Learning from COVID-19 and Planning for the Future
In a short period of time, the world has gone through an unbelievable process of acknowledging, responding, and acclimating to a global pandemic. “[This response] didn’t happen out of nowhere,” explained Dean and Vice Chancellor for Health Affairs, Duke University School of Medicine, Mary Klotman, MD. “There was a broad base of fundamental work and infrastructure that allowed a rapid generation of vaccines that goes back 20-30 years. There is a need to keep that tech and infrastructure going as we anticipate the next challenge.”
As Congress works to draft bipartisan legislation to strengthen the nation’s public health infrastructure and prepare for future pandemics, Duke in DC and Duke Health Government Relations convened a group of Duke experts to brief federal policymakers. The briefing focused on the importance of federal investment in research, the impacts from their work, and additional recommendations to bolster our nation’s public health, medical preparedness, and response systems.
The April 11th event was moderated by Dean Klotman and the panelists included Tom Denny, MSc, M.Phil, the chief operating officer of the Duke Human Vaccine Institute (DHVI) and professor of medicine at the Duke University Medical Center; Christina Silcox, PhD, digital health policy fellow at the Duke Margolis Center for Health Policy; and Tony Moody, MD, professor of pediatrics and immunology at Duke University Medical Center and DHVI member.
Vaccines are one of the most critical public health investments needed to protect us from current and emerging infectious diseases. DHVI has been a global leader in vaccine research since the 1980s, addressing global health issues such as HIV/AIDS, tuberculosis, influenza and zika. Reflecting on some of the successes from the pandemic, Denny noted, “the fact that we identified a pathogen and were able to provide multiple vaccine candidates with EUA (emergency use authorizations) approval was truly amazing,” while also stressing the need for more countermeasures.
“One of the things the vaccine institute (DHVI) is working on, with funding from the NIH (National Institutes of Health), is a new generation of pan-coronavirus vaccine,” said Denny. This vaccine, which would provide broad coverage for several SARS-like pathogens along with a separate flu vaccine that Duke is working on, could work in tandem to provide protection for a number of illnesses over time. As a result, Denny stated, “There is reason to be optimistic, but we can’t take our foot off the pedal.”
Also critical to the pandemic response are public health interventions including testing, screening, treatments, infrastructure-based mitigation, technology and more. The Duke Margolis Center for Health Policy has offered pioneering policy expertise to address the COVID-19 pandemic and to create a pathway to reopen the nation successfully and create a more secure health care system.
Silcox emphasized, “The hard science around identifying the virus, making the vaccine and inventing the test is really only the first step.” Building up implementation, the delivery system, data infrastructure, and most importantly communication and trust are key to managing the pandemic on a global scale.
“We focus on the biomedical science, and often forget about the social science,” added Klotman.
Silcox pointed to a real need for researchers and policymakers to “understand the different subpopulations and attitudes throughout the United States and learn how to communicate with them.”
Denny stressed the importance of maintaining a flexible, growth mindset around emerging findings and building better efforts around the global surveillance of viruses and testing.
Moody added that the pandemic highlighted existing challenges in our global infrastructure. “We have a globally interdependent economy, and supply chain was an incredible issue,” he stated, “which we have to plan for and deal with. We learned to be flexible.”
Manufacturing capacity, central reporting for at-home tests, and the lack of ability to alert people who are at high-risk were challenges in the pandemic response and critical to plan for in the future. “We also need to find a way to make testing less logistically complicated,” said Silcox.
An underappreciated aspect of the pandemic response is the importance of investing in data and infrastructure. “If you’re going to make policy decisions,” said Moody, “you need the best data you can get your hands on.”
The panelists agreed that ventilation requires more attention when it comes to future mitigation strategies. “There are a lot of benefits to focusing on ventilation, but we need to make sure there is equity,” explained Silcox. Many high-risk settings including nursing homes, prisons, and schools have aging infrastructure where the ventilation is not good. She also added that “wastewater testing has been invaluable,” and provides an early warning sign that over-the-counter testing can’t provide.
Policy and Next Steps
As Congress and the Biden administration consider how to develop strong policies to prepare for future pandemic threats, Moody emphasized communication and investment in infrastructure are key.
“You build a fire station for the size of the fire you want to contain,” said Moody, “you can’t decide to build the fire station when the fire starts, you have to build it upfront.” We need to “learn from this and build on this, otherwise we are going to be in a situation during the next pandemic where we are recreating all the things, we just spent two years creating,” he explained.
When it comes to public mistrust and misunderstanding, clear and consistent communication is critical. “If we don’t communicate with the public in an effective way, we won’t make much progress,” added Klotman.