Preparing for the Next Pandemic: A Call to Action for Policymakers and Providers

Vincent Hsu, MD, MPH, FSHEA, FACP
Healthcare Epidemiologist, Infection Control Officer
AdventHealth

From the Black Death in 14^th century Europe to the 1918 influenza outbreak, pandemics and their aftereffects spurred society to make substantial healthcare improvements. The recent COVID-19 pandemic should be our next tipping point. It laid raw many weaknesses in the US healthcare system, including challenges with capacity, the supply chain and staffing as well as growing disparities in racial and socioeconomic outcomes. Widespread disinformation and political divisions exacerbated the obstacles we faced as healthcare providers and eroded trust in public health. Within my field of epidemiology and infectious disease prevention, these impacts weighed especially heavy.

Ever since I was young, I’ve been driven by a desire to make a difference, and when I was in medical school, I knew I wanted to make a difference for a larger population – beyond what I could do caring for one patient at a time. I was drawn to public health and tackling infectious diseases because of the opportunities to lead changes on a larger scale.

That is why I firmly believe the numerous lessons we learned throughout COVID-19 can help us better prepare for the next pandemic when, not if, it happens. For me, the experiences and knowledge I gained strengthened connections with my colleagues across the country and to become more involved with The Society for Healthcare Epidemiology of America (SHEA), a professional society with a mission to identify policy changes needed to bolster pandemic preparedness and a vision of “safe healthcare for all.”

In late 2020, because of my work leading COVID-19 efforts at AdventHealth, I was invited to step into a leadership role within SHEA, chairing their Pandemic Preparedness Workgroup. Over the course of the next three years, I worked alongside colleagues from leading academic and medical institutions throughout the country, including the University of Massachusetts Chan Medical School, Yale School of Public Health, Harvard Medical School and Cedars-Sinai just to name a few. Together we studied the lessons learned from COVID-19 to identify specific policy changes and actions needed to bolster future pandemic preparedness. Our work culminated in the development of six position papers that are now serving as a template for advocacy efforts:

• Pandemic Preparedness for Policymakers: Introduction and Overview
• Building a Strong and Resilient Healthcare Workforce
• The Role of Healthcare Epidemiologists in Communicating During Infectious Diseases Outbreaks
• Mitigating Supply Shortages
• Emerging Infectious Threats
• Pandemic Data Collection, Maintenance, and Release
  

My Experience Navigating the COVID-19 Pandemic at AdventHealth

Reports of an emerging and dangerous respiratory virus began circulating in the fall of 2019, and by January 2020, it was clear to me that this was going to be something big that would affect us worldwide. As Infection Control Officer for AdventHealth, I was fortunate to have leadership support to help prepare our system for COVID-19. Following Centers for Disease Control and Prevention (CDC) guidance, we focused on doing everything we could to keep our staff members safe, to continue to care for our patients and to communicate with the public.

It was far from easy, but we were able to move forward together. Whether it was securing personal protective equipment (PPE), ensuring adequate staffing, educating our teams and community, correcting misinformation, promoting vaccines or deploying new therapies as they became available, our alignment and preparation enabled us to mobilize quickly, despite the large healthcare system AdventHealth has become. That said, no system is perfect, and we know we must continue to improve. That desire to do better fueled my work with the SHEA Pandemic Preparedness Workgroup.

Key Findings and Recommendations of the SHEA Pandemic Preparedness Workgroup

As epidemiologists and infection preventionists, we use science to guide strategies in reducing the spread of transmissible disease. In our work together on the SHEA Pandemic Preparedness Workgroup, we delved into the greatest challenges that arose during COVID-19 and developed actionable recommendations to help ensure we are all better prepared for the next pandemic. Our work centered on six topics:

Challenge: Healthcare workforce resiliency

Overall Recommendation: Implement policies to ensure a robust, dynamic and cross-trained healthcare workforce during current and future pandemic states, including those with expertise in healthcare epidemiology and infection control. Cross training additional professionals in infection prevention and epidemiology as well as strengthening the relationships between public health, frontline workforce and infection prevention specialists will be necessary to ensure appropriate responses during future pandemics.

