H5N1

Medical associations confront Canada's healthcare crisis

Via Medscape.com: Medical Associations Confront Canada's Healthcare Crisis. Excerpt:

The Canadian healthcare system has reached a breaking point and requires immediate and long-term changes to prevent a total collapse, according to new recommendations from three of the country’s top medical associations.  

The Canadian Medical Association, Canadian Nurses Association, and College of Family Physicians of Canada developed an action plan to rebuild the healthcare workforce, reduce burnout, and retain healthcare workers who have felt strained for more than 2 years.

“We’ve really seen the challenges in the healthcare system brought much more to the forefront during the pandemic. It’s reaching a level of crisis that we’ve not seen before,” Katharine Smart, MD, president of the Canadian Medical Association, told Medscape Medical News.  

“We’re hearing daily from people across the country about how bad things are,” she said. “From primary care to hospitals to specialists, everything is starting to implode.”  

The organizations presented the policy recommendations to the House of Commons’ Standing Committee on Health and the federal/provincial/territorial Committee on Health Workforce in April. The action plan was published on the organizations’ websites on May 16.  

Collaboration and Support  

The Canadian healthcare system was struggling before the COVID-19 pandemic, the authors wrote. For more than 2 years now, healthcare workers have tried to keep the system from buckling under the strain.  

Now healthcare workers are burning out and leaving the industry, which has pushed the system to a tipping point, they wrote. Healthcare professionals are facing massive patient backlogs and cannot provide the care that is needed.  

“We’ve spent the last several months raising awareness of how dire things are,” Smart said. “Canadians have pride about our healthcare, but it idealizes our system and gets in the way of being realistic about what’s happening.”  

The Canadian Medical Association, Canadian Nurses Association, and College of Family Physicians of Canada developed health human resources solutions to address the healthcare workforce in a “proactive and sustainable way,” she said. The plan offers immediate, medium, and long-term policy recommendations for the federal government to adopt and share with provinces and territories.

Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study

Via The Lancet Regional Health - Americas: Exacerbation of COVID-19 mortality by the fragmented United States healthcare system: A retrospective observational study. The summary:

Background  

Before widespread vaccination, the United States was disproportionately affected by COVID-19 with a mortality rate several times that of other affluent societies. Comparing regions with different rates of health insurance, we assess how much of this excess mortality may be due to the relatively large population without health insurance.  

Methods  

We use daily surveillance data from the US Centers for Disease Control and Prevention (CDC) stratified by region, age group, gender, and race in regression analysis of daily COVID-19 cases, hospitalization, and mortality. COVID-19 data have been matched with structural characteristics of the region including average proportion with health insurance. As checks, we have estimated regressions for different time periods, different groups of states, and by comparing adjacent counties between states with and without Medicaid expansion.  

Findings  

Groups with lower health insurance coverage had significantly higher mortality as well as greater case counts and hospitalization. Early in the pandemic, they were also less likely to be tested for COVID-19. Applying our regression estimates, we estimate that had there been full health insurance coverage of the population, there would have been 60,000 fewer deaths, 26% of the total death toll in the period of this analysis.  

Interpretation  

Our study demonstrates that a significant share of COVID-19 mortality in the United States, and much of the excess mortality in the United States compared with other countries, is due to our reliance on a system of market-driven healthcare. Providing universal insurance coverage should be part of our campaign to reduce COVID-19 mortality. It also suggests that these concerns should not be restricted to COVID-19 but apply across all diseases, contributing to many unnecessary deaths in the United States each year even apart from the COVID-19 pandemic.

COVID-19: It ain’t over ’til it’s over

Via Science, an editorial by Editor in Chief H. Holden Thorp: It ain’t over ’til it’s over. Excerpt:

The Biden administration is sheepishly waving a checkered flag on the pandemic. If you look closely, you can see its members cringing as they do so. 

Chief Medical Advisor Anthony Fauci told the PBS Newshour that the United States was “out of the pandemic phase” and then walked it back, saying he meant that the “acute compo­nent” of the pandemic phase was over. President Biden attended the likely superspreading White House Corre­spondents’ Dinner last weekend but skipped cocktails and the meal, opting to just give his talk. Fauci avoid­ed the whole affair. 

