No room for COVID complacent in the year 2023

The Role of Public Health in Defending Pandemics: Vaccines, Workforce Safety, and the Early Warning System

Everyone should be concerned by the market’s failure to support vaccines due to the risk of future Pandemics. Even as COVID-19 continues to spread, in a given year there is a 2% chance of a new pandemic outbreak. Population growth, climate change and human migrations help to spread and escalate quickly.

Worker safety is another missed opportunity. People in a workplace benefit from colleagues feeling unwell. It will happen only with a change in culture about sickness and the provision of paid sick leave, especially for lowincome workers in the gig economy. In the retail and healthcare industries, where infections tend to be more common, paid sick leave is most important. But many employers still do not provide paid sick and family medical leave, and Congress has refused to pass legislation requiring it, despite the mountain of data on workplace spread from coronavirus and other respiratory infections.

Public health agencies will still have an important role to play, empowering locals with educational programs and coordinating the response, Tomori adds. The frontlines of novel diseases could offer the best early warning system. “If you take care of that first case, you can prevent an epidemic,” he says.

What Africa can do to contain pandemics? A panel discussion with Tomori, Jean-Vivien Mombouli, and Christian Happi

The domestic production and supply of raw material for protective equipment, including face coverings, gloves and disposable gowns, has yet to be ensured by the government.

It did not fix the clinical research system, which proved slow in producing useful results on a number of issues, such as vaccine schedules and the evaluation of drugs to counteract Covid symptoms. The reliability of the clinical results proving the benefits of steroids and the problems with Hydroxychloroquine were found in Britain and other countries. The National Institutes of Health don’t change how they organize and fund clinical trials for large, pragmatic trials even when there is a public health emergency.

To better understand their grassroots efforts, I spoke with Tomori, Jean-Vivien Mombouli, and Christian Happi, who worked at the African Centre of excellence for genotoxicity in Nigeria. I wanted to learn what they think Africa needs to do to contain infectious diseases. They offered three key ideas: developing community-based disease surveillance; building capacity to produce protective gear, vaccines, and other pandemic-busting tools; and investing more in health-care workers.

He tries not to get too upset about global health inequities because he thinks they’re inevitable. The real issue, he says, is that African countries rely too much on the West — which is not exactly a formula for success. For one, Tomori says, Western aid always comes too little, too late. He insists that your help isn’t helping us. It is making us more dependent.

Four weeks ago, I visited Mulago National Referral Hospital, in Kampala, where I used to work. It is home to one of the Uganda’s isolation wings. During my visit, I witnessed some of the challenges that the government and health-care workers were facing to contain this terrible outbreak without the most effective tool there is: vaccines. The Sudan strain of ebolavirus has killed 56 people and spread to 9 districts in Uganda, including the capital city of 2 million people and regions that border other nations. It could cause a crisis in other countries.

Part of the problem is that, of the 47 countries in sub-Saharan Africa, six of them don’t even have a single medical school while 20 countries only have one. By 2030, WHO estimates that Africa will be short 6.1 million health-care workers, relative to the Sustainable Development Goal threshold of 4.45 health-care workers per 1,000 people.

From Vaccines to Diseases: A Paradigm for Cape Town, South Africa, as a Vaccination “Value Chain”

The most notorious example of this was when it took nearly three months to discover the cause of the epidemic in West Africa. WHO reported that the country took so long because “Clinicians had never managed cases. The patient specimen had never been diagnosed by a laboratory. No government had ever witnessed the social and economic upheaval that can accompany an outbreak of this disease.” The virus was already “primed to explode” after being identified as the culprit of the disease.

Likouala prefecture is a swamp area in the north of the country which is one of the least developed regions. He calls Likouala a “paradise for pathogens,” rife with everything from the disease-causing bacteria treponema to the viral disease Rift Valley Fever. “You know something terrible is going to come out of that area,” he says. Without proper pathogen monitoring, it’s only a matter of time.

