Pharma Focus Asia
Klöckner Pentaplast - Pentapharm® alfoil® films

START WITH Y

A case for better pandemic preparedness

Leigh Farrell, Lead, Health Security Systems Australia (HSSA)

In both an Australian and a global context, there is a pressing need to consider a rebalance and increased investment in preparedness planning for pandemics and other significant national emergencies, rather than the current heavy focus on response and recovery.

While COVID-19 is not yet behind us, there has never been a better time to consider the meaning of national resilience and to prepare for the next threat.

It’s almost universally agreed—in respect of pandemic preparedness—that there will be a . Monkeypox, while not a pandemic, has been formally proscribed as a public health emergency by the World Health Organization (WHO). If COVID has been the wake-up call the world needed to shatter its complacency about a so-called Disease X, then how are we ensuring that we’ll be better prepared for Disease Y?

Working in the defence and national security sector exposes you to a lot of jargon. The military is infamous for its acronyms and often accused of having a language all of its own.

One of those terms that I’ve taken to heart is the idea of system-of-systems challenges. These are wickedly complex scenarios for which a truly comprehensive view of capability development is needed. The Australian Defence Force describes this with terms like fundamental inputs to capability, a recognition that an enormous range of enablers and other factors must be considered—and are critical to success to deliver an effect such as pandemic preparedness in addition to the acquired commercial ‘product’ or equipment solution.

It’s no surprise that these wickedly complex problems such as global pandemics require system-of-systems solutions, but this is where we see cracks starting to appear in relation to resilience and disaster response. While we see innovative work on elements of those systems, there is too often a lack of situational awareness of one system as it relates to another system. Planning in one system is developed often independently from that in other another system. One example might be assumptions made about the capacity and capability of Defence to contribute to hazard management or humanitarian assistance missions, from the point of view of civilian first responder agencies. Another might be data collected in one system or agency that is not shared (either in time or at all) with other nodes of the system.

In the solutions space, key players across the sector (governments, industry and researchers) need to come together to create collective early warning systems that take account of multiple inputs—disease surveillance, epidemiological testing, open source intelligence and industry capability analysis among them—rather than focusing on any one dimension of the solution.

There is also more work needed on the macro health security implications and macro-economic cost considerations of national response planning. Creating pull factors for innovation is one example. Australia is very good at some elements of innovation, but not so much, I would contend, in innovative policies around agile procurement and policy settings. Where supply chain vulnerabilities are evident, the steps to remedy those are slow and an appetite for transformational ideas is wanting. The potential to implement and fully leverage public-private partnerships, similar to Operation Warp Speed in the US, is yet to be fully explored. Special economic zones are another example of a transformative idea with big potential to drive innovation and build sustainable industry capacity.

Coordination across state and federal jurisdictions and with the industrial sector is occurring and some agility is evident, so to look in the rear vision mirror and say “everything we’ve done before was rubbish” would be simplistic at best. We should acknowledge those elements of the system, the muscle that has been exercised and is building nicely, while also committing to doing better in other areas.

In thinking about the prevention and preparedness elements of the Prevention, Preparation, Response, Recovery (PPRR) risk weighted model, it’s hard not to conclude that more balanced investment is needed. Australia’s Productivity Commission has reported that 97 per cent of funding allocated for natural disasters is spent in the response and recovery phases, and only 3 per cent in the preparedness and prevention phases.

In assessing the gaps in PPRR planning for particular threats, it is clear that a multi-faceted approach is required to align our PPRR plans with global best practice. Investment also has to be balanced in respect of not putting all of our eggs in one basket. It was already known, but is now even clearer from global experience, that the world could not simply vaccinate our way out of the pandemic. Of course, vaccines and therapeutics are important tools for managing infectious diseases and pandemics but it’s important that we use all the tools at our disposal and develop system-of-systems approaches. This includes considerations like PPE, modelling and simulation, decision support tools, medical devices and surveillance.

We are also learning hard lessons about the fallacy of the ‘one bug, one drug’ mindset. Focused attention and priority needs to be given to the development of platform technologies and developing broad-acting, threat-agnostic countermeasures against families of bacterial and viral pathogens. In seeking to catalyse research and development activities, further attention is needed to setting more precise strategic requirements rather than more general guidance on areas of interest.

