Evaluating a Pandemic

The following sections are included:

• Dedication
• Foreword
• Introduction
• About the Editor
• About the Contributors
• Contents

Analysis of the published sequence of SARS-CoV-2 from an early patient with COVID shows the presence of a short sequence of amino acids in the spike protein that is absent in samples taken from nine different horseshoe bats. This lends credence to the proposal that COVID-19 was not passed to humans directly from an animal in the Wuhan live food market. Rather it is likely that the virus escaped from a laboratory where it was being modified to make it more infective and hence a better source for a vaccine.

Developing, testing and licensing a vaccine in less than a year is an incredible achievement, but to do this as an academic institution adds to this triumph. In this chapter we start by discussing the work that helped lay the foundations for this success, notably the development of an accessible platform technology and the clinical infrastructure in place at the University of Oxford. We then move on to discuss how as academics we had to step out of our comfort zone and innovate, to ensure that our promising vaccine could join the global stage in the fight against the COVID-19 pandemic.

This chapter sheds light on the milestones and history of mRNA vaccine development. The challenges encountered with an mRNA-based vaccine, and how MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome) impacted the success of finding quick and effective vaccines, are described. I show how an already existing platform was modified to target the new coronavirus pathogen, and what factors played a crucial role in public acceptance or refusal of the RNA-based vaccines.

Diagnosis is a fundamental component of patient care and surveillance and a major driver of economic and health outcomes across health systems. However, the importance of timely access to diagnostics remains under-recognised, causing diagnostics to be critically underfunded and the weakest link in the care cascade comprising screening, diagnosis, treatment, and control. The COVID-19 pandemic further exposed fundamental gaps around diagnostics in the care cascade and made clear how profoundly a lack of diagnostics can affect patients, providers, communities, and economies. Here, we first discuss some of the key lessons from the COVID-19 pandemic before laying out a cohesive plan for a better diagnostics ecosystem, based on those learnings, to prevent future pandemics. Experience from the COVID-19 pandemic and other outbreaks and recent technological advances in diagnostics and digital tools bode well not only for the future of pandemic preparedness but also for making major inroads in closing the global diagnostics gap for common endemic diseases seen every day. However, formidable organisational, logistical, and financial obstacles must be overcome. The future can look bright if the political will is there.

Since the beginning of the COVID-19 pandemic, the United States has recorded epidemiological outcomes ranking far below those achieved by other wealthy democracies. In this discussion, I suggest that the nation’s COVID-19 response has, under two different presidential administrations, been compromised by American exceptionalism — a cultural sense of specialness and superiority imagined as unique to the US. Both by reifying individual freedoms that are constructed as quintessentially American, and by resisting and “othering” pandemic control measures that have succeeded elsewhere in the world, US leaders and the public have committed ideologically to less effective — and often counterproductive — approaches in public health.

Using the unique, recently made public sample-based estimates of infections produced by the Office for National Statistics (ONS), this research extends Meenagh and Minford [1] to the four waves of illness in the UK by the end of 2021. These allow us to estimate the effects on the COVID hospitalisation and fatality rates of vaccination and population immunity due to past infection: the latter was the most significant factor driving both trends, while the vaccination rate also had a significant short-run effect on the fatality rate. For the most recent data, we again updated our policy comparison with Sweden and came to the same conclusions: in waves 1 and 2, reduced Swedish lockdown intensity compared to personal response resulted in much lower economic costs with no appreciable impact on infections.

In this chapter I examine the role of trust in the response of the UK Government to the COVID-19 pandemic. I start by showing the importance of trust to a successful response. I then document the Government’s lack of trust in the reactions of the public, which was rooted in mistaken assumptions about the psychological frailty of people, especially under crisis conditions. I show how these led to a series of policy decisions that limited the containment of virus transmission: the delay in introducing measures at the start of the pandemic; the failure to provide people with support to self-isolate; the lack of community engagement initiatives to increase vaccine roll-out. Finally, I propose that this lack of trust, support and engagement in turn dented the trust that the public had in the Government and in each other — further undermining the pandemic response. I conclude by arguing that a successful response to COVID-19 and to future such events depends upon a fundamental shift in thinking whereby the public are seen as a partner and part of the solution — not the problem — in a crisis.

The coronavirus (COVID-19) pandemic altered many workforce environments, driving almost a forceful directive for employees to work from home. Such a shift in workforce dynamics had many ripple effects on private and public sector businesses and employees. The Internal Audit Unit, that provides internal audit assurance and consulting activities on risk, control and governance processes, at the eThekwini Municipality in Durban, KwaZulu-Natal, South Africa, had compelled its leadership to start looking differently at how internal audit operates and conducts work as a professional unit within the municipality. Having to work under such conditions affected many aspects within the work environment; hence the department had seen the need to assess its working environment, allowing staff to work remotely to ensure it maintained its effectiveness and productivity whilst keeping its employees safe during the various lockdown levels declared by the president of South Africa. This chapter sets out a study of how internal auditors in the South African context have had to harness their emotional agility in order to embrace working remotely as a consequence of COVID-19. The factors considered in this chapter can be used as a benchmark for other internal audit entities to consider in their employee management and remote working strategy. Although the current pandemic of COVID-19 through the various lockdown levels have been restricting workers to come to their offices, the long-term sustainability of internal auditors in bringing innovation and creative solutions to its clients is essential and by evaluating their main resource (employees), based on continuous engagements, commitment levels from employees, and the development of skills, it will better equip the unit on areas for improvement.

The dramatic demographic and scientific changes that have occurred in the world over the last 70 years in some key respects limit the value of comparisons between COVID-19 and previous major pandemics. Yet some lessons remain from past experience; both the comparisons and differences between the circumstances in which COVID-19 occurred and those of past pandemics tell us much about what is needed for confronting the increasing threat of future pandemic diseases…

Since the completion and publication of Doom: The Politics of Catastrophe in the spring of 2021, we have learned several important things about the COVID-19 pandemic. Firstly, naïve attempts to blame responsibility for excess mortality on populist leaders lost whatever credibility they had. Second, the pandemic mortality exceeded most expectations, despite the speedy development of vaccines with high efficacy. Third, non-pharmaceutical interventions colloquially known as lockdowns succumbed to diminishing returns, most obviously in China. Fourth, the fiscal and monetary measures taken to offset the economic impact of lockdowns — which were comparable with those of a world war — turned out to be more inflationary than most economists foresaw. Fifth, as in previous times of plague, there was not only popular unrest but also war, the effect of which was to exacerbate the inflationary problem. Finally, it has become clear that the pandemic itself exacerbated global trends towards social, political and geopolitical instability that predated 2020…

Overall, whether or not COVID-19 fits with particular definitions of global catastrophic risk (GCR), it provides a case from which researchers, policy makers and practitioners can learn and improve their understanding of how GCRs and responses to them might play out. Likewise, scholarship from the field of existential and GCR studies, and from global catastrophic biological risk (GCBR) studies in particular, can help inform broader understanding of the pandemic.

The following section is included:

• Index