World

A three-layer system to win the war against COVID-19 and invest in health systems of the future

Attachments

Feng Zhao, Sulzhan Bali, Rialda Kovacevic, Jeff Weintraub

Correspondence to Dr Sulzhan Bali, Health, Nutrition, and Population, World Bank, Washington, DC 20443, USA; sbali@worldbank.org

Abstract

The COVID-19 pandemic taught us many lessons, most critically that its human and economic toll would have been significantly smaller if countries had in place strong layers of defence that would have either prevented the spillover of the SARS-CoV-2 into a human population in the first place, or, failing that, contained the outbreak to avert its global spread. Further, the brunt of COVID-19 impacts on some countries considered ‘most prepared’ for pandemics underscored the need for an integrated approach to ensure resilience to future epidemics. Consequently, as countries plan ahead to prevent future pandemics, they should give priority to investments that transform their systems, particularly in the precrises phase, to preparedness and response through a multilayered defence. We propose a three-layered approach for post-COVID-19 investments in public health functions and service delivery, particularly at the community and precrises levels. This framework highlights the interventions that enable countries to better prevent, detect and contain epidemic threats, and that strengthen the efficient use of limited resources towards high-impact precrises systems.

Summary Box

As countries draw on the lessons of COVID-19 to prevent future pandemics, they should give priority to investments that transform their systems, particularly in the pre-crises phase, to preparedness and early response through a multi-layered defense. We propose a three-layered approach for post-COVID-19 investments that integrates public health system functions and primary health care. This framework adapts the traditional, ‘Prevent, Detect, and Respond’ model of health security to enable prioritization, and integration of health security investments within the service delivery systems.

The first layer is the primary foundation of pandemic defense that, among other measures, focusses on pandemic risk reduction and emphasizes primary health care systems that can monitor and detect emerging disease outbreaks at the community level.

The second layer of defense operates primarily during the early phase of an outbreak through identification and protection of at-risk populations, scaling up of testing and contact tracing, epidemic intelligence, risk communication, and public health measures.

Layer three includes, which would ideally be the last and rarely needed line of defense, includes surge responses,and secondary and tertiary hospital interventions that require advanced case management.

Expenditures in first two pre-crises’layers are far smallerand are ultimately more effective in strengthening resilience to epidemics, and their secondary impacts than investments to fight a full-fledged epidemic in the final layer.