the U.K., which has among the highest vaccination intent.

In many countries, one of the main reasons for vaccine hesitancy is that corners have been cut due to the speed of the clinical trials, and that unknowable long-term side effects potentially exist.

In addition, conflicting public health messages have led to increased mistrust from the public. For example, inconsistent guidance on face-coverings earlier in the pandemic has primed people to distrust proclamations about vaccine safety and efficacy. This has led to many people wanting to “wait and see” real-world proof of safety and efficacy before getting a shot. As a result, a critical element of increasing COVID-19 vaccine uptake is building vaccine confidence among this “wait and see” group, the moveable middle.

“Wait and see” approach to COVID-19 vaccines

Because of concerns on the speed of development and potential unknown side effects, a share of the population wants to “wait and see” how the COVID-19 vaccines work for other people before they get vaccinated themselves.

The share of people in this “wait and see” category has declined since vaccines have started rolling out globally.

Smooth rollout and social proof as tools to increase vaccine trust among the “wait and see”
The emerging evidence, including from the U.K. vaccine rollout, shows that social proofing through communication about widespread acceptance and a fast and uninterrupted vaccine rollout seems to increase trust in COVID-19 vaccines. The more people get vaccinated and the more people hear about others getting vaccinated, the more normal it becomes. A study by Rockefeller Foundation from March 2021 found that social proof of others getting immunized and seeing the tangible benefits that come with it might be the most determining factor in motivating people to get vaccinated.1 In their study they found that among U.S. adults who weren’t sure they’ll get the vaccine, 43% said they were waiting for more people to get vaccinated before they do so themselves. Other research found that people are more willing to get the COVID-19 vaccine when hearing about its popularity, suggesting that public health officials should communicate about the growing and widespread intention to get vaccinated among the population rather than overstating vaccine hesitancy. Finally, in a study conducted amongst 18-30 year olds in the U.K., study participants reported slightly stronger intentions to take the vaccine when they learn that 85% of others plan to take the vaccine, versus 45% of others.

The U.K. is a good example of how social proofing and a smooth rollout may help address vaccine hesitancy, particularly among the “wait and see” group. The U.K.’s rollout strategy has been to vaccinate as many people as possible from the start. Within the U.K., the Welsh rollout program has been the speediest in the world, faster than Israel. A key element of that was the decision to delay the administration of second doses in order to get a first dose in as many arms as possible, as quickly as possible. Experts believe that the speed of the U.K. rollout and the decision to delay second doses had an important impact on attitudes towards COVID-19 vaccines. Another important component of the U.K. strategy has been to proactively emphasize the widespread uptake of COVID-19 vaccines, for example social media posts such as “Join the millions already vaccinated.” With more and more people knowing or hearing about someone who had had their first vaccination, it helped build momentum as well as create social proof to build trust and convince those in the “wait and see” category to eventually get vaccinated.  

In January, 90% of people in the U.K. said that they would either probably or definitely take a COVID-19 vaccine, up 7% since December, when the rollout started. Just two months later (March 2021), the proportion of adults who said they would not be likely to get vaccinated had more than halved since December — from 14% to just 6%. Between January and March, 53% of adults shifted to a more positive attitude — either already receiving a jab or reporting that they are now more likely to do so. According to Imperial College’s Year Review of ‘COVID-19 Global Behaviours and Attitudes’, of the 29 countries surveyed for study,  the U.K. had the highest intention of vaccination among those not yet vaccinated in April 2021 (67% of those not yet vaccinated), and had the lowest share of respondents who stated they were worried about side-effects (27%).

The U.K. also had a different response to the AstraZeneca and Johnson & Johnson (J&J) blood clotting issues compared to the U.S. and many European countries.  The U.K. did not pause the use of the AstraZeneca shot, instead it simply updated its guidelines advising people with a predisposition to blood clots and those under 30 (in April) and subsequently under 40 (in May), to get an alternative shot. Research and pollings indicate that the U.K.’s ‘restrained reaction’ helped keep hesitancy low. A study found there was no change in the intentions and attitudes of the U.K. public in the aftermath of the blood clot story. A YouGov poll in April suggested this led to only a minor decrease in trust. The number who considered the drug to be unsafe ticked up only slightly, from 9% in March to 13% in April, with still 75% of Britons considering the vaccine to be very or somewhat safe. 