“It’s not like they swallow whatever ‘truths’ you tell them. Mombouli says that they ask tough questions. They transmit the information and have proper behavior once they get it. Early disease detection and containment can be enabled by community members’ active support and vigilance.

As such, Mombouli thinks the continent should develop its own epidemic “value chain,” a term referring to the entire manufacturing process from acquiring raw materials to distributing finished products. Presently, a few African manufacturers have experience making vaccines from start to finish, including the Biovac Institute in South Africa, which produces a hepatitis B vaccine, and the Institut Pasteur de Dakar in Senegal, which produces a yellow fever vaccine.

Last year, WHO chose South African biotech company Afrigen to be the hub for mRNA technology transfer, and 15 spokes have since been identified across various low- and middle-income countries, including six in Africa. Although Moderna and Pfizer-BioNTech refused to share their technology and expertise, Afrigen used publicly available information to make their own version of the mRNA vaccine — one that doesn’t require cold storage — and already started training the spokes. The ultimate promise, Mombouli suggests, will be African countries using novel vaccine technology to contain diseases that are spreading on the continent in particular.

He says that if the company moves out, we will go back to square one. Aspen’s plant in South Africa might shut down because of insufficient demand due to hesittancy and difficulties in distributing the vaccine, as one example.

This will take time, with clinical trials expected later this year and vaccine approval coming in 2024, but there are things we can do in the interim. Beyond fill-and-finish operations, Tomori says that African countries can identify other aspects of the value chain where they can start contributing immediately. For instance, one might manufacture glass vials, another rubber stoppers, another testing swabs and so on. Each country doesn’t need to produce everything end-to-end, but Tomori says they should all be starting somewhere instead of patiently waiting for international aid.

Things are beginning to change. Namibia, for instance, is one of four African countries that has surpassed the WHO threshold — with 10.28 workers per 1,000.

This fledgling success stems from government prioritization. In a recent paper in World Health and Population, authors from Namibia’s Ministry of Health and Social Services described how they used a WHO tool to diagnose the country’s staffing shortcomings. They used the data to make decisions about expanding nurses’ scope of practice and redeploying health-care workers to the regions of greatest need.

While it’s critical to continue building more medical institutions, such as the Kenyan General Electric (GE) Healthcare Skills and Training Institute and the University of Global Health Equity in Rwanda, there must also be a focus on retention.

In a 2011 study in the British Medical Journal, it was estimated that sub-Saharan African countries lost $2 billion (in terms of returns on educational investment) because doctors trained on the continent moved abroad. “Africa has to look inward in order to pay people their correct salary so that they wont leave the region for other countries”, he says. The Zimbabwean Nurses Association claims that most nurses in the country earn less than the World Bank’s international poverty line.

This wouldn’t necessarily stop the exportation of health-care workers, but having the West fork over the money could help African countries replenish their workforce. “People should be honest enough to say that you cannot deplete a continent of its own resources,” Happi says.

It’s not to say partnerships with Africa shouldn’t be looked at. Sikhulile Moyo was the laboratory director of the Botswana-Harvard AIDS Institute Partnership and a researcher at the Harvard T.H. Chan School of Public Health when he first spotted the omicron variant. Similarly, Happi collaborates with Broad Institute computational geneticist Pardis Sabeti, and together they deployed COVID-19 tests in hospitals in Nigeria, Senegal and Sierra Leone well before any U.S. hospital had them. Partners in Health also recently announced plans for the $200 million Paul E. Farmer Scholarship Fund, which will support students at the University of Global Health Equity in order to “educate future health care leaders in Africa.”

The pandemic of the unvaccinated: Individual risk versus social risk and vaccines in the early 1980s and 1990s, according to Bajaj

A American journalist, Simar Bajaj, has previously written for the Washington Post, TIME, The Atlantic and more. He is a professor at Harvard University studying the history of science and chemistry. Follow him on social media.