Meanwhile, Vice President Harris continued to isolate after her positive COVID-19 test, and many members of Congress and the administra­tion announced positive test results as well. All of this happened while the White House allowed a renegade federal judge in Florida (where else?) to end the nationwide mask mandate without much of a fight. 

These mixed messages have been emanating from the administration for months now, and although those with resources have tools to manage COVID-19, care needs to be taken that those without such means are not forgotten. 

When Biden pledged to “follow the science,” it was hard to imagine that the country could have ended up here. But the administration made a big bet that vaccines would provide sterilizing immunity and end the pandemic, allowing it to move on to other priorities. 

Leaving behind the insanity of ivermectin, hydroxy­chloroquine, and bleach was certainly a great step forward. However, evolution has had other plans, and variants of severe acute respiratory syndrome corona­virus 2 (SARS-CoV-2, the virus that causes COVID-19) have kept the pandemic going. This left the White House in a very tight spot: There was little political will to keep pushing nonpharmaceutical interven­tions, yet the pandemic was far from over. Add to this mounting inflation worries and concerns about the war in Ukraine, and the response has been a clumsy pivot to a message that politicians always turn to: personal responsibility. 

Get vaccinated, get boosted, wear a mask, get a prescription for the antiviral Pax­lovid—if you want to. This may be fine if you have a healthy immune system, great health insurance, and the ability to navigate the US health care system. But what about everyone else? 

COVID-19 is at a similar place to where the HIV/AIDS global pandemic was when the antiretroviral drugs came along. Yale epidemiologist Gregg Gonsalves told me about important parallels between both pandem­ics. “The HIV epidemic didn’t go away,” he said. “It just went to where people could ignore it. It went into the rural South, it went to communities that were already facing disparities in health.” 

At that time, confusion between medicine and public health was also an im­portant factor. “The discourse shifting to private choice and private adjudication of risk is really not what public health science is,” he said. “We work in populations. And if we’re talking about medicine, it’s about private risk and private choices.”

WHO: 14.9 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021

A news release from WHO: 14.9 million excess deaths associated with the COVID-19 pandemic in 2020 and 2021.

New estimates from the World Health Organization (WHO) show that the full death toll associated directly or indirectly with the COVID-19 pandemic (described as “excess mortality”) between 1 January 2020 and 31 December 2021 was approximately 14.9 million (range 13.3 million to 16.6 million).    

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is committed to working with all countries to strengthen their health information systems to generate better data for better decisions and better outcomes.”  

Excess mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years.   

Excess mortality includes deaths associated with COVID-19 directly (due to the disease) or indirectly (due to the pandemic’s impact on health systems and society). Deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic. The estimated number of excess deaths can be influenced also by deaths averted during the pandemic due to lower risks of certain events, like motor-vehicle accidents or occupational injuries.   

Most of the excess deaths (84%) are concentrated in South-East Asia, Europe, and the Americas. Some 68% of excess deaths are concentrated in just 10 countries globally. Middle-income countries account for 81% of the 14.9 million excess deaths (53% in lower-middle-income countries and 28% in upper-middle-income countries) over the 24-month period, with high-income and low-income countries each accounting for 15% and 4%, respectively.   

The estimates for a 24-month period (2020 and 2021) include a breakdown of excess mortality by age and sex. They confirm that the global death toll was higher for men than for women (57% male, 43% female) and higher among older adults. The absolute count of the excess deaths is affected by the population size. The number of excess deaths per 100,000 gives a more objective picture of the pandemic than reported COVID-19 mortality data.  

“Measurement of excess mortality is an essential component to understand the impact of the pandemic. Shifts in mortality trends provide decision-makers information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden,” said Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO. “These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach.”  

“Data is the foundation of our work every day to promote health, keep the world safe, and serve the vulnerable. We know where the data gaps are, and we must collectively intensify our support to countries, so that every country has the capability to track outbreaks in real-time, ensure delivery of essential health services, and safeguard population health,” said Dr Ibrahima Socé Fall, Assistant Director-General for Emergency Response.   