The impact of pauses on vaccine trust globally
After extremely rare cases of blood clots, unlike the U.K., a number of governments in the U.S. and Europe temporarily paused the roll-out of the AstraZeneca or J&J vaccines. These pauses have had a significant impact on public trust, not only in the countries where the rollout was paused, but globally. 

Despite the European Medicines Agency (EMA) safety committee’s recommendation from 11 March “that the vaccine’s benefits continue to outweigh its risks and the vaccine can continue to be administered while investigation of cases of thromboembolic events is ongoing”, at least 13 European countries paused the use of the AstraZeneca shot. Skepticism in France and Germany increased rapidly after the use of the AstraZeneca vaccine was paused over blood clot concerns in March. In a YouGov poll conducted in March, 32% of Germans said the AstraZeneca vaccine was safe, down from 42% a month before. Confusion also plagued the rollout of the AstraZeneca vaccine in European countries, further tarnishing the shot’s reputation. For example, in February when it finally started using the AstraZeneca vaccine, German health officials decided to restrict its use to people under 65. It took until March 4 for Germany to update its guidelines and recommend AstraZeneca’s use for people over 65. Just 11 days later, on March 15, Germany paused its use entirely for several days over blood clot concerns. Finally, on March 30, Germany officials tweaked their recommendations yet again, limiting its use to people over 60. In the case of France, it all started with a comment by French President Emmanuel Macron in January incorrectly describing the shot as “quasi-ineffective” for people over the age of 65. Like Germany, French officials then also did a U-turn on their age restriction guidelines in addition to pausing the vaccine use for a few days in mid-March.   

In the US, public trust in the safety of the J&J shot was down to 37% after the government paused the rollout in April, compared to 52% before the announcement. A Washington Post-ABC News poll from mid-April found significant mistrust in the J&J vaccine after health officials paused its use with fewer than 1 in 4 Americans not yet immunized willing to get the shot. The Kaiser Family Foundation COVID-19 Vaccine Monitor found that in early May less than half of Americans believed the J&J vaccine was safe, and concerns about potential side effects had increased among those not yet vaccinated, especially women. About one in five unvaccinated adults say the news caused them to change their mind about getting a COVID-19 vaccine. The Monitor also found indications that concerns about side effects from the vaccines in general had increased following the pause, particularly among women. The reputation of the AstraZeneca vaccine that has not been approved for use in the U.S. yet has also been damaged by blood clotting concerns and temporary suspension in Europe. Only 38% of Americans surveyed in April 2021 considered the AstraZeneca vaccine safe.  In contrast, trust in the Pfizer-BioNTech (Pfizer) and Moderna vaccines appeared unaffected. The Ad Council found that conservatives, in particular, increased in skepticism after the J&J pause.2

Even beyond Europe and the U.S., these short pauses and confusion around age restrictions have damaged the reputation of the AstraZeneca and J&J shots around the world, including in low-income settings where they are particularly crucial. Both the J&J and AstraZeneca vaccines that use adenovirus-vector technology have raised hopes of better global access and, in the case of the J&J shot, faster rollout. These vaccines are less expensive, more stable, and easier to distribute than their mRNA-based counterparts from Moderna and Pfizer. Because they are less expensive and easier to store than Moderna’s or Pfizer’s, and the J&J vaccine requires only one dose, these shots have been considered particularly crucial for less developed and hard-to-reach parts of the world. Yet, experts raised concerns that short suspensions in Europe and the U.S. may further hit an already fragile vaccine confidence in low-income countries and threaten to undermine vaccination campaigns in these settings. Cameroon, the Democratic Republic of Congo, Indonesia, and Thailand all suspended the AstraZeneca vaccine rollout following pauses in European countries. Concerns about rare blood clots on top of the rubbishing of COVID-19 vaccines by some African leaders and confusion over expiry dates have slowed vaccine uptake across the African continent. Health workers in countries such as Nigeria, Ivory Coast, and Malawi noticed growing fears and conspiracy theories, as well as slower demand for vaccines. Africans have expressed their reluctance to use the AstraZeneca shot when Europeans have stopped using it.  At the G7 Vaccine Confidence Summit hosted by the U.K. in June 2021, Dr John Nkengasong, Director of Africa CDC, highlighted that confidence in Africa was significantly hit by the suspension of the AstraZeneca vaccine in a number of European countries with some African ministries being reluctant to continue the rollout of the vaccine. 