Of course that is a very good deal. But it also means that, given the underlying age skew, a twice-boosted 87-year-old shares a similar risk of Covid death as a never-vaccinated 70-year-old. Which is saying that there is some real risk. If it was ever comfortable to say that the unconscionable levels of American deaths were a “pandemic of the unvaccinated,” it is surely now accurate to describe the ongoing toll as a “pandemic of the old.”

One solution is that we prefer not to see the deaths of several hundred deaths a day as a sort of background noise or morbid wallpaper. We don’t need to understand who is dying or why in part because we don’t want to reckon with the fact that around 300 Americans are now dying from Covid-19 every day, at a rough pace of about 100,000 per year, making it the country’s third leading cause of death. This is normalization at work, but it is also a familiar pattern: We don’t exactly track the ups and downs of cancer or heart disease either.

The country has not been able to consider individual risk and social risk in a single way. In the first year of the pandemic, we seemed to build our sense of individual risk backward from the social need to limit spread — underemphasizing some of the differential threat and focusing instead on universal measures like social distancing and mask wearing. With the arrival of vaccines, we began to build a collective picture of social risk in the opposite way, up from an individual basis instead.

Covid-19 in Beijing: a city-wide crisis before it hits the global scale and what it tells us about the world, and what we need to know

Editor’s Note: A version of this story appeared in CNN’s Meanwhile in China newsletter, a three-times-a-week update exploring what you need to know about the country’s rise and how it impacts the world. Sign up here.

China is bracing for an explosion of Covid-19 cases as it dismantles parts of its zero-covid policy, with a leading expert warning Omicron variant were spreading quickly and signs of an outbreak rattling the country’s capital.

The health tracking function for the mobile itinerary card was to be eliminated the following day.

It was a point of contention for many Chinese people because of the use of data collection by local governments and the fact that anyone who has been to a high-risk zone can be banned from reentering that city.

‌We need to prepare to fight disease outbreaks just as we prepare to fight fires. If a fire is left to burn outside of control, it could cause serious damage to not only one home, but the entire community. The same is true for infectious diseases, except on a much bigger scale. As we know all too well from Covid, an outbreak in one town can quickly spread across an entire country and then around the world.

Business were closed in Beijing throughout the weekend, and city streets were mostly empty, as people either became ill or were afraid of being exposed to the virus. The biggest crowds were outside of the pharmacy and testing booths.

The China Youth Daily reported hours-long lines at a Beijing clinic and said that experts urged people to not visit hospitals unless necessary.

A hospital official on Saturday appealed to residents who have mild to no symptoms to not call the emergency services line, as a surge of emergency calls led Health workers in the capital to be grappling with.

The daily number of calls to the emergency center in Beijing had increased from 5,000 to over 30,000 in the last week or so, according to the chief physician of the center.

Viral Zero Covid Impact Beijing 2020: State Media and Experts Comment on the State of the Epidemic, and the Implications for the Outbreak of Omicron

It will be hard to completely cut off the transmission chain if prevention and control is strong, according to Zhong, who has been a crucial public voice since the beginning of the Pandemic in 2020.

With official data now seeming meaningless, it’s harder to gauge the extent of the spread because of the rapid roll out of testing nationwide.

Last Wednesday, top health officials made a sweeping rollback of the mass testing, centralized quarantine, and health code tracking rules that it had relied on to control viral spread. Some aspects of those measures, such as health code use in designated places and central quarantine of severe cases, as well as home isolation of cases, remain.

Outside experts have warned that China may be underprepared to handle the expected surge of cases, after the surprise move to lift its measures in the wake of nationwide protests against the policy, growing case numbers and rising economic costs.

While Omicron may cause relatively milder disease compared to earlier variants, even a small number of serious cases could have a significant impact on the health system in a country of 1.4 billion.

Zhong, in the state media interview, said the government’s top priority now should be booster shots, particularly for the elderly and others most at risk, especially with China’s Lunar New Year coming up next month – a peak travel time where urban residents visit elderly relatives and return to rural hometowns.

Measures to be undertaken include increasing ICU wards and beds, enhancing medical staff for intensive care and setting up more clinics for fevers, China’s National Health Commission said in a statement.

