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Resolving to Improve Situational Awareness for Public Health Emergencies in 2020

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
January 18, 2020

The year 2020 has wasted no time presenting challenges that are both new and familiar. One such challenge is the emergence of a cluster of pneumonia-like illnesses in China that are believed to be associated with a virus in the same family as Severe Acute Respiratory Syndrome (SARS). SARS first emerged in 2003, affecting people in China, Singapore and Canada most acutely. By the time the emergency was declared over, 8,096 cases and 774 deaths from SARS had been reported. It is unclear at this time to what extent this virus presents a threat to the rest of China or to other countries. However, it should result in the United States government taking stock of how far we have come in regard to being able to prepare for and respond to a public health emergency, and the vulnerabilities that still exist. Of particular interest to this article are policies for improving situational awareness.

The book SARS Unmasked by Michael Tyshenko with Cathy Paterson provides a strong overview of the SARS response in Canada. Tyshenko credits the World Health Organization with creating a strong network in which infectious disease experts could pool information to quickly identify the virus. Both the WHO and Canada developed pandemic influenza plans in the wake of SARS, which noted the importance of moving information from the international to the local level for an effective response. The need for updated information at the local level was illustrated in the Canadian response by healthcare workers receiving regular updates and training on how to contain the virus.

Tyshenko notes that individual citizens will also have to assess their own vulnerabilities to a pandemic virus, so government officials and public health leaders must be prepared to engage in risk communication to address rumors and mis/disinformation. After SARS, Canada took steps to bolster their surveillance system to improve their capacity to trace those who may be infected, connect clinical and epidemiological data and to keep track of patients as they moved through the system, as outlined in the Naylor report. Surveillance systems can also be employed to identify human behaviors that can facilitate the spread of a virus. Tyshenko also notes that epidemiologists should focus identifying trends as to which groups are most likely to be affected so that information can be transmitted to medical professionals.

Tyshenko writes that government should use information from surveillance systems before an event occurs for planning, priority setting and the design of preventive programs. We have already seen strengths and challenges of current international information sharing in the context of the current Wuhan outbreak. On one hand, China has been accused of not being sufficiently transparent and for repressing the voices of those in the country who believe the situation could be more severe. On the other hand, rapid information sharing helped to facilitate the swift sequencing of the complete genome of the virus to further efforts to design diagnostics and countermeasures.

In October 2019, the Center for Health Security at Johns Hopkins University co-sponsored and facilitated a tabletop exercise, Event 201, in which participants addressed a scenario involving a SARS-like virus. A primary focus of discussion was how misinformation and disinformation could be effectively countered, particularly if the virus became a global emergency. Recommendations presented after the exercise included a collaboration between social and traditional media to develop, “Nimble,” strategies for combatting mis/disinformation and called on media companies to take steps to emphasize messages from government authorities and suppress mis/disinformation.  

 Looking ahead to the next decade, the United States government must be proactive in making sure that responses to emerging crises, whether natural or man-made, are guided by the best possible information and that those in positions to best contain a crisis have the data to do so. As noted above, situational awareness is complicated by a number of international dimensions. However, the example of Canada, particularly Ontario, speaks to how these issues have important ripple effects at the national, regional, and local levels. Healthcare personnel bore the brunt of these effects. It took some time for authorities to recognize that healthcare workers were being infected at increased levels and to take appropriate steps.  Misinformation in the general public also resulted in healthcare personnel being socially isolated and stigmatized.

It is important to recognize that the United States, Canada and the global community have learned much from SARS and subsequent responses and developed policies accordingly. However, particularly in the area of information sharing/situational awareness, challenges remain. Interoperability hinders the ability of healthcare facilities to communicate with each other, and the healthcare sector and public health sectors need to be better integrated. Policies like the International Health Regulations need to continue to be strengthened and ways to better enforce them must be pursued to address countries providing misleading data. As noted in the Event 201 exercise, public-private cooperation will be needed in terms of sharing information to develop countermeasures and combatting misinformation. As we enter the 2020’s, we must be careful not to allow bad information to lead us to the wrong actions or lull us into inaction.

Author: Nathan Myers an associate professor of political science and public administration at Indiana State University. Among other research in the area of public health emergency preparedness, Myers recently published the book Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies. Twitter: @nagremye1980

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