Lessons learned and recommendations
The world has only started its vaccination effort against COVID-19 with millions of people around the globe, particularly in developing countries, still needing to get inoculated against the disease. Yet, lessons can start to be drawn from vaccination programs that started in early 2021.

  • All indications point to the fact that consistent messaging about the safety and efficacy of vaccines and about widespread acceptance, as well as smooth and effective rollouts that build social proof of the safety, efficacy, and benefits of COVID-19 vaccines have been key ingredients to build trust and increase vaccination intent and intake.
  • On the contrary, conflicting public messages and guidance as well as temporary suspensions of the use of certain jabs have created a breeding ground for doubt, fears, and conspiracy theories, not only in the country where they occurred but globally. As Heidi Larson, the founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine, said: “Don’t let the ambiguity drag on. Because every day just opens the space for misinformation, disinformation, anxiety, and confusion.”

As they progress in their vaccination campaign and in advance of vaccination delivery, decision-makers should take stock of these lessons learned and quickly adjust their strategy accordingly.

Decision-makers should:

  • Increase vaccine trust through a social proofing strategy. Decision-makers should put social proofing at the heart of their vaccination rollout strategy, learning from best practices in countries that have successfully deployed this approach. Such best practices may include proactively emphasizing the growing and widespread intention/acceptance to get vaccinated of others rather than overemphasizing hesitancy levels. Another way may be, where the supply and timing of the second second for two-dose vaccines is guaranteed, delaying the administration of second doses in order to get a first dose in as many arms as possible, as quickly as possible. Experts believe this can have an important impact on attitudes towards COVID-19 vaccines as more people know someone who has been vaccinated.
  • Refrain from temporarily suspending the use of shots over unconfirmed safety concerns (unless recommended by the regulator), and instead take swift decisions to prioritize certain demographics while concerns are being investigated. Total suspension, even when temporary, increases mistrust not only in the countries where the rollout was paused, but globally. For example, the temporary suspension of the use of the AstraZeneca vaccines in a number of European countries despite the EMA’s recommendation to continue to administer the vaccine led to many African countries suspending the use of the shot and increased hesitancy globally, including on the African continent where the AstraZeneca jab is particularly crucial because it is less expensive, more stable, and easier to distribute than the mRNA-based counterparts from Moderna and Pfizer.
  • Always act on scientific advice and follow the regulator recommendation before making any statement on the safety or efficacy of COVID-19 vaccines as well as before introducing any demographic restrictions. Unfounded statements and age restrictions in some European countries early in their roll-out, i.e., limiting the use of the AstraZeneca vaccine only to young people, created confusion and a fertile ground for fear and conspiracy theories. Scientific evidence should be very carefully and regularly assessed by decision-makers and their teams before making any decision or statement on the use of COVID-19 vaccines.

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1 The research included focus groups among people expressing concerns about getting the vaccine in March 2021 and a message testing study in February 2021
Source: Ad Council | IPSOS National survey conducted April 12-19, 2021

It’s Time to Pandemic-Proof the World: A 2021 Agenda for Action

The devastating health, economic, and social impacts of the COVID-19 global health crisis show that it is well past time for world leaders to prepare for pandemics as the existential, catastrophic, and growing global security threat they are. In 2010, well before COVID-19, there were six times more zoonotic spillover events than in 1980, and the number of new outbreaks continues to grow. Persistent gaps in international pandemic preparedness and response capacities have been flagged by various expert panels in the wake of previous health emergencies, but time and again, once the crisis disappears, political attention and funding shifts to other priorities. This dereliction of duty must stop once and for all.

