Stories, data, and plans: Preparing for the next pandemic

By Abhas Jha

Even before the current COVID-19 outbreak, a September 2019 report compiled at the request of the United Nations Secretary-General warned that there is a “very real threat” of a pandemic that is spread airborne around the world and could wipe out almost 5 percent of the global economy.  The late Nobel Prize-winning molecular biologist Joshua Lederberg had once famously warned that viruses pose “the single biggest threat to man’s continued dominance on this planet.” In the context of the current COVID-19 epidemic, on February 15, WHO Director General Dr. Tedros Ghebreyesus, speaking at the Munich Security Conference, said that "For too long, the world has operated on a cycle of panic and neglect.”   For those of us who work on disasters and preparedness, this cycle of panic and neglect is familiar. We even have a name for it: NIMTOF, which stands for Not In My Term Of Office. Politicians are rational beings. Let’s say you are a mayor or some other elected official. You face a choice of investing in preparedness for a disaster or pandemic that may or may not happen under your watch. Or you can use that money for other pressing and more visible priorities. Unfortunately, the evidence shows that voters “reward the incumbent party for delivering disaster relief spending, but not for investing in disaster preparedness spending.” So, no prizes for guessing where the investment priorities will lie.

On any rational cost-benefit basis, investing in preparedness, whether for pandemics or natural hazards, is possibly one of the best investments any country can make. A dollar spent on preparedness for disasters is worth about $15 in terms of the future damage it mitigates.  In the case of pandemics, a 2017 World Bank report found that that annually it would take less than $1 per person globally to put in place robust mechanisms to prepare for the next (inevitable) pandemic.

So, what lessons have we learned from major disasters about dealing with the “curse of NIMTOF”? 

The first lesson is that you should never let a serious crisis go to waste. The research on major disasters shows that the potential for major policy reform and investments in preparedness is in the weeks and months right after the disaster. This is the narrow window of opportunity in which one can put into place the institutional structures that enable long-term, multi-stakeholder planning that is essential for preparedness.  After Hurricane Sandy, the New York City administration and the New York City Panel on Climate Change worked with a multi-disciplinary group of technical experts to develop the next version of PlaNYC–New York City's long-term sustainability plan. With respect to pandemic preparedness, after SARS, Singapore put into place a “whole of Singapore” integrated national response where public agencies, private organizations, and the community work in a coordinated way to deal with both health and non-health issues.

Interestingly, studies have consistently found that major disasters have a “half-life memory” of about a generation and a half, after which recollection of the impact of the disaster begins to fade from the memory of the general public, as does the priority to invest in preparedness. Unfortunately, even the quite recent memories of SARS and MERS seem to have faded from public memory quite quickly. So, communities should invest in structures and stories to keep the collective memory of past disasters alive.  Japan, for example, has invested in what has been described as “disaster heritage” – monuments and traditional storytelling to keep memories of disasters from centuries ago alive within communities. The coast of Japan is dotted with stone tablets referred to locally as "tsunami stones" denoting past earthquakes and tsunamis. Something as simple as a bright red line in the center of the town denoting the high flood water mark can be an extremely useful memory device. In the case of pandemics, this would be, for example, celebrating annual “pandemic preparedness days,” talking to patients who were cured, or honoring the heroic efforts of individual frontline health providers.

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