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Increase national preparedness in facing pandemics
In 1918, the global influenza pandemic caused worldwide morbidity in one third of the world’s population and killed as many as 50 million people (2
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n 1918, the global influenza pandemic caused worldwide morbidity in one third of the world’s population and killed as many as 50 million people (2.8 percent of the total population).
Over a century later, the world is still not ready to face another emerging pandemic. The World Health Organization estimates that if the same outbreak occurs now with a population four times larger, then 50 to 80 million lives will be lost.
The 2019 novel coronavirus (2019-nCoV) is suspected to have first emerged from direct contact with animals in the Wuhan seafood market in China’s Hubei province. As of Monday, WHO recorded 17,205 cases in China, with 361 deaths.
The number does not include confirmed cases in other countries. Based on these rapidly growing number of cases across borders, on Jan. 30 WHO declared the situation a global health emergency.
Although WHO does not impose trade and travel restrictions under emergency conditions, many countries have
used their sovereignty to restrict foreign nationals and close borders in a bid to stop the spread of the virus.
These actions present dire economic implications, especially on trade and tourist visits.
Since 2005, WHO has reminded the world of possible implications of a pandemic on global development sustainability.
Therefore, the International Health Regulation (IHR 2005) was issued as a treaty by which its protocols bind WHO member states to prevent, protect and control the spread of epidemics.
Each country is required to follow these regulations as a responsibility to uphold global health security.
The importance of the IHR was further strengthened by an initiative to form a group of like-minded countries to conduct an external evaluation of health security preparedness to meet each indicator in the IHR.
Since 2015, Indonesia has become one of the 67 member countries in the Global Health Security Agenda group that measures each country’s preparedness to face a pandemic.
And in 2017, Indonesia was declared ready to carry out pandemic prevention, detection and treatment through an external assessment mechanism.
However, the question remains as to whether we are ready to face a pandemic. Some of the prerequisites in pandemic management are as follows:
• First is leadership. Each state leader should prioritize preparedness and dedicate domestic resources to the preparedness of the system as an integral part of global and national resilience.
Even though the evacuation of Indonesian citizens in China has been carried out on the direct orders of President Joko "Jokowi" Widodo, evacuation is only one part of the overall measures of the pandemic.
• Second, regulatory framework. Indonesia has had a regulatory framework on infectious disease outbreaks since 1984, which was strengthened by Presidential Instruction No. 4/ 2019 on increasing capabilities in preventing, detecting and responding to plagues, global pandemics and nuclear, biology and chemistry emergencies.
The regulation stipulates the roles and functions of 22 ministries and government institutions, governors and regents and mayors in handling pandemics.
• Third, financing. Domestic and international financing options help ensure the mobilization of resources to handle health emergency cases.
Government Regulation No. 22/2008 on funding and management of disaster assistance establishes a one-stop policy to coordinate financing for disaster management through the National Disaster Mitigation Agency (BNPB).
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A pandemic eventually becomes a benchmark for global preparedness and for countries in the face of a health emergency.
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• Fourth, health surveillance. Surveillance activities are essential in the cycle of prevent, detect and respond. Yet, efforts to collect, analyze and interpret health data, which the WHO states is needed to produce strategic information for effective and efficient decision-making, is often not conducted properly due to a lack of trained personnel and logistics, as well as complex recording and reporting mechanisms, coupled with fragmented and less user-friendly information systems.
The results of the WHO Joint External Evaluation report on Indonesia’s IHR capacity in 2017 also found that surveillance data analyzing and integration were still very weak.
• Fifth, early detection. As a maritime country with over 17,000 islands, Indonesia has 304 points of entry (land, air and sea). The government has carried out quarantine activities as well as the inspection of transportation equipment and goods at the points of entry, along with temperature screenings and risk screenings at several ports and airports.
However, studies show that temperature screening is ineffective in preventing the most infectious diseases, particularly since the new coronavirus has an incubation time of at least two to 10 days before showing symptoms.
• Sixth, primary health care. The spread of an outbreak can disrupt the entire health system by reducing access to health services.
A strong, effective, accessible and quality health system to provide primary health services, as well as mental health and psychosocial services, are also important aspects of epidemic prevention and treatment.
Primary healthcare centers at the forefront of community health services should able to conduct initial screenings of symptoms of the new coronavirus and make referrals.
Yet not all primary health services are equipped with diagnostic facilities and qualified health workers across the country’s nearly 10,000 community health centers (Puskesmas).
• Seventh, public communication and risk communication. Conveying prevention, detection and control measures, as well as the latest developments to the public, is vital in building public trust in the government and reducing the risk of misinformation and chaos in society.
Unfortunately, the message conveyed to the public has often been ineffective, thereby reducing public confidence in the government’s efforts in protecting public health. The initial protests of people in Natuna Islands who refused the Indonesian evacuees’ arrival from China is a good example.
A pandemic eventually becomes a benchmark for global preparedness and for countries in the face of a health emergency. Our government should realize that in today’s interconnected world, the weakness of national preparedness has a significant global impact.
The government must act quickly to ensure the resilience of all parties in the national health system in the face of a pandemic.
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Olivia Herlinda is policy director at the Center for Indonesia’s Strategic Development Initiatives. Diah S. Saminarsih is senior adviser to the World Health Organization’s director general on gender and youth; she was formerly active in Global Health Security Agenda negotiations with the Health Ministry.