Meanwhile, experts have warned a lack of experience with the virus – and years of state media coverage focusing on its dangers and impact overseas, before a recent shift in tone – could push those who are not in critical need to seek medical care, further overwhelming systems.

Bob Li, a graduate student in Beijing, who tested positive for the virus on Friday said he wasn’t afraid of the virus, but his mother, who lives in the countryside, stayed up all night worrying about him. Li said that she finds the virus very scary.

Source: https://www.cnn.com/2022/12/12/china/china-zero-covid-impact-beijing-intl-hnk-mic/index.html

How will the ebola pandemic unfold? Seven years after the COVID-19 wake-up call: how wealthy countries can play their part?

China’s market watchdog said on Friday that there was a “temporary shortage” of some “hot-selling” drugs and vowed to crackdown on price gouging, while major online retailer JD.com last week said it was taking steps to ensure stable supplies after sales for certain medications surged 18 times that week over the same period in October.

Those 50 and older and anyone with a chronic condition should be evaluated for treatment after they test positive for Covid-19, according to Jha.

People withsymptomatic inflections are not in need of medication. It is enough to rest at home, maintain a good mood and physical condition,” Li Tongzeng, chief infectious disease physician at Beijing You An Hospital, said in an interview linked to a hashtag viewed more than 370 million times since Friday.

There are three candidate vaccines for Sudan ebola that have been identified in early testing, thanks to research and development driven by CEPI, IAVI, the US National Institutes of Health and others. Last week, Uganda received the first vaccine shipment for scheduled trials. Because of the number of deaths and the number of infections, vaccine trials will be too late to determine vaccine efficacy.

In a Nature column seven years ago, I warned about this problem. It remains one of the biggest chinks in our armour despite the COVID-19 wake-up call.

A new variant is needed to make sure that more people are getting vaccine in low-income nations. The creation of global collaborations, such as CovaX, meant the delivery of vaccines equitably. But they were hampered by the fact wealthy nations prioritized their own populations. Too often, vaccines for Low- and middle-income countries were delivery at different times of the year, posing a challenge of rolling them out to places with limited health-care infrastructure.

What will it take to finally catalyse change, so that I’m not writing this again seven years from now? We have come a long way from not talking about this issue at all and now living through a Pandemic that daily highlights its relevance. I am optimistic that a change in mindset is in view.

Wealthy countries should take the lead. The International AIDS Vaccine Initiative is based in New York City, and the Coalition for Epidemic Preparedness Innovations (CEPI), which is based in Norway, should be fully funded to do this work.

The director of the US National Institute of Allergy and Infections Diseases, Anthony Fauci, is leaving the organization in this month after more than 38 years in the post. He has led the institute under seven US presidents and overseen its research and response to the HIV/AIDS epidemic, the Ebola outbreak that began in 2014 and the COVID-19 pandemic. The 81-year-old physician-scientist became a household name during the pandemic, during which he was revered as a trusted source of advice by some and disparaged by others, including former US president Donald Trump, who saw his advice as inconsistent and overbearing. On December 11, he was attacked on his account by Musk, who took over the platform in October. Fauci spoke to Nature about Musk’s comments, the pandemic and his own legacy.

One of the most important is in the area of HIV. In 1981, when we first became aware of the cases of HIV, [it was] a mysterious disease of unknown etiology that was killing virtually everybody who was infected. It was one of the most difficult periods in my career to work in infectious diseases. We went from that bleak time of not knowing what was killing all of these mostly young gay men to getting the [underlying virus], a diagnostic test and, within a few years, an entire series of drugs, which when used in combination, have completely transformed the lives of people with HIV. We can prevent the spread of the disease with a combination of prevention techniques and treatment, like pre-exposure prophylactics and treating people who are carriers of the disease.