Despite impacting people around the globe, COVID-19 has not affected everyone equally. The pandemic has exposed and exacerbated long-standing health and socio-economic inequalities within and across countries and in marginalized and vulnerable populations, including inequalities due to gender, race, ethnicity, class, and disability. The glaring disparities in global access to lifesaving COVID-19 vaccines, therapeutics, diagnostics, and vital tools such as oxygen and personal protective equipment (PPE) underscore the inequitable global health and preparedness system. And the lack of proactive attention by leaders to address and account for these inequities has significantly undermined the global COVID-19 response.

As the Global Preparedness Monitoring Board (GPMB) made clear in its September 2020 report A World in Disorder, the world cannot afford to continue to ignore or delay preparations to bolster our collective defenses against emerging pandemic threats. As they battle the current crisis, countries and international institutions must act now to ensure the world is better prepared for the next pandemic threat, which may be lurking just around the corner. These commitments should include building and reliably funding a well-trained and well-equipped health and research workforce, more resilient frontline health systems, timely and transparent disease surveillance, and effective supply chains for vaccines, diagnostics, PPE, and other tools to enable every country to detect, prevent, and rapidly respond to outbreaks before they become deadly and costly pandemics. It is time to invest in a smarter, more responsive, and more resilient global health security architecture.

Pandemic Action Network’s 100+ partners urge world leaders to take urgent action in the following areas to bolster the global COVID-19 response, hasten an end to this global crisis, and lay the groundwork for a more pandemic-proof world.

Support an equitable global response to COVID-19

The only way to end this pandemic is to end it for everyone through a coordinated global response. Yet as world leaders navigate the second year of responding to COVID-19 and securing vaccine doses for their constituents, nationalist inequitable approaches are still pervasive. Recent data shows that the world has now procured enough COVID-19 vaccine doses to reach herd immunity globally, but while some high-income countries have secured multiple times the number of doses as there are eligible adults in their countries, only 0.2% of doses administered have been in low- and middle-incomes countries (LMICs). Although it may seem intuitive for governments to first take action at home, this approach belies the fact that the virus — and its swiftly spreading variants — do not respect borders. Many countries that managed to control or even stop the spread of the virus earlier in the pandemic are once again seeing a surge in cases. There simply is no effective domestic response without also embracing a global approach. Everyone deserves to hope for a swift end to the pandemic, regardless of where they live. But it will only be possible if political leaders act globally as well as locally, knowing no country will be safe until every country is safe.

1. Accelerate global access and delivery of COVID-19 vaccines needed to achieve at least 70% coverage in all countries and enable an equitable global response and recovery.

World leaders should:

  • Fully fund the Access to COVID-19 Tools Accelerator (ACT-A) in 2021, filling the $22.1 billion funding gap as soon as possible with countries paying their fair share for this global public good. Countries should also commit to continue to invest in research and development (R&D) as well as scale-up of proven tools to prevent, test, and treat COVID-19 and ensure that medical countermeasures are effective against all strain mutations and all variants of concern. Given the scale of resources required, countries will need to tap into fiscal stimulus funding and other financial sources beyond official development assistance (ODA).
  • Agree to a roadmap to achieve at least 70% coverage of vaccines for LMICs, with at least 30% being secured, delivered, and administered in 2021. Leaders need to agree to a fully costed plan to achieve equitable global coverage as soon as possible. The full costs of delivering and administering doses in-country should be included in this roadmap, as well as the investments in vaccine education required to increase vaccine confidence.
  • Commit to donate, free of charge, all excess COVID-19 vaccine doses to the COVAX facility in parallel to their domestic vaccination efforts and start those donations as soon as possible. Countries should immediately announce commitments to share their full surplus supply on the most ambitious timeline possible, putting plans in place to deliver on this commitment as soon as is feasible in 2021 in line with COVAX’s dose sharing principles. These donations should not count as ODA, and should be in addition to funding the ACT-A.
  • Commit to “slot swaps” as another way to give COVAX additional supply. “Slot swaps” should be undertaken whereby high-income countries reallocate some of their existing orders immediately, potentially ordering replacement vaccines to arrive farther in the future, effectively giving their earlier “slots” to COVAX to help provide vaccines for LMICs to close the current acute gap in supply.
  • Ramp up global access and delivery of rapid testing, medical oxygen, and personal protective equipment to the frontlines. Continuing shortages of PPE and medical oxygen for frontline health workers and extremely limited deployment of testing — including genetic sequencing capacity to detect variants of interest — especially in LMICs, is hampering the global COVID-19 response and is a rate limiting factor for global rollout of COVID-19 vaccines and restoration of essential health services.

