In a recent article in Health Affairs, U.N. Foundation vice president Peter Yeo and former Director of The Global Fund Mark Dybul, MD, broke down the elements and imperatives of a process underway to develop a better approach to pandemic preparedness. Currently in draft form, the “Pandemic Accord” is being shepherded by the World Health Organization at the behest of its 194 Member States after the global COVID-19 response called to mind that familiar acknowledgment/non-admission: mistakes were made.
While the authors make a salient case for why the U.S. is right to stay engaged in the process, there remains an equally important issue to tackle: what exactly is this process?
On this latter point, American health care professionals – and the public served by them – should take note. Because the fact is, mistakes were made in the context of COVID-19. Many of those mistakes were unavoidable; others were unsurprising: lack of interstate coordination, weak integrated surveillance, unreliable supply chains, and poor culturally competent, community-based prevention. These issues predated COVID; they exploded amid the outbreak.
So while debates will endure about missteps within the global health ecosystem, my concern is how domestic health care performed. It was a story of hits and misses: more hits from individuals and a lot of misses from institutions. Sure, there were pockets of greatness. Social media feeds were replete with heroic actions from communities and clinicians, with people applauding shift changes from urban balconies. Incredible innovations were propelled in health care delivery, like experimentation with telehealth, integrated case management across health and social sectors, a focus on social determinants of health, and community-based health strategies. If one could “thank” COVID-19 (I’m far from there), the experience yielded unprecedented transformation in health care.
Now, in the sober wake of calamity, it’s time for the dreaded, all-too-familiar moment every health professional knows well: the M&M. What the World Health Organization is doing right now in Geneva may be the biggest mortality and morbidity conference we’ve ever known.
We do M&Ms because medicine performs better with more uncomfortable conversations and way more collaborative problem-solving. This is true on the macro and the micro level. Practitioners perform better when they have practice circles, Balint Groups, and peer support to navigate clinical uncertainty. Patients fare better when they work with their providers and loved ones to grapple with treatment options and make more informed decisions. Departments and institutions better serve populations when they conduct post-ops to flag areas of needed improvement. We talk a lot in America about the drivers of high cost, low patient satisfaction, poor clinical outcomes, and soaring rates of provider exodus. At the heart of so many of these problems is a glorification of “Lone Rangerism” – that it’s best to figure out and forge ahead in isolation. Turns out that “going it alone” is a really poor approach to better health.
This brings me back to the 32-page pandemic preparedness draft being negotiated by the World Health Organization. While I won’t belabor the process (Yeo and Dybul did an exceptional job), I’ll say this of the two big takeaways from the negotiations.
First, the Pandemic Accord will gives American health care professionals and researchers access to more – and better – data. I don’t have to tell you that epis, clinicians, and policymakers rely on transparent, honest data-sharing networks. And absent existing platforms, they build their own. We’ve seen this in public health emergencies from extreme outbreaks like COVID-19 to perennial spikes in influenza.
In fact, transparent data sharing is so much a part of America’s domestic health infrastructure that the U.S. Department of Health and Human Services created a framework that allows states to voluntarily contribute to the national Healthy People Dashboard. And while participation in Health People is voluntary, it’s universal. States join because it helps their own populations – saving lives, reducing health care costs, and shoring up prevention.
Second, we’d gain a better understanding of global health trends and forecasts, which only benefits domestic health care. Like Healthy People, much of the new WHO guidelines are a page from the playbook of HHS policy to “protect and promote the health and wellbeing of Americans through global action.”
On March 19, 2020, I was giving a Grand Rounds lecture at the University of Colorado School of Medicine when I received a text that the state was shutting down. Two things crossed my mind when I looked out at that room of 150 providers. First, I knew that whatever laid ahead, providers would be among those most deeply impacted. I also knew they’d take it like champs. They’d do the work that was needed regardless of the risks that were not yet known.
Today, in Geneva, the world has a chance to do better. My message in this moment for clinicians is to let the international community help you by shoring up the global infrastructure of prevention and preparedness. And for the world, if we can do this pandemic planning well, then we’ll serve everyone better.
The WHO Pandemic Accord is an act of necessary accountability. And in its own way, it’s also an act of love.
Elizabeth Métraux is a writer and medical anthropologist.