28
Jan

The COVID-19 pandemic highlighted the critical need for robust health security systems that can effectively prevent, detect, and respond to future outbreaks. A need that came once again quickly to the fore again with WHO’s recent declaration of a public health emergency of international concern in August 2024 around MPOX outbreaks across Africa. Hospital-centric approaches to pandemic response are insufficient, as the pandemic demonstrated that the human and economic toll could have been significantly smaller if countries had in place strong multilayers of defense. This means investing in upstream interventions that promote and preserve human capital and avert losses during and between crises.

To build pandemic-ready health systems, it is essential that difficult lessons from COVID-19 are learned and then employed. To this end, we propose a three-layered approach for post-COVID-19 investments that integrates public health system functions and primary healthcare (PHC). This framework adapts the traditional "Prevent, Detect, and Respond" model of health security to enable prioritization and integration of health security investments within service delivery systems. The result is a directly adaptable and actionable framework for country health systems to focus their investments and ready themselves for the next outbreak.

As efforts to build emergency-ready health systems intensify across the globe, "Strategic Investment for Health System Resilience: A Three-Layer Framework" provides a practical investment framework and a diverse set of country cases to inform decision-making and strategic resource allocations. The framework includes:

• Layer 1: Risk Reduction—Promoting emergency-ready primary health care, public health, prevention, and community preparedness.
• Layer 2: Detection, Containment, and Mitigation Capabilities.
• Layer 3: Advanced Case Management and Surge Response.

This three-layer framework prioritizes interventions that prevent a public health threat from developing in the first place (layer 1), limit its spread should one emerge (layer 2), and manage a widespread crisis that compromises a health system’s ability to deliver care sustainably (layer 3). All three layers play a role in achieving health system resilience, but not all of them have been leveraged equally in the past.

"Strategic Investment for Health System Resilience" offers a glimpse of the relatively low cost of investments in improving the operation of the weakest parts of the three layers. Layer 1 functions are estimated to cost between US$2 per capita in low-income countries and US$4 per capita in lower-middle-income countries. The framework applies equally to short-term epidemics of communicable diseases and to slow-moving trends in non-communicable diseases. The pace of the needed response to health threats can vary, but all require a system that is resilient across multiple layers of response. Although there is no universal blueprint for every setting, it behooves all countries to seize the moment and invest in the three layers in ways that fit their needs.

The COVID-19 pandemic highlighted the critical need for robust health security systems that can effectively prevent, detect, and respond to future outbreaks. A need that came once again quickly to the fore again with WHO’s recent declaration of a public health emergency of international concern in August 2024 around MPOX outbreaks across Africa. Hospital-centric approaches to pandemic response are insufficient, as the pandemic demonstrated that the human and economic toll could have been significantly smaller if countries had in place strong multilayers of defense. This means investing in upstream interventions that promote and preserve human capital and avert losses during and between crises.

To build pandemic-ready health systems, it is essential that difficult lessons from COVID-19 are learned and then employed. To this end, we propose a three-layered approach for post-COVID-19 investments that integrates public health system functions and primary healthcare (PHC). This framework adapts the traditional "Prevent, Detect, and Respond" model of health security to enable prioritization and integration of health security investments within service delivery systems. The result is a directly adaptable and actionable framework for country health systems to focus their investments and ready themselves for the next outbreak.

As efforts to build emergency-ready health systems intensify across the globe, "Strategic Investment for Health System Resilience: A Three-Layer Framework" provides a practical investment framework and a diverse set of country cases to inform decision-making and strategic resource allocations. The framework includes:

• Layer 1: Risk Reduction—Promoting emergency-ready primary health care, public health, prevention, and community preparedness.
• Layer 2: Detection, Containment, and Mitigation Capabilities.
• Layer 3: Advanced Case Management and Surge Response.

This three-layer framework prioritizes interventions that prevent a public health threat from developing in the first place (layer 1), limit its spread should one emerge (layer 2), and manage a widespread crisis that compromises a health system’s ability to deliver care sustainably (layer 3). All three layers play a role in achieving health system resilience, but not all of them have been leveraged equally in the past.

"Strategic Investment for Health System Resilience" offers a glimpse of the relatively low cost of investments in improving the operation of the weakest parts of the three layers. Layer 1 functions are estimated to cost between US$2 per capita in low-income countries and US$4 per capita in lower-middle-income countries. The framework applies equally to short-term epidemics of communicable diseases and to slow-moving trends in non-communicable diseases. The pace of the needed response to health threats can vary, but all require a system that is resilient across multiple layers of response. Although there is no universal blueprint for every setting, it behooves all countries to seize the moment and invest in the three layers in ways that fit their needs.