Challenge: Effective communication

Overall Recommendation: Disseminate a unified messaging approach that builds consensus across public health agencies, scientific experts and media to build trust and prevent misinformation. Healthcare epidemiologists and infection preventionists need to be supported as effective communicators, ensuring bidirectional and coordinated flow of information to and from governments, public health agencies, healthcare institutions, providers and patients.

Challenge: Preparedness in the supply chain

Overall Recommendation: Ensure robust supply chains and strategies for delivery of devices, supplies and therapeutics required for patient care and personal protective equipment for healthcare personnel to areas of need quickly and efficiently. While maintaining an uninterrupted supply of medical equipment involves preparedness on federal, state and institutional levels, it also relies upon a unique and ever-changing global supply chain. Adequate and timely access to medical supplies requires a transparent and accessible national stockpile.

Challenge: Preparedness for emerging infectious threats

Overall Recommendation: Prepare for microbial threats, including emerging, re-emerging and endemic microbes that have the potential to cause pandemics in a dynamic environment. An improved network of surveillance systems and multiple health agencies must be coordinated to detect potential pandemics at an early stage. Additional research for pandemic preparedness, such as in vaccine development and understanding the interplay between animals, humans and the environment, remains crucial. Healthcare must play a role not only in training providers to respond to these threats, but in reducing the emergence of such pathogens through antimicrobial stewardship, climate change mitigation and reducing socioeconomic disparities.

Challenge: Healthcare data management

Overall Recommendation: Coordinate and enhance efficiency of data collection, analysis and reporting transparency across different public health agencies, scientific experts and media to build trust and prevent misinformation. Streamlining and reporting of data between healthcare entities and multiple agencies must be thoughtfully redesigned and implemented to ensure that the greatest amount of standardized data is collected and organized. This also means data are as widely available and transparent as possible, while able to remain relevant and funded for the long term, regardless of the next pandemic pathogen.

Challenge: Health disparities

Overall Recommendation: Recognize and address disparities in risk of infectious disease acquisition; access to medical care or preventive care; and/or uneven care once within the medical system. Healthcare epidemiologists and professionals in infection prevention have a duty to address the need for equitable outcomes, not only in times of crisis, but during routine surveillance and prevention for healthcare-associated infections.

Each SHEA position paper details specific tasks and action items for the general recommendations above. As a workgroup, we recognize that implementing these recommendations in their entirety requires major changes within the healthcare system. However, we believe any movement toward adopting recommended policy actions is a step in the right direction toward future pandemic preparedness.

Taking a Community-Based Approach

While academic research and leadership is important, SHEA recognizes that community hospitals like AdventHealth play a key role not only in advocating for pandemic preparedness but also in employing these new guidelines and recommendations into real-world practice. In fact, I’m excited to also be a part of a newly formed SHEA committee that brings together epidemiologist leaders of community healthcare systems throughout the country to focus on just that. Closer to home, I’m proud of the work we are doing at AdventHealth, including our efforts to identify and address health disparities under the leadership of Chief Equity Officer Alric Simmonds, MD, as these populations are at greatest risk of being affected when the next pandemic arises.

Moving Forward More Prepared

I know the world has grown weary of COVID-19, and it is human nature to want to simply “move on.” However, we must move forward more informed, ensure that the lessons we learned are not lost and keep the fire of pandemic preparedness burning.

Another pathogen is certain to threaten our world – it could be another coronavirus or influenza or something altogether different. Regardless, we must learn from the mistakes made during COVID as well as the experiences and knowledge gained and use this intelligence to guide our policies and preparations. It's more than what just one healthcare system can do alone – it requires that we continue to collaborate and pool all our resources, from elected officials and lawmakers to scientists and community healthcare providers, to pave a better and more prepared path forward.