One of the holy grails of infectious-disease research is a safe and effective vaccine for HIV. Both for treatment and prevention of disease, we have made spectacular advances. But the one thing that’s eluded us up to now has been a safe and effective vaccine. That is one of the things we are looking forward to. The other is the possibility, although it’s a stretch, in some respects, to have a cure for HIV, where you can have durable suppression or elimination and eradication of virus in the absence of any further therapy. We have not reached that point yet, but that is an aspirational goal.

Yes, we do. And you do it by just doing it. Social sciences can be incorporated into the hard sciences of vaccine development. It is very disturbing that, in our country, we have 68% of the total population vaccinated with the primary vaccine for COVID. Of those, only half have received a single boost. Despite the availability of a booster that’s effective and bivalent, only 13% of the eligible population has received it. It is disturbing and embarrassing for us to have that low enthusiasm for a life-saving vaccine.

CoVID-19 is not a pandemic. It’s a cesspool of misinformation, and it isn’t going to go away

Another aspect that has been brought to the fore by COVID-19 is the importance of mental health, and paying attention to the stresses that [the pandemic] has put on society: not only on health-care workers, doctors and nurses, but also on the general population, including children. [Their] growth and development has been [shaped] not only by missing in-person school, but also by the stress of losing grandparents and parents, and seeing the disruption of the normal flow of their childhood. The negative impact on mental health has been caused by all of that.

That’s impossible to answer. If countries or groups are not transparent, it will be a problem for public-health efforts. And I would hope that all the countries of the world come to a realization that we’ve got to be completely cooperative, collaborative and transparent in everything we do, because there’s no such thing as a pandemic, particularly of an infectious disease spread by the respiratory route, that’s going to stay in one country. COVID spread all around the world and has already resulted in over seven million deaths, and that’s probably a gross underestimate.

I don’t pay attention to that, Max, and I don’t feel I need to respond. I don’t tweet. I don’t have a Twitter account. I don’t worry about that stuff because it’s just a cesspool of misinformation.

Of course it’s at risk. I have armed federal agents with me all the time. A lot of hate is stirred up by that because many people have no idea why they hate it, and somebody like that is following it.

Source: https://www.nature.com/articles/d41586-022-04432-7

Covid-19 in the United States is not going to be like last winter’s flu: Public health officials, state and local governments are concerned

They shouldn’t be discouraged because they can make a huge difference in society if they get into public service and public health. It is really extraordinary. It overcomes and counters all of the other bad stuff. The attacks on public health officials are unfortunate. You can achieve great things in the field. It supersedes all the other stuff.

When you were planning on going to visit your Aunt Mary for the holiday, you were alarmed by the outbreak of the flu and the presence of a variety of infectious diseases.

Health officials are emphasizing the availability of the protective measures, tests and treatments that they say will be key to preventing a repeat of the Covid-19 surges of the past two winters.

Case numbers are now below those of earlier waves, but about 14% of the US population is in an area that meets the US Centers for Disease Control and Prevention’s criteria for a “high” Covid-19 community level, up from less than 5% last week. New York City, Los Angeles County and Phoenix’s Maricopa County are among those areas.

Covid-19 hospitalizations have been on the rise since early November and older people are bearing the majority of the burden. Hospitalization rates are four times higher for seniors than for any other age group.

In the first week of December, the US had the most Covid-19-related deaths in months. Even with vaccines and treatments widely available, the CDC reported nearly 3,000 deaths for that week.

The White House said Thursday that this Covid 19- season does not need to be like last winter’s, when a large spike in cases with the Omicron coronaviruses variant occurred.

“We have the tools, we have the infrastructure, and we have the know-how to manage this moment,” White House Covid-19 response coordinator Dr. Ashish Jha said at a briefing.

The Biden administration has been in daily contact with state and local public health leaders, monitoring hospital levels, he said. And the federal government has medical personnel, supplies and other resources ready if states and communities need them.

The government is allowing more Americans to take free tests after reopening Covidtests.gov. Everyone in the US can order up to four at home tests as early as next week.

Only about 14% of eligible Americans have gotten an updated Covid-19 booster, and 1 in 5 people in the US remain completely unvaccinated, according to the CDC.