Prioritize and invest in pandemic preparedness and prevention

According to the IMF, the pandemic will cost the global economy and the World Bank projects that more than 160 million people will fall into poverty by the end of 2021. Conversely, recent estimates are that as little as $10-20 billion annually can ensure the world is much better prepared to detect, prevent, and respond to the next infectious disease outbreak before it becomes another deadly and costly pandemic. To minimize human lives lost from infectious diseases and lessen the impact on countries due to economic fallout, leaders should take the actions below to be prepared for the next pandemic.

2. Establish a catalytic, sustainable multilateral financing mechanism that is dedicated to promoting pandemic preparedness and prevention.

World leaders should:

  • Pledge new investments toward a target $20 billion initial capitalization co-funded from public, private, and philanthropic sources. Priorities for this new multilateral financing mechanism — which will fill a strategic gap in the existing global health architecture — should be on supporting LMICs to develop and implement national action plans for health security and pandemic preparedness, to close their urgent health security gaps, and foster a global “race to the top” among all nations for preparedness. The catalytic nature of this mechanism will help ensure both countries and other global health initiatives prioritize coordinated, multisectoral, prevention and preparedness funding in their domestic budgets, including support for country-level programmatic and managerial capacity in health systems strengthening.
  • Align funding with target country priorities to strengthen pandemic preparedness and containment as well as promote efforts toward pandemic prevention. Programs that should be financed at scale include detecting and stopping the spread of outbreaks and ensuring compliance with the International Health Regulations (IHRs), strengthening laboratory and manufacturing capacity, bolstering and protecting a trained, compensated health workforce, building and strengthening health information systems, ensuring resilient national and regional supply chains, One Health initiatives, and stopping zoonotic spillover from causing new outbreaks through measures such as reductions in deforestation and wildlife trade.

3. Bolster financing and at-the-ready global R&D capacity and coordination to combat emerging infectious diseases and pandemic threats without undermining important funding for existing epidemics research and innovation, including poverty-related and neglected diseases.

Applying the lessons learned from COVID-19, leaders should support the development and financing of mechanisms and initiatives that coordinate and catalyze research and development for new tools, including the Coalition for Epidemic Preparedness Innovations (CEPI), Global Antibiotic Research and Development Partnership, and other not-for-profit product development partnerships (PDPs) addressing the broad range of health threats.

World leaders should:

  • Fully fund CEPI’s $3.5 billion replenishment. This funding would support the organization’s moonshot initiative of compressing vaccine development for new pandemics to 100 days, and continuing efforts to develop vaccines for known threats. It would also support CEPI’s other objectives, including preparing clinical trial networks to quickly respond to new threats, coordinating with global regulators to streamline vaccine oversight, and linking manufacturing facilities to speed up global production.
  • Support integration of R&D into the Global Health Security Agenda (GHSA) framework to include R&D capacity-building for medical countermeasures. Inclusion of metrics through a GHSA R&D taskforce will help countries assess, prioritize, and better plan for strengthening their R&D capabilities.
  • Build on the ACT-A’s response to COVID-19 to ensure a robust, end-to-end, and sustainable investment in global health R&D for pandemic preparedness, including long-term investments to strengthen global research, laboratory, and manufacturing capacities. This future readiness state should also foster more investments and partnerships with diverse research and academic institutions to both build regional R&D prior to crises and scale up support during emergencies. Investments should be made with policies that promote equitable global access to and affordability of tools like vaccines, diagnostics, and therapeutics.

4. Strengthen global and national surveillance capacities & outbreak analytics.

COVID-19 has demonstrated global gaps in early detection and data sharing around emerging threats, as well as gaps in ongoing surveillance capacities of countries, especially low-resource countries. Current emerging infectious disease surveillance and investigation is poorly allocated, with the majority of the globe’s resources not focused on areas with the most zoonotic hotspots where the next emerging deadly pathogen is likely to originate.

