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OXFORD: The World Health Assembly met in May amid many proposals for stricter and more applicable global rules to deal with future infectious disease outbreaks.
The latter was from the United Nations Independent Pandemic Preparedness and Response Team.
A new global pandemic compact, more reliable and independent international institutions and an international pandemic financing mechanism all come together.
But a bottom-up strategy might work better.
IMPROVING WORLD HEALTH
A separate review by the World Health Organization earlier this year identified four ways to strengthen global health governance.
He called for a centralized approach to strengthening countries’ preparedness for health emergencies; a worldwide notification system to ensure reliable compliance monitoring; global capabilities such as genomic sequencing infrastructure; and closer coordination among international organizations, including WHO, the World Organization for Animal Health, the Food and Agriculture Organization and the United Nations Environment Program.
These are all worthy goals. But is a top-down approach the best way to solve them?
To answer this question, global health experts need to pay more attention to successful local disease control efforts.
CASES OF EFFECTIVE COMMUNITY OVERVIEW
Consider dealing with onchocerciasis or river blindness.
In the 1970s, it was led by World Bank President Robert McNamara, Merck CEO Roy Vagelos and WHO Director General Halvdan Mahler. But over time, a bottom-up strategy, in which nearly half a million rural health workers recognized the problem, proved to be more effective.
1994-95 multicountry study Shown that coverage is higher when communities are responsible for organizing their own distribution of ivermectin (a drug that treats onchocerciasis) than when the drug is delivered by the health system.
READ: Commentary: We’ve learned five lessons from the pandemic that should help us cope with any spike in cases.
Another Carter Center report highlights the role of kinship and local networks in the fight against this disease.
Likewise, the Bombay Leprosy Project is a long-standing program in Mumbai’s largest slums like Dharavi.
Community volunteers trained by paramedics conduct door-to-door interviews with the population to identify new cases.
During the pandemic, it was one of the most efficient channels for delivering personal protective equipment (PPE), health care, food, and now COVID-19 vaccinations to the poorest of the poor in areas where Maharashtra and federal governments are largely absent. …
RESTORING NATIONAL SUSTAINABILITY
The importance of bottom-up initiatives in response to the pandemic is not limited to developing countries.
The United Kingdom government has invested heavily in a centralized national COVID-19 testing and tracking service. But evidence suggests that even relatively underfunded local schemes have performed better, forcing the government to rethink its approach.
Increased efficiency is not the only reason to consider a mass deployment strategy.
Politically, many countries – perhaps terrified by their experience of trade blockages at the start of the pandemic, the global struggle for PPE supplies, and nationalism in vaccines – are now focusing more on national resilience than global commitment.
Thus, a new focus on local sustainability could find a much more receptive audience in communities around the world.
One of the shortcomings of the International Health Regulations during the COVID-19 pandemic was the inability to prepare, provide and coordinate adequate resources at the country level. A bottom-up approach can change that.
(“Vendors are not stupid or stubborn.” Find out why KF Sitoh says that saving Singapore’s food culture will take more than delivery-ready and digitalized peddlers in CNA’s Heart of the Matter podcast .)
FINANCING EARLY WARNING OF PROBLEMS
Moreover, investing in community health surveillance capabilities is likely to be the key to tackling this and future pandemics. The right financial incentives are critical here.
Smallholders in Africa and Asia are the first to know when some of their chickens or ducks appear to be sick – possibly with the avian flu virus, which could trigger a human pandemic.
But if farmers reporting an outbreak are faced with the prospect of destroying their entire herd without receiving adequate compensation, they may well choose not to share this information.
In the same way, as Stefan Dercon of the University of Oxford argued, investments in public health coverage and quality and in the protection of health workers are vital to ensure continued delivery of essential health services.
These include vaccinations, provision of antiretroviral drugs, complementary feeding, maternal health, distribution of bed nets and malaria treatment. Community health workers are also important to protect the most vulnerable in densely populated areas, and to track and control disease.
Such bottom-up approaches will require government support, including funding for local efforts. Any support may need to be legalized to be sustainable, as was the case with funding from the Brazilian Public Health Research Institute Fiocruz in the early 20th century.
Such a charter can protect organizations from attempts to cut budget allocations or fund other programs at their expense.
Historically, global health and environment collaboration has reflected various combinations of top-down and bottom-up measures.
While the 1987 Montreal Protocol to Protect the Ozone Layer was an example of top-down regulation, the 2015 Paris Climate Agreement was the result of a much longer process involving communities, cities and countries around the world.
Academic research and research from hundreds of universities, institutes and academics, as well as early initiatives by mayors and individual communities, have greatly increased the awareness of ordinary citizens and the commitment of families, schools, local media, municipalities and regional administrators.
After all, even the best bottom-up disease control efforts risk being thwarted by the inability of the international community to provide access to PPE, genetic sequencing or vaccines. But politicians should not neglect local health care.
To better prepare for future pandemics, our top-down models and agreements must shape a response that is firmly rooted in local communities and values community participation, responsibility for risk and concern.
Ngair Woods – Dean of the School of Government. Blavatnik University of Oxford. Ok Pannenborg is a former Chief Health Adviser and Chief Scientist at the World Bank.
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