World leading experts came together to share their insights into how we can prepare for future pandemics, at the Jameel Institute Symposium.
Now in its third year, the annual event brought together leaders from academia, industry and the public sector to share their experiences to inform decision makers and those working in public health.
This year focussed on the need to take an interdisciplinary approach – spanning economic, social and behavioural sciences and epidemiology – in learning lessons about how the experience of the COVID-19 pandemic could help improved preparedness and responses to future pandemics.
Professor Neil Ferguson, Director of the Jameel Institute at Imperial College London, said: "We know COVID-19 has had a huge impact globally, but the extent of the health and economic impacts have varied widely between regions and countries, as well as within countries.
"Bringing together expertise from a wide range of disciplines can help us to better understand the forces behind these varied outcomes, as well as inform researchers, institutions and decision makers so we are better positioned for future outbreaks."
Economic Impacts
Kicking off the first of three sessions, Deputy Director of the Institute Professor Katharina Hauck delved into the economics of pandemic preparedness, drawing on expert insights from academia, the private sector, and the World Bank.
"What we know from this kind of pandemic, is that it was a really expensive economic event," said Dr Andrew Burns of the World Bank. He explained that globally, a large amount of government expenditure was in countering the economic impacts of COVID, rather financing the health response. Dr Burns used models of GDP loss to show how widely the economic impact of the first wave of the pandemic varied around the world, ranging from less than 5% in Japan to more than 21% in the UK.
Discussing the challenges facing the insurance industry, Dr Gunther Kraut, from insurance firm Munich Re, said the scale of financial risk associated with pandemics was too large for insurers to carry alone. But bringing in other sectors, such as capital markets, can help to carry the risk and cover financial losses in future pandemics. Dr Kraut explained insurers have good data from previous outbreak events to help structure, price and underwrite epidemic and pandemic risks.
Professor Tim Hallett, lead investigator at the Jameel Institute and Associate Director of the MRC Centre for Global Infectious Disease Analysis at Imperial, highlighted the importance of public health security in mitigating future risks and the need to invest in healthcare systems. He explained how this is especially true in many low- and middle-income countries, where healthcare systems may often be fragile and stretched, but undergoing important reforms.
"We've got to overcome this difficulty we have in not really being able to quantify the return on investment," said Professor Hallett. "Everyone knows it's important to have a strong health system with plenty of staff, strong supply chains, and cold chains…but quantifying these benefits is difficult. We need to get better at that."
Changing Behaviour
In the second session, led by Professor Marisa Miraldo from the Imperial College Business School, led a panel of behavioural scientists and engineers to discuss how individuals and populations engaged with non-pharmaceutical interventions during the pandemic.
The COVID-19 pandemic caused huge shifts in people's behaviour, as the world adapted to new rules to reduce contacts to curb the spread of the disease. But it wasn't clear how effective some of those behavioural changes were in practice, explained Professor Dame Theresa Marteau, of Cambridge University.
Boosting the capability and capacity of behavioural science could help to overcome current gaps, she explained, as would strengthening the weak systems used to evaluate policies. "We have great guidance…but the norm is we don't evaluate policies," said Dame Theresa, explaining how self-reporting adherence to policies, such hand washing, is typically much higher than when objectively measured, and so unreliable.
Messaging was a powerful tool for behavioural change during pandemic, but there remains a lack of empirical evidence on which approaches and interventions work best, said Dr Matteo Galizzi from the London School of Economics. He explained trust in science and trust in government, as well as people's perceptions of social norms are key.
"[Successful campaigns] make people recognise how their behaviours will have an impact on something they value Professor Rafael Calvo Dyson School of Design Engineering
Giving the example of low rates of mask-wearing by commuters on the London Underground, Dr Galizzi said "reasonable, common-sense behaviours to protect yourself and others during the pandemic [have] almost disappeared". When all enforced restrictions are lifted at once, such behaviours may no longer be seen by people as reasonable social norms.
Professor Rafael Calvo, from the Dyson School of Design Engineering at Imperial, discussed the critical need for people to endorse the technologies and platforms being used to modify behaviour. People care about their privacy, and how their data is managed and used, and developers and health agencies overlook this at their peril, as users stop engaging, or find ways around the system.
He discussed how people need to align the motivations behind behavioural change with their own personal values. Offering the UK's 'Protect the NHS' campaign as an example, Dr Calvo explained "it made people recognise how their behaviours will have an impact on something they value".
Tackling Inequality
In the final session, a panel led by Professor Nimalan Arinaminpathy, a lead investigator at the Jameel Institute, provided crucial insights from middle income countries into the unequal nature of the impact of pandemics.
Professor Indrani Gupta, from the Institute of Economic Growth in Delhi, said many countries had significant inequalities before COVID-19, with the pandemic exacerbating issues such as a lack of healthcare coverage. She explained the complete shutdown of non-COVID health services in India (such as sexual health services) during the pandemic likely impacted poorest communities the most.
The strongest line of defence we will have [against future outbreaks] will be our underlying health status and the strength of our health system Dr Tonatiuh Barrientos-Gutierrez National Institute for Public Health, Mexico
The combination of a lack of social protection measures, a non-resilient health sector and lax policies governing the way industries operate "have all aggravated existing inequalities on all fronts", said Professor Gupta, adding the impacts "will be medium to long term, and go beyond the current generation and impact future generations as well".
For South Africa, the impact of extensive restrictions has left a legacy of increased debt and interest payments, squeezing health and social budgets, explained Dr Mark Blecher, of the National Treasury of South Africa. "The effects on our country were really quite devastating," said Dr Blecher, highlighting how almost three years later, South Africa is heading into 2023 with billions of dollars cut from the health budget.
In Mexico, the underlying prevalence of chronic diseases in the population provided a 'perfect storm' which most affected the poorest in society. Dr Tonatiuh Barrientos-Gutierrez, from Mexico's National Institute for Public Health, explained how changing diets played a huge role, with rising obesity rates contributing to poor health.
Expanding healthcare capacity in communities and a network of cooperation across low- and middle-income countries could boost capacity to respond to future threats. Dr Barrientos-Gutierrez added: "The strongest line of defence we will have will be our underlying health status and the strength of our health system."
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Videos of the symposium will be available soon.
