Scott Dowell
Senior Advisor, Global Health Emergency Corps, World Health Organization
Former Lead, COVID-19 Response Deputy Director for Surveillance and Epidemiology, The Bill and Melinda Gates Foundation
Connecting