Treatments can reduce a person’s risk of being hospitalized or dying from Covid-19, but Paxlovid works best if started within days of when symptoms appear.

Given how widespread and how available those tools are, I think we could get through the Covid-19 season if people used them.

Source: https://www.cnn.com/2022/12/15/health/covid-19-christmas-2022/index.html

High-Scale Covid-19 Vaccination in Low-Energy Countries Revisited after the SARS/COVID-19 Pandemic

In Philadelphia, when schoolchildren come back from the winter break, they will be required to wear masks for 10 days as a “proactive measure” to reduce the spread of Covid-19 and other respiratory illnesses, a district spokesperson said.

The CDC recommends masking for anyone who’s on public transportation. It suggests wearing one in public places in places with high Covid-19 levels. People at high risk of severe illness are told to wear masks in areas with only medium community levels.

In many places, life took on a semblance of pre‑COVID normality in 2022, as countries shed pandemic-control measures. Governments scaled back or abandoned mask-weary mandates as a result of the recent events. Travel returned to normal.

There were optimistic proclamations, too. In January, Danish Prime Minister Mette Frederiksen declared that SARS‑CoV-2 no longer poses a threat to society. In September, US President Joe Biden remarked during an interview that the pandemic was over. Even Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), has expressed hope that COVID-19’s designation as a global emergency will end in 2023.

The result is that only one-quarter of people in low-income countries have received at least one dose of a coronavirus vaccine. Many low-income countries need to get back to tackling neglected priorities such as malaria, tuberculosis and infant mortality, all of which were sidelined as the worst of the pandemic swept through. It’s possible that ignoring COVID-19’s continued toll could endanger these efforts.

One path to renewing vaccination efforts lies with technology. Development of mucosal vaccines is under way. They are designed to be given through the nose or mouth, with the hope of triggering immunity that prevents transmission of illness. China has approved an inhalable booster dose and a nasal vaccine, and India a two-dose nasal-drop primary vaccine. Russia and Iran have both approved the vaccine. Researchers are waiting to find out if any of these deliver on their promise to stop the disease.

Moon said that the draft seeks to “strike a grand bargain” in sharing data. Moon says that rich states want their countries to quickly share data on diseases, and low-income states want cheaper access to the biological information that comes with it. The draft requires signatories to supply pathogens to a laboratory in the WHO’s network within hours of a new pathogen with pandemic potential being identified, and to upload genomic sequences to public repositories. 20% of the vaccines, diagnostics and drugs produced by states will be donated to the World Health Organization in exchange for half of them being at an affordable cost. The text does not require states to share their intellectual property rights as part of the agreement.

WHO can’t declare the COVID-19 outbreak as a disease in every country: What is it telling us? The case of Saudi Arabia, Libya and Egypt

The researchers found that in most years, influenza, especially the H5N1 variant, was reported at the highest frequency of any infectious disease — 776 outbreaks have been documented since 1996.

Saudi Arabia and the Democratic Republic of the Congo were the places that documented the most cases of the disease, with Saudi Arabia reporting 179 instances of the disease. Few reports were associated with countries in Eastern Europe.

Other variations can be explained by the quality of country’s health systems. Egypt has had more than 100 outbreaks of flu in the last 23 years. Libya, which has an under funded and unstable health system as a result of two civil wars, has never reported an outbreak. The analysis shows that the WHO cannot track all infectious diseases in the world, and so must pick and choose which ones to keep an eye on.

The database allows researchers to look at factors such as weather events and conflicts that have an effect on a specific outbreak. The study states that there are no known epidemics in every region.

Katz says the WHO could improve the DON reports by increasing transparency around how it prioritizes the thousands of notifications it receives, creating more-specific criteria for an outbreak’s inclusion, and adding information about contextual factors such as climate hazards or outbreaks in animal populations.

David Heymann is an epidemiologist at London School of Hygiene and Tropical Medicine and chaired the WHO emergency committee on the mosquito-borne Zika virus outbreak in 2016; he says the decision on change of the PHEIC status on COVID-19 will be based on politics.