World leaders should:

  • Strengthen integrated national disease surveillance capacities in LMICs. Such surveillance capacities should take a One Health approach and be responsive to local needs (i.e., give results in real-time for use by clinicians and public health officials). Such capacities should not be developed in a silo for pandemic risk monitoring; rather they should provide utility for day-to-day public health programs, leverage the latest developments in digital tools to streamline operations for health workers, and accelerate data flow and analysis.
  • Strengthen mechanisms and platforms that allow for independent sharing and verification of data related to emerging health threats, complementary to and in partnership with the WHO’s role in collecting data from official sources under the IHRs. Such capacities should enable and promote more transparency and accountability in data access for all relevant stakeholders.
  • Commit to the rapid publishing and sharing of line list and pathogen genome data into shared repositories (e.g., the Global Influenza Surveillance and Response System and the International Nucleotide Sequence Database Collaboration) to ensure that data necessary to monitor variants of concern can be acted upon before they become dominant.
  • Support innovations in outbreak detection and analytics capacity nationally through emergency operations centers, regionally through academic centers of excellence, and globally through laboratory and disease surveillance networks. The ACT-A has taught the community about the importance of collaboration and rapid response, and these lessons should be applied to future tools.

5. Bolster global capacities, institutions, and systems for pandemics, health security and resilient health systems, including through reforming WHO and strengthening international frameworks for pandemic preparedness and response.

World leaders should:

  • Build consensus for, and rapidly move to implement, proposals that will strengthen the WHO as the global coordinating authority on health. Leaders should support proposals for sustainable financing of the WHO, including incremental increases in assessed contributions and more (and more flexible) voluntary financing. Such resourcing should go hand-in-hand with strengthening the WHO’s normative and technical capacities, including the Chief Scientist’s Office, the Health Emergencies Programme, and the WHO Academy, and with encouraging greater staff mobility and budget flexibility to bolster the WHO’s capacities at the country-level. In line with the Framework for Engagement with Non-State Actors (FENSA), leaders must enable more robust and transparent engagement with key stakeholders such as civil society and the private sector.
  • Strengthen the IHRs to foster more timely and accountable response to pandemic threats, including to authorize international investigations. Leaders should afford the WHO the ability to independently investigate potential and emerging threats, specify better information sharing, and better calibrate the definitions of a Public Health Emergency of International Concern (PHEIC). Metrics on equity, R&D, infection prevention control, capacity strengthening, and water, sanitation and hygiene should also be included in the IHR Monitoring and Evaluation Framework, to incentivize countries to assess, plan, prioritize, and better support sustainable and resilient health systems, and promote healthcare worker safety.
  • Support other voluntary and compulsory instruments to strengthen accountability of nation states and foster multilateral cooperation for pandemic preparedness and response. Many gains can be made by strengthening existing mechanisms and instruments, which should be prioritized alongside the proposal for a new pandemic treaty. Such instruments should promote accountability in functions including ensuring novel countermeasures are treated as global public goods; motivating faster flow of financing to address direct and collateral impacts of pandemics, including protecting frontline health workers and social protection for vulnerable populations such as refugees and those living in conflict-affected areas; reaffirming the centrality of human rights considerations in the context of a pandemic; boosting domestic R&D and manufacturing capacity; and establishing up data surveillance systems, and norms and standards around data sharing and data privacy.
  • Scale up national and global vaccine education efforts to increase vaccine confidence, distribution, and uptake. Countries should have budgets dedicated for vaccine education within health ministries, initiate public education campaigns to manage the spread of misinformation online, and build capacity for vaccine hesitancy research. Training should be prioritized for frontline healthcare workers, community leaders, and others in how to engage in difficult conversations on vaccine hesitancy.

6. Promote equity-focused initiatives and human rights protections in all aspects of pandemic preparedness, response, and recovery, including specific attention to address the intersectional and gendered effects of outbreaks.

