Anticipating Continued COVID-19 Needs: Lessons from Yesterday
At the time of writing, 33.7 million cases of COVID-19 have been reported worldwide. Regardless of socioeconomic standing, health systems around the world have shuddered beneath the weight of an international pandemic; leading to overflowing ICUs, overextended health care resources, and disrupted critical supply chains.
Accordingly, international attention and funding has turned to global public health and preparedness. The World Health Organization (WHO) has estimated approximately US$1.7 billion total funding is needed to adequately respond to COVID-19 until December 2020. As of September 21, 2020 WHO reports receiving 79.5% of their goal, with an additional 4% expected from pledges—a combined US$1.51 billion raised in the span of a few months. Resources have been rightly and urgently mobilized to offer aid now, but as a responsible global health community, we must look toward the future and set in motion plans to meet anticipated gaps and needs.
If we are to respond effectively and reach the most vulnerable populations, our future interventions to protect people from COVID-19 transmission will inevitably rely on community health structures to disseminate aid and vaccines. If the systems in place are not adequately equipped to respond, those interventions will fall short. Further, if we lack good data on the population and location of communities, getting resources to all those in need will be even more challenging. However, presently, population data are often inconsistent, outdated or quite coarse. Compromised by unclear boundaries or moving populations, the resulting data typically offers only a blurred picture of communities, making it challenging for public health teams to allocate resources effectively.
The Ebola crisis in West Africa represents one such example of lagging systems leading to challenges deploying adequate response. Unbalanced investments left public health systems with little funding to rapidly fortify logistic, infrastructure, drug supply, and surveillance capacities to manage the Ebola situation. Ten months after the first diagnosis, Ebola was declared an international public health emergency. Instead of engendering an adequate response to novel circumstances, West African health systems fell captive to pre-existing shortfalls, exacerbated by an unpredictable outbreak.
To deploy strong responses to crises like COVID-19, countries require more disaggregated data to build a nuanced picture of a population, its members’ locations, and the precise shape of their needs. In 2014, Akros, in partnership with UNICEF and the Zambian Ministry of Water, Sanitation and Environmental Protection, leveraged such community-level surveillance and data-driven solutions to help over 40,000 villages eliminate water and food contamination. By providing Community Champions with innovative mobile phone systems that automatically aggregated and shared data, local health teams in the field were able to deploy resources to pinpointed locations lacking adequate latrines. Akros utilized a similar approach to help Zambia in their fight to eliminate malaria. In that instance, community health workers used DHIS2-linked mobile phones to submit weekly malaria reports. Akros has also assisted several governments to deploy a spatial intelligence approach to map populations and ensure interventions such as indoor residual spraying (IRS), mass drug administration (MDA), and vaccinations reach the last mile. In offering detailed, dynamic population data, resources are able to be allocated more efficiently to achieve maximum impact.
These types of strategies—the capture of detailed, dynamic population data and the support of community-based surveillance structures which Akros has assisted governments to create—has helped to maximize impact by better informing health intervention plans. A parallel approach could be applied to COVID-19 interventions, articulating gaps in health interventions, vaccination coverage, or care services. As we continue to respond to COVID-19, it is imperative that we draw on the increased attention on public health to create similar spatial backbones required to inform future responses.
Without such clarity, we risk replicating past crises, in which strained health system infrastructures have struggled to respond rapidly and comprehensively to epidemics. Rather than replicate previous shortcomings, the public health community has the international support to brace itself for the future. By creating a spatial backbone designed to strengthen and streamline local responses, we better prepare local governments to prevent at-risk populations from falling victim to unresilient health systems.