How the WHO labels the outbreak is important because it sends a signal to the global community. What signal is sent by it to the International Air Travel Agency? What signal is it sending to researchers, to manufacturers and investigators developing new drugs and new vaccines?”

That definition doesn’t really hold true for COVID-19 anymore, says Preben Aavitsland, director for surveillance at the Norwegian Institute of Public Health in Oslo. “The disease has already spread to every corner of the world. When the virus is already abundantly present in Nairobi, Napoli, Nashville, Nagoya, Nagpur and Nanjing, there is no extra risk introduced by travel and trade.”

The WHO didn’t declare the COVID-19 outbreak a disease in March 2020 as reported, says Tarik Jaarevi. Instead, the organization merely “characterised the situation” as a pandemic by using the term.

Putting an end to equity in pandemic prevention and response: A review of the zero draft of the WHO WHO Convention on Diseases, Pandemics and Society

Kelley Lee, co-director at the Pacific Institute on Pathogens, Pandemics and Society in Canada says that it has more heart and brain than she expected. It still has insufficient teeth and spine to make sure that we have a better response next time.

The first of a series of WHO member states meetings will discuss the terms of the document later this month. Some of the language is expected to be watered down before the agreement is adopted and researchers expect negotiations to be contentious.

There are encouraging signs regarding bird flu, such as the federal discussion of a mass poultry-vaccination program. But each of these projects could take at least six months, and almost certainly we would find ourselves wasting the early stage of a new pandemic — and possibly more than that — repeating debates over the last one. Some people think the Covid response went too far to mock the idea that the same measures could be imposed to hold off a new contagion as though it were.

A key focus of the zero draft is equity. Articles in the treaty include establishing a global network for the supply and distribution of ingredients used to produce drugs; strengthening research and the development of vaccines and therapeutics; and sharing that knowledge with the world.

Parties are required to allocate 5% of their annual health budget for pandemic prevention and response under the treaty. Developing countries should be given an as-yet-unspecified percentage of their gross domestic product in order to prepare for the occurrence of Pandemics. If agreed, Moon says this would be the first instance she knows of in which governments commit to setting aside a specific amount of money for international aid in a treaty. “I don’t think it’s likely, but it’s a bold proposal.”

But researchers are concerned that even if countries do sign up, the treaty in its current form is too weak to stop signatories from ignoring the rules when the next pandemic strikes. The document is intended to be legally binding, but in some key instances, the text avoids strong language, such as ‘shall’ and ‘must’, instead using fuzzier terms such as ‘encourage’ and ‘promote’, say researchers. Lee says that it is still heavily reliant on voluntary compliance.

Negotiations around how to ensure compliance have been pushed back, to be addressed after the treaty comes into force, which is problematic, says Layth Hanbali, a health-policy analyst at Spark Street Advisors who is based in Ramallah, in the occupied Palestinian territories. The treaty document will not have any meaning unless a mechanism is in place to hold states accountable.

The value of the treaty-building process should not be underestimated. Discussions and debates over the provisions will help to build trust between governments, change behaviour and establish international norms of solidarity.

How to Prepare for the Next Pandemic Using the World Health Organization (W.H.O. and the Global Health Emergency Corps)

Imagine there’s a small fire in your kitchen. Your fire alarm goes off, warning everyone nearby about the danger. Someone calls 911. You attempt to put the fire out yourself, and could even have a fire extinguisher under the sink. If that doesn’t work, you know how to get out. By the time you get outside, a fire truck is already pulling up. Firefighters use a hydrant in front of your house to fight the flames before they spread to your neighbors homes.

I believe the W.H.O. and its partners will build a new network called the Global Health Emergency Corps. The leaders of the world’s top health emergency will work together to prepare for the next Pandemic. Just as firefighters run drills to practice responding to a fire, the Emergency Corps plans to run drills to practice for outbreaks. Everyone, including governments, emergency health workers and health care providers, should know what to do when there is a potential outbreak.