The production of these estimates is a result of a global collaboration supported by the work of the Technical Advisory Group for COVID-19 Mortality Assessment and country consultations.   

This group, convened jointly by the WHO and the United Nations Department of Economic and Social Affairs (UN DESA), consists of many of the world’s leading experts, who developed an innovative methodology to generate comparable mortality estimates even where data are incomplete or unavailable.

This methodology has been invaluable as many countries still lack capacity for reliable mortality surveillance and therefore do not collect and generate the data needed to calculate excess mortality. Using the publicly available methodology, countries can use their own data to generate or update their own estimates.

“The United Nations system is working together to deliver an authoritative assessment of the global toll of lives lost from the pandemic. This work is an important part of UN DESA’s ongoing collaboration with WHO and other partners to improve global mortality estimates,” said Mr Liu Zhenmin, United Nations Under-Secretary-General for Economic and Social Affairs.

Mr Stefan Schweinfest, Director of the Statistics Division of UN DESA, added: “Data deficiencies make it difficult to assess the true scope of a crisis, with serious consequences for people’s lives. The pandemic has been a stark reminder of the need for better coordination of data systems within countries and for increased international support for building better systems, including for the registration of deaths and other vital events.”

Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada

Via medRxiv: Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada. This could have serious implications for healthcare systems around the world. The abstract:

Importance Most adults with COVID-19 do not require hospitalization, but the subsequent risk of post-COVID condition, including associated psychological and cognitive dysfunction, remains poorly understood among non-hospitalized versus hospitalized cases.  

Objective To assess the prevalence and duration of post-COVID condition, including physical, psychological and cognitive symptoms.  

Design Case series and case-control study between December 2020 and May 2021  

Setting Healthcare workers in Quebec, Canada  

Participants Eligible cases were symptomatic healthcare workers with PCR-confirmed COVID-19 between July 2020 and May 2021. Among 17,717 contacted cases, 6061 (34%) participated. A random sample of symptomatic healthcare workers with negative PCR result between November 2020 and May 2021 served as controls. Among 11,498 contacted controls, 4390 (38%) participated.  

Exposures In multivariable models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared self-reported cognitive dysfunctions (difficulty concentrating; difficulty organizing oneself; forgetfulness; loss of necessary items) among cases with post-COVID condition to controls, adjusting for psychological distress and fatigue.  

Outcomes Post-COVID condition was defined by symptoms persisting ≥4 weeks or ≥12 weeks after COVID-19 onset.  

Results Four-week and 12-week post-COVID condition prevalences of 46% (2,746/5,943) and 40% (653/1,746), respectively, were observed among non-hospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex and age were associated with higher risk.  

A substantial proportion of non-hospitalized cases with 4-week post-COVID condition often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%) and loss of necessary items (10%), with no decline at 12 weeks. All four aspects of cognitive dysfunction were 2.2 to 3.0 times more prevalent among cases with post-COVID condition than in controls, but also independently associated with psychological distress and fatigue.  

Conclusions and relevance Post-COVID condition may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many healthcare workers infected since the beginning of the COVID-19 pandemic, the ongoing implications for quality healthcare delivery could be profound should cognitive dysfunction and other severe post-COVID symptoms persist in a professionally-disabling way over the longer term.  

Question How common and long-lasting are the physical, psychological and cognitive effects of post-COVID condition in healthcare workers, both hospitalized and non-hospitalized?  

Findings The prevalence of post-COVID condition was 46% at 4 weeks and 40% at 12 weeks among non-hospitalized cases and 76% and 68% among hospitalized cases. One third of non-hospitalized healthcare workers with post-COVID condition reported cognitive impairment, which was independently associated with persistent physical symptoms, but also psychological distress and fatigue.  

Meaning Persistent cognitive and other professionally-disabling sequelae of COVID-19 in essential workers could have critical implications for quality healthcare delivery during and after the pandemic.

