Pandemic preparedness and response: are we better off than pre-COVID

Two articles by University of Otago, Christchurch, researchers in this week's New Zealand Medical Journal (NZMJ) raise concerns about global and local readiness to deal with a future pandemic - with one saying we risk falling into "a cycle of panic and neglect" and the other exposing self-reported gaps in health worker preparedness.

In the journal's editorial, concerns have been raised by two of AotearoaNew Zealand's leading voices in the Covid-19 pandemic - former University of Otago Vice Chancellor and government vaccine taskforce epidemiologist Professor David Murdoch, and the man who led Aotearoa'sCovid-19 response, former Director General of Health Sir Ashley Bloomfield.

David Murdoch

Both claim there's a sense of "collective global amnesia" about the Covid-19 pandemic, with investment in pandemic prevention, preparedness and response (PPPR) "nowhere near the scale or speed necessary".

The say despite repeated warnings from experts, numerous initiatives and the direct, lived experience of a major pandemic, the level of activity now does not match what is required to mitigate the widespread health, social and economic impacts of the next "inevitable" pandemic.

With an updated national pandemic plan published by the Ministry of Health in July, and findings from the Royal Commission of Inquiry into Covid-19 Te Tira Ārai Urutādue next month, the pair say New Zealand's pandemic planning is continually dynamic and will, rightly, need continuous updating to evolve.

They say New Zealand must avoid reliance on an influenza-centric pandemic plan - which they say was one of the earliest key lessons learned from Covid-19.

"It quickly became apparent in early 2020 that Covid-19 was not behaving like seasonal influenza," they write, and that "a significant shift in strategy was required, making it clear that pandemic planning must incorporate the ability to adapt to the specific characteristics of the pathogen at hand".

They say future pandemics need to be considered primarily as a security threat, rather than a health threat, and in future should be led by the Department of the Prime Minister and Cabinet, to ensure responses are able, from the start, to address threats to economic and social wellbeing as well as public health.

They stress too the importance of clear leadership and decision-making structures, writing that in New Zealand "it became clear early on" that leadership structures envisioned in planning frameworks needed to be re-thought to quickly respond to the evolving situation and emergence of elimination as the overall strategy.

"Rapid, highly co-ordinated cross-government leadership and decision-making were needed. The complexity of the situation meant that no pre-existing framework could fully account for the range of challenges the pandemic threw up."

The also call for pandemic planning processes to be regularly tested to evaluate the core "pillars" of a response against a range of different pathogens, with the national pandemic plan updated at least annually, tested in biannual exercises, and made easily accessible to stakeholders - including government officials, frontline health workers and communities.

To conclude, they say New Zealand needs to ensure it has the infrastructure needed to underpin and support our future pandemic preparedness - not only at healthcare level, but supply chain and logistics, communication technology, financial systems, community services and in education.

Reflecting these concerns is a second study published in this edition of the NZMJ, which identifies self-reported gaps in pandemic preparedness among New Zealand healthcare workers.

The international TMGH-Global COVID-19 Collaborative Study provides the first global insight into awareness and preparedness of COVID-19 during the initial pandemic phase, with a survey of 158 Christchurch hospital doctors, nurses and other frontline health staff.

Ibrahim Al-Busaidi

Co-author Dr Ibrahim Al-Busaidi from the University of Otago, Christchurch's, Department of Primary Care and Clinical Simulation, says while workers demonstrated strong awareness of the disease, their overall reported readiness for the pandemic was significantly lower.

"Awareness was significantly influenced by gender and profession, while preparedness was affected by age, profession, clinical experience and Covid-19 training," Dr Al-Busaidi says.

"Prior experience with infectious outbreaks and participation in Covid-19 training courses were low among participants, and most had no exposure to a Covid case due to the virus's late arrival here."

He says around one-quarter were unsatisfied with the equipment on hand such as personal protective equipment (PPE), saying they either had no knowledge of existing equipment and infrastructure, or it was not available to them, thus lowering their preparedness further.

Dr Al-Busaidi says of potential concern too was the fact most relied on either mainstream media (94.3 per cent) and social media (46.8 per cent) for their Covid-19 information.

"Widespread misinformation was not only circulated by the public but also by some mainstream and social media outlets, community leaders and government officials, potentially influencing clinical practice during a rapidly developing pandemic."

On the positive front, the survey found despite the low levels of previous pandemic training and experience treating Covid-19 cases, most participants reported a degree of confidence in handling suspected Covid patients.

"These eye-opening findings underscore the need for urgent policy, training, and infrastructure improvements to better equip healthcare workers for future pandemics in New Zealand," Dr Al-Busaidi concludes.

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