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How countries can prepare for pandemics with essential supplies

It's time to re-think how we stock essential supplies for the future.

How countries can prepare for pandemics with essential supplies
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Photo by Anshu A on Unsplash

Over recent months, we have seen the world battling to counter a global threat, with nations tested on their preparedness for pandemic outbreaks, and the infrastructure that binds us together supporting global commerce and shrinking distance between countries breaking as restrictions on travel are enforced, and countries close their borders.

This comes in a year when we celebrated the 400th anniversary of the Pilgrim Fathers' voyage settling North America, having set out from Europe to make a new life for themselves. Since that time, the world has continued to open up, becoming ever more interconnected through virtual and physical means, with one 2015 report by Visa estimating by 2025, 280 million households worldwide will make one international journey per year, fueling a predicted 35% increase in international travel.

Travel is not confined to business and leisure, with migration continuing as people seek new lives elsewhere. The tragedies of deprivation, oppression, war, and famine drive migration. Migrants crossing continents seeking safety and better lives for themselves and their families, bypass border controls and, therefore, opportunities to detect and prevent the transmission of diseases as they enter new countries.

This issue is unlikely to diminish and may well increase as changes to our climate make parts of the globe harder to survive, driving people to make drastic decisions to seek new lives elsewhere. Arriving from locations where routine vaccination has been problematic, and traveling in conditions that do nothing to control infection, the reality of disease arriving and spreading rapidly is considerable and very real. Climate change itself is enabling the spread of diseases as temperatures increase.

For instance, dengue fever is now endemic in countries like Nepal, which were previously too cool for the disease's emergence. New emerging diseases, such as Crimean Congo Hemorrhagic Fever (CCHF), transmitted in Spain from tick bites, and Chikungunya, which is present in Italy and transmitted by disease-carrying mosquitos, continue causing concern in Europe, each requiring public health precautions and steps to control outbreaks.

As globalization shrunk the world, we have all become reliant upon the benefits it has to offer. Our food supplies depend upon international connections. However, the drivers of globalization, international trade, ease of investment, and massive advances in communication technology, have also allowed the rapid transfer of malign knowledge and materials, equipping those holding hostile intent with the means and opportunity to develop capability.

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Accessing information online has allowed people to develop the capability to harm, as was shown in the Cologne, Germany during the ricin terrorist plot. Sief Allah H, a Tunisian extremist living in Cologne, had made 84.3 milligrams of ricin and was in possession of 3,000 castor bean seeds. It is against this background countries have recognized the threat and taken steps to counter it.

In 2018, the U.K. published its Biological Security Strategy and the U.S. Biodefense Strategy, both recognizing the increased threats arising from intentional, accidental, and naturally occurring biological incidents. Each of those strategies not only seeks to address the external threat arising from state and non-state actors by reducing the ability to acquire and produce weapons and precursor materials, but also by managing and mitigating internal threats through effective responses, the provision of treatment including medical countermeasures and readiness to scale up response by holding stockpiles of essential equipment and means of treatment.

The apparent rapidity with which SARS-CoV-2 spread worldwide in late 2019 and early 2020, also evidences our global populations' highly connected nature. The economic impact likewise shows us how dependent our economies are on world trade and unInterrupted supply chains. This health crisis has also demonstrated the need for stockpiles, with Australia being able to draw on its National Medical Stockpile for 20 million face masks.

That, along with other essential materials, reduce risks to the front line and key staff, contributing to the overall effective management of the outbreak in Australia and New Zealand, falling back on a highly efficient stockpile in its National Reserve Supply.

Indeed, it may be that New Zealand is an exemplar in this area, having first instituted this program between 2006 and 2009, holding a stockpile of items including antibiotics, vaccines, and equipment to the tune of some $28.62 million, with a system for regular review and re-stocking; careful management to replace items approaching expiry dates. However, the evidence would suggest those countries with limited stockpiles, and a heavy reliance upon supply chains have increasingly found the lack of available equipment has hampered their response.

During the early stages of the pandemic in Europe, there were reported shortages of reagent to support testing, and supplies of personal protective equipment having run short across nations, leading to key responders alleging they're ill-equipped to protect themselves in the face of a growing crisis. As borders close, manufacturing centers become disrupted with workers unable to travel and components in short supply.

Stockpiles at sub-national levels, held by agencies or local governments always face the challenge of cost. Convincing financial controllers to commit significant sums to stockpiles is a significant challenge, especially when items in those stockpiles have expiry dates and may go past them without being called into use.

There are, however, solutions to this.

Cross organization cooperation can allow items to be used within expiry dates and replaced to maintain stockpile levels. This approach is also being replicated in Europe, where under the European Civil Protection Mechanism and driven by the acute need arising from the current pandemic, Europe is creating a stockpile of ventilators, masks, vaccines, therapeutics, laboratory supplies, and other essential items that can be distributed rapidly when required.

Cooperation between stockholders at both the sub-national and national levels has the potential to create systems that manage stockpiles effectively, maintaining currency of items stocked, and ensuring ready availability when required. The same can apply to partnerships with the private sector, conceivably commissioned to provide stockpile items and manage stocks by moving close to end date items into the supply chain for immediate use whilst replenishing stockpile items with longer expiry date stock.

Cutting edge technology can also provide solutions in this area, such as the data integration software powered by Palantir Foundry used in the World Food Programme to drive its global logistics network, where the software predicts demand and disruptions to supply and amends routing accordingly. It is feasible with this type of technology to start planning distribution at an early stage of an outbreak, using spikes in search terms on internet search engines to predict outbreak locations and stepping up supply before crisis causes logistical paralysis.

The challenges evidence the requirement for stockpiling, but stockpiling must not be seen as a specific step in its own right. Stockpiling must be part of wider resilience systems, where the threat is recognized and assessed. Plans are formulated and capability built. It is vital these systems concentrate on the public sector and embrace the private sector, ensuring business continuity plans are robust to allow the production and service to continue despite external challenges.

Shortages in PPE in the U.K. have apparently hampered many organizations in their attempts to resume activity. So surely now is the time for business continuity plans to not only consider physical threats to their environments and operating systems, but also assess the risk arising from pandemic crisis and significant disruption, and stock accordingly. Depending upon the reliability of information regarding the outbreak's source, SARS-CoV-2 is a naturally occurring pandemic, but one from which we can learn a great deal and apply those lessons in the field of CBRN preparedness.

Agencies responding to the Salisbury nerve agent incident in the U.K. in March 2018 experienced PPE shortages for a relatively confined incident. A deliberate attack on a larger scale can quickly replicate the challenges we have seen from the SARS-CoV-2 pandemic. It is reasonable to foresee panic buying, disruption to supply chains and infrastructure, and heightened demand for key essential products, including medical countermeasures.

Suppose we are serious about protecting populations and responders. In that case, we must not let the lessons from managing the current pandemic pass us by. We must apply those lessons to the broader field of CBRN response, where the risk remains significant. Those with the motive to cause harm no doubt monitoring the impact from the SARS-CoV-2 pandemic and planning how they can replicate those impacts through a deliberate attack.

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