World leaders should:

  • Commit to equitable financing to support populations most at risk for morbidity and mortality, including addressing inequities due to disparities in gender, race/ethnicity, sexual orientation, socioeconomic status, and disability.
  • Ensure commitments to human rights and equity are met, in alignment with IHR Article 3 on human rights, the United Nations Security Council Resolution 1325 for Women, Peace and Security, the UN Political Declaration for Universal Health Coverage, and the UN Sustainable Development Goals.
  • Commit to equal and diverse representation on emergency committees, including the IHR Emergency Committee and UN technical working groups, with active and meaningful participation of gender advisors and civil society groups as non-participant observers of EC meetings.
  • Ensure that all data pertinent to pandemic preparedness and response collected by the WHO and other health-focused UN bodies (as well as national governments) is published and disaggregated by sex and key socioeconomic groups.

 


 

An array of upcoming international summits — including the G20, G7, World Health Assembly, World Bank/IMF Meetings, and UN General Assembly — offer opportunities for leaders to act on this agenda. Critically, while health ministers have a key role to play, a concerted effort to end pandemics is a whole of government effort — and must be addressed at the level of heads of state. That is why the Pandemic Action Network supports the GPMB’s call for the UN Secretary-General to convene a focused UN High-Level Summit on Pandemic Preparedness and Response to mobilize increased domestic and international financing and advance efforts toward a new international framework for pandemic preparedness. Such a summit at head of state level should take up the forthcoming findings of the Independent Panel for Pandemic Preparedness and Response (the Independent Panel), the G20 High-Level Independent Panel for Financing the Global Commons (HLIP), the International Health Regulations (IHR) Review Committee, and the proposal for a new international treaty on pandemic preparedness and response.

World leaders must seize this opportunity to commit to action and leave a legacy of a healthier and safer world. We can pandemic-proof the future if world leaders act now. The world can’t afford to wait.

Our Pandemic Anniversary Wish: Let’s Pandemic-Proof the Planet

Co-founders of Pandemic Action Network: Carolyn Reynolds, David Kyne, Eloise Todd, and Gabrielle Fitzgerald

One year ago, on March 11, 2020, the World Health Organization (WHO) finally told the world what was already clear: that with 118,000 cases in over 110 countries and territories around the world, COVID-19 could be “characterized as a pandemic.” Of course, we had no idea at that time just how large and protracted this global crisis would become, with more than 117 million cases and over 2.6 million deaths worldwide and counting as of today.

It’s been a year of both horrible and amazing developments. Around the world, governments have scrambled, misinformation has flourished, advocates have rallied, scientists have mobilized, frontline healthcare, public health, essential workers have stepped up. There have been incredible stories of resilience, adaptation, and innovation by families, communities, and businesses. Yet crisis can be a great revealer, and this one has also exposed and preyed upon deep and longstanding global inequities, vulnerabilities, and broken systems.

The anniversary of this crisis should be a moment for all of us to reflect on what we have learned, and to commit to bold and urgent action.

Leaders have an historic opportunity to take actions now that will not only hasten the end of this pandemic, but will also begin to pandemic-proof the planet so that future generations never again experience the health, economic, and social devastation we have seen over the past year. 

The pandemic has affected every aspect of our lives and the solutions require leadership from all of us. We need the best and brightest not only working in science and health but also in finance, defense, technology, education, manufacturing, transport, and across every other sector of the global economy to join forces to solve this global challenge. And pandemic-proofing the planet demands that we tackle the dual threats of climate and health hand-in-hand.

We are calling on world leaders to seize this moment to commit to take action in four areas that will help pandemic-proof the planet and leave humanity healthier, safer, more resilient, and more prosperous.

Pandemic Action Network’s Pandemic-Proof Agenda

Speed up access and delivery of COVID-19 vaccines and other lifesaving tools to everyone, regardless of where they live. This starts with fully funding the Access to COVID-19 Tools (ACT) Accelerator and COVAX Facility. It also means countries which have secured more vaccine doses than they need should start donating vaccines to reach other nations in need, in parallel to their domestic vaccine rollout. Governments and industry also must join together to find the resources, and eliminate the bottlenecks, necessary to ramp up global manufacturing capacity, as part of a roadmap to get to at least 60-70% vaccine coverage in every country. With the evolving virus strain mutations, we are in a race against time to control this pandemic. But let’s also make sure these efforts do not come at the expense of other global health needs and goals.