With COVID-19 we saw innovation in the regulatory system where master protocols were adopted for clinical trials, for example, and this allowed a pooling of the data globally, in turn leading to more rapid approval for these vaccines. Anticipatory work on master protocols and streamlined emergency use authorisations is one area where an investment in preparedness and prevention could reap substantial dividends.

We need more sophisticated simulation, modelling and decision support tools – as well as advanced measurement technologies and access to expertise in foresighting – to understand what we are dealing with, on a domestic and international scale. Recovery and response strategies need to be comprehensively stress-tested in both desktop and field exercises involving all relevant responding agencies.

As part of its CBR Sensing System Program, the Health Security Systems Australia (HSSA) division of Australia’s DMTC Limited is investing in projects focused on the development of sensing technologies that alert the wearer to chemical and biological threats, allowing more time for interventions such as medical countermeasures, and supporting rapid operational decision making. We are also working on hazard-prediction models that could provide time-critical information to decision-makers. Fasterthan-real-time urban wind and plume transport models hold the potential to revolutionise atmospheric transport and dispersion modelling and simulation tools that are used to predict the spread of airborne hazards in urban environments.

In our own backyard, surveys have consistently shown that Australia’s medical technology and health innovation system has A-class components but, by comparison, only C-class connectors and wiring. These judgements are useful inputs to discussions about priorities and actions that can be taken to address gaps in both capacity and capability. Surveys, however, are only limited in their scope and value. They are static snapshots and what is needed, in their place, is a dynamic and evolving picture of the landscape.

Working with stakeholders across the Australian Government, my division is taking important first steps towards this envisioned outcome for Australia by developing a national health security database. With unknown but anticipated threats ahead of us, a database like this will identify health security sector capability and supply chain resilience, which will inform both policy development and targeted investment.

To draw on another bit of Defence jargon that I think is most relevant here, the Australian Army often talks about the challenge of being “ready now and  future ready”. Lashing these two horizons together is an acknowledgement of a dynamic and constantly evolving threat landscape, and the need for a balanced view when it comes to priority setting, investment decisions and policy frameworks. Achieving one of the twin aims at the expense of the other is simply not an option. It requires a culture and decision-making mindset that keeps pace with change rather than lagging behind it.

Conclusion

Whether for natural disasters or pandemics, experts agree that there is little time to sit and ‘admire the problem’. The resources and investment needed to tackle these problems are finite, and contested, which focuses attention on selecting the most relevant research and investing in proposed solutions that show the most potential. The capacity for thinking beyond borders is also sorely needed. Horizon scanning is critical to identify and implement best practice, and to stay ahead of the curve.

References:

  • https://dmtc.com.au/wp-content/uploads/2022/08/PPRR_Brochure_HSSA_digital.pdf
  • https://dmtc.com.au/health-security-systems/modelling-simulation/
  • https://www.mtpconnect.org.au/Story?Action=View&Story_id=464

--Issue49--

Author Bio

Leigh Farrell

Leigh Farrell is an experienced senior executive having held senior global roles in the biotech and pharmaceutical industries. He currently Head Health Security Systems Australia (HSSA), a newly-formed division of Australia’s DMTC Limited. HSSA operates within DMTC’s program management structure and focuses on the protection of military and civilian personnel against chemical, biological and radiological threats, and emerging diseases. Its work is built around the success of a Medical Countermeasures program that DMTC has led in Australia, with support from  a whole-of-government agency group, since 2016. The division’s work extends beyond medical countermeasures to include other areas such as modelling and simulation, and sensing systems.

magazine-slider-imageBIOVIA from Molecule to MedicineMFA + MMA 2024CPHI China || PMEC China 2024Asia Healthcare Week 2024Advance DoE WorkshopCPHI Korea 2024CHEMICAL INDONESIA 2024INALAB 2024 Thermo Scientific - DynaDrive and DynaSpinRehab Expo 2024ISPE Singapore Affiliate Conference & Exhibition 20242024 PDA Cell and Gene Pharmaceutical Products Conference 2024 PDA Aseptic Manufacturing Excellence Conference2024 PDA Aseptic Processing of Biopharmaceuticals Conference3rd World ADC Asia 2024LogiPharma Asia 2024