Evaluation of science advice during the COVID-19 pandemic in Sweden

Oh boy. This is devastating. Via Nature.com, an article in Humanities and Social Sciences Communications: Evaluation of science advice during the COVID-19 pandemic in Sweden. The abstract:

Sweden was well equipped to prevent the pandemic of COVID-19 from becoming serious. Over 280 years of collaboration between political bodies, authorities, and the scientific community had yielded many successes in preventive medicine. Sweden’s population is literate and has a high level of trust in authorities and those in power. During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway. 

In this report, we try to understand why, using a narrative approach to evaluate the Swedish COVID-19 policy and the role of scientific evidence and integrity. We argue that that scientific methodology was not followed by the major figures in the acting authorities—or the responsible politicians—with alternative narratives being considered as valid, resulting in arbitrary policy decisions. 

In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute. With this setup, the authority lacked expertise and could disregard scientific facts. 

The Swedish pandemic strategy seemed targeted towards “natural” herd-immunity and avoiding a societal shutdown. The Public Health Agency labelled advice from national scientists and international authorities as extreme positions, resulting in media and political bodies to accept their own policy instead. 

The Swedish people were kept in ignorance of basic facts such as the airborne SARS-CoV-2 transmission, that asymptomatic individuals can be contagious and that face masks protect both the carrier and others. Mandatory legislation was seldom used; recommendations relying upon personal responsibility and without any sanctions were the norm. Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives. 

If Sweden wants to do better in future pandemics, the scientific method must be re-established, not least within the Public Health Agency. It would likely make a large difference if a separate, independent Institute for Infectious Disease Control is recreated. 

We recommend Sweden begins a self-critical process about its political culture and the lack of accountability of decision-makers to avoid future failures, as occurred with the COVID-19 pandemic.

South Korea reports all-time high of 441,423 daily COVID-19 cases

Via Yonhap: S. Korea reports all-time high of 441,423 daily COVID-19 cases. The authorities seem to be trying to turn COVID into flu, with a tolerably small fatality rate. But many COVID survivors will still experience long COVID, and the South Korean healthcare system is taking punishment it didn't need.

SEOUL, March 15 (Yonhap) -- South Korea reported 441,423 new COVID-19 cases on Tuesday, setting a new daily record as the country battles through the worst wave of the virus sparked by the omicron variant.  

The all-time high was reported as of 9 p.m., with three hours left until the daily tally ends. The total will be announced the following morning.  

Earlier Tuesday, the Korea Disease Control and Prevention Agency (KDCA) said the country added 362,338 new COVID-19 infections the previous day, mostly locally transmitted, putting the total caseload at 7,228,550.  

The previous record was 383,664 cases reported Saturday. The daily counts tend to decline on Mondays due to fewer tests on the weekend before rising sharply toward the end of the week.  

The death toll from COVID-19 hit a record high of 293 on Tuesday, up 93 from Monday, with the total at 10,888. The fatality rate came to 0.15 percent.  

The number of critically ill patients also reached an all-time high of 1,196, up 38 from the previous day.  

South Korea has seen a spike in the COVID-19 caseload since the beginning of this year, with the numbers surging from four digits to six digits in about three weeks last month.  

The focus now in the fight against COVID-19 has been about how to bring back everyday life as much as possible while maintaining steps to rein in the virus surge.  

"Managing the fatality rate is very important," Sohn Young-rae, a senior health ministry official, said in a briefing. "The fatality rate for the past four weeks has been lower than 0.1 percent, so the short-term fatality rate is similar to that of the seasonal flu," Sohn said. The fatality rate of seasonal flu stands at 0.05-0.1 percent.  

Health authorities forecast the current virus wave will enter its peak between later this week and next week. Sohn said the numbers of critically ill cases and deaths are expected to continue to rise until two to three weeks after the peak.  

Health authorities said they would begin to consider readjusting social distancing rules that currently limit business hours till 11 p.m. and private gatherings of up to six people, as those measures are due to end this week.  

The government announced children aged between 5 and 11 will be able to receive vaccine shots starting March 31. It began to allow uninfected students and school staff members to attend school in person even if family members who live with them are virus positive.  

Of the locally transmitted cases reported Tuesday, 66,067 cases came from Seoul and 102,983 from the surrounding Gyeonggi Province. The western port city of Incheon reported 20,444 cases. Fifty-five cases came from overseas, raising the total to 30,358.  