Get serious on investing in pandemic preparedness. Donor nations, private foundations, and investors should come together to establish a sustainable global financing mechanism for pandemic preparedness, with an initial funding target of US$20 billion. Now is the time to fuel a global “pandemic-proof challenge” to ensure that every country has the plans, capacity, trained workforce, and functioning system it needs to effectively prevent, detect, and respond to outbreaks at their source before they spread and become deadly pandemics. This initiative should also incentivize countries to prioritize pandemics in their domestic budgets as a long-term security threat. Smart climate, biodiversity, and land-use policies must be a critical piece of those plans.

Bolster global research, development, and delivery of tools for emerging infectious disease threats. The COVID-19 crisis has shown that the world needs an at-the-ready capacity for timely delivery of the health technologies and supplies needed to combat both the known and unknown diseases likely to spark the next pandemic. A good start will be to support the US$3.5 billion five-year strategy of the Coalition for Epidemic Preparedness Innovations (CEPI) to achieve its moonshot goal to have a new vaccine ready within 100 days when the next novel disease outbreak happens. And we must build a seamless global network of regional R&D, manufacturing, and supply hubs and streamline regulatory processes so that every nation can quickly get the tools when they need them.

Build a smarter global pandemic defense system. Defense starts with prevention, and the UK’s five-point plan for the G7 and the COP26 meeting later this year offer the opportunity for bold action on climate which could drastically reduce the chances of pandemics occurring in the first place. But we know outbreaks will happen, and more frequently. So the WHO must be strengthened and fit-for-purpose, with reliable funding, enhanced authority to conduct early and independent outbreak investigations, and the ability to hold member states accountable for compliance with the International Health Regulations (IHRs). To help “pandemic-proof” the future, the world also needs a new international preparedness framework or pandemic treaty and a state-of-the-art, global virus surveillance and detection system to better predict and manage cross-border threats.

A year into this crisis, we are all experiencing pandemic fatigue. The rollout of new vaccines is providing hope that the end may be near, and we can get on with our lives. Yet the reality today is that for the vast majority of the world’s population, that hope remains elusive. Everyone will remain at risk until there is universal access to the vaccines and the virus is contained everywhere. Unless we speed up the global response, we could be marking the second anniversary of this pandemic next year. Furthermore, the next pandemic could be around the corner, and could be even more lethal and costlier than this one.

But it doesn’t have to be this way: we can pandemic-proof the future if world leaders heed our wish and take action now in these four areas. The world can’t afford to wait.

The Missing Piece of the Puzzle: Getting from Vaccine Hesitancy to Acceptance

For too long, the global health community has ignored the warning signs, assuming that anti-vaccination challenges were limited to a single geography or vaccine, and that anti-vaccination beliefs were fringe and would not impact broader uptake. In 2019, the WHO finally listed vaccine hesitancy as one of the world’s top ten global health threats. In 2020, this threat has been supercharged by the pandemic, representing a critical tipping point in the decades-long trend of vaccine distrust and hesitancy. The world must now act urgently to address this growing threat in order to end the COVID-19 pandemic and help stop future deadly outbreaks.

As multiple promising vaccine candidates come to market, there is hope that the world will soon turn a corner on defeating COVID-19. But in many countries around the world, fewer than 70% of the population plan to get themselves vaccinated—less than the threshold at which public health experts estimate herd immunity to COVID-19 to be effective. Within communities across the globe, vaccine hesitancy threatens countries’ ability to effectively stop the spread of COVID-19 and risks prolonging the outbreak further, costing more lives. The Pandemic Action Network released a policy paper with a set of recommendations for a wide range of actors, including governments, community leaders, multilateral institutions, and social media companies. This paper urges the world to address the various issues leading to vaccine hesitancy to ensure individuals can make critical decisions about their health and the health of their families and communities based on trustworthy and factual information. No one actor can address vaccine hesitancy alone. The challenge of vaccine hesitancy demands collective global action for vaccine confidence and acceptance.

Read the paper here: The missing piece of the puzzle: Getting from vaccine hesitancy to acceptance