As of Tuesday, 32.15 million people out of the 52 million population, or 62.7 percent, had received booster shots. Fully vaccinated people came to 44.43 million, representing 86.6 percent, the KDCA said.

COVID-19 is in for the long haul

Here's a screenshot of this evening's Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

It's notable for several reasons. First, the US is now far back in the 28-day case count—seventh, behind Germany, South Korea, Russia, Vietnam, France, and Brazil.

 

Second, almost all the case and mortality numbers are likely severe undercounts, since so many countries have simply abandoned any pretence of testing and contact tracing. I would not be shocked if the true number of cases were around 1.5 billion, and deaths close to 20 million.

 

The numbers for Russia (3.7 million cases in the last 28 days, 20,000 deaths) and Ukraine (458,000 cases, 3,800 deaths) are especially implausible, given the events of the past 15 days. But we'll surely see an explosive growth in cases as over 2 million Ukrainians move through Europe in search of refuge.

 

The early-success countries have largely succumbed to Omicron. While China pursues its zero-COVID policy, it's still recorded 539,000 cases and 2,600 deaths. Hong Kong has seen 533,000 cases in 28 days, and 2,600 deaths. Vietnam racked up 26 million cases in the last 28 days, and 2,400 deaths. New Zealand had 267,000 cases and 12 deaths; it had only 38,900 cases in the previous 23 months of the official pandemic.

 

The graphs on the right tell us that the Omicron spike has fallen sharply from its peak of 23,333,000 in the week ending January 23; we're now at 10,706,000 as of the week ending March 6. That looks impressive, but it's still about 5 million more than the three previous waves.

 

Omicron also drove a spike in deaths, peaking at 75,000 in the week of February 13 and now fallen to 50,400. Meanwhile, vaccinations have fallen from a recent high of 257,000 in the week of February 6 to 105,600 in the week ending March 6.

 

Yet many countries are effectively declaring the pandemic over, making masks and distancing optional, junking vaccine passports, and dropping regular reports by public health officials. Governments seem to think COVID-19 can now sink back into the background noise with other diseases, while we turn our attention to war and inflation and the next election.

 

On February 1, Johns Hopkins reported 381,232,070 cases, so we have seen almost 72 million cases of COVID-19 in the past six weeks alone. Even if the Omicron spike continue to drop, the next six weeks will see tens of millions more cases, and likely another 40 or 50 thousand people now alive will be dead before May 1. 

 

We are nowhere near the end of the pandemic. In fact, I expect it will in many ways get worse as healthcare systems really do collapse, and as sequelae like Long COVID affect more and more cases. The pandemic that began two years ago really is in the for long haul.

Africa marks two years of COVID-19 fight

Via WHO AFRO: Africa marks two years of COVID-19 fight.

Brazzaville – Africa today marks two years since the first COVID-19 case was detected in the continent. Countries across the region have made great efforts in combatting the pandemic in which more than 11 million cases and over 242 000 deaths have so far been recorded.     

While the impact of COVID-19 has been widespread and devastating, Africa has drawn from its experience in responding to other outbreaks to tackle the pandemic, and with the support of World Health Organization (WHO) it has bolstered public health measures, learned crucial lessons, improved tactics and grown better at responding to the virus.     

The continent’s capacity to manage COVID-19 cases has improved, with the increased availability of trained health workers, oxygen and other medical supplies. The number of Intensive Care Unit beds has increased across the continent, from 8 per 1 million people in 2020 to 20 today. WHO has also helped increase the number of oxygen production plants in Africa from 68 to 115 – a 60% rise – through supporting the repair, maintenance and procurement of new oxygen plants. Where plants have been set up, the cost of oxygen has decreased by 40%. Despite these improvements, oxygen availability remains a concern, and a large majority of patients who require oxygen as part of their clinical treatment plan are unable to access it.  

“This year we can end the disruption and destruction the virus has left in its path, and gain back control over our lives,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Controlling this pandemic must be a priority, but we understand no two countries have had the same pandemic experience, and each country must, therefore, chart its own way out of this emergency.”     

Although Africa’s pandemic response capacity has improved, the continent must now significantly ramp up COVID-19 vaccination coverage. Only 11% of the population is fully vaccinated so far. Vaccine supplies have increased in recent months and WHO is working with countries facing challenges to overcome the hurdles and widen vaccination reach.

Future pandemics: Failing to prepare means preparing to fail

An editorial in The Lancet Respiratory Medicine: Future pandemics: failing to prepare means preparing to fail.

Governments of high-income countries with high SARS-CoV-2 vaccination rates have been encouraged by evidence of decreasing COVID-19-associated morbidity and mortality, and can begin to think about the change from pandemic to endemic and the prevention of future pandemics. Meanwhile, some low-income and middle-income countries (LMICs) are still grappling with high numbers of COVID-19 cases, hospitalisations, and deaths, and low vaccination rates. 

A similar pattern has been seen with previous pandemics, including HIV/AIDS, tuberculosis, and malaria. Although these diseases kill millions of people globally every year, they are often referred to as endemic. As stated by Prof Ali Zumla in a recent Perspectives article, “The pandemic exposes weaknesses of current leadership of global public health systems, inequities of resource allocation to Africa, and broken promises by wealthier nations for vaccine equity and resource allocation. This status quo is unacceptable.” 

Rather than allowing a splintering of attention and resources across the COVID-19 pandemic, other current pandemics, and future threats, we should move towards an integrated, multipronged approach that targets these threats collectively. We must learn from the way in which different countries responded to the COVID-19 pandemic and build on successful approaches to ensure equitable pandemic preparedness in the future. Tackling a pandemic requires a global response. Individual countries need to prepare, but success will be hindered if some countries are left without the capacity to respond to a new threat. 

An analysis in the BMJ examined 28 national responses in the first year of the COVID-19 pandemic. Countries that were considered to be high performing were able to “partner, coordinate, develop, and strengthen” various public health, health-care system, and socioeconomic measures. Ultimately, these actions led to decreased disease transmission and lower mortality rates. Government cooperation, effective community engagement, and coordination across all levels of response led to successful procurement of resources and transformation from evidence-based policy to practice. 

A recent Global Burden of Disease study also found that measures of trust in government, and less government corruption, were associated with lower infection rates and higher SARS-CoV-2 vaccination coverage in middle-income and high-income countries. Therefore, efforts to improve communication surrounding risk of disease and community engagement strategies could help to boost public confidence in pandemic response strategies. 

Low-performing countries identified in the BMJ analysis had four common themes: devaluation of effective pandemic preparedness plans through inadequate infrastructure and underfunded health systems; denial from heads of state of scientific evidence that COVID-19 was a severe risk to health, and lack of support for those most vulnerable to economic risks of COVID-19; delays in enacting rapid responses to different stages of the pandemic despite supporting evidence; and finally, distrust between the public, government leaders, and the scientific research community. Unfortunately, these factors have been compounded by the politicisation of many actions, including the use of facemasks and vaccines. 

At present, many countries are severely underprepared to enact any plans for future pandemic prevention or response. They face numerous challenges in providing universal health coverage for citizens and are not able to allocate adequate investment or resources towards, for example, an increased workforce equipped to deal with current or future pandemics.

The Global Fund is actively involved in pandemic preparedness and response with their COVID-19 Response Mechanism (C19RM), which provides grant support to LMICs for COVID-19 tests, treatments, personal protective equipment, and critical elements of health system strengthening. C19RM aims to mitigate the impact of COVID-19 on programmes to fight HIV, tuberculosis, and malaria, and initiates urgent improvements in health and community systems; as of Jan 25, 2022, total funds approved to support C19RM reached US$4·1 billion, made available through support from donors in the USA, Germany, the Netherlands, and Switzerland. The hope is that funding will not be diverted from current pandemic action and that separate income will be generated for future threats.

Increased investment in COVID-19 tests, treatments, and vaccines has been extraordinary. To fully prepare for future pandemics, investment in mechanisms to prevent, detect, and respond to emerging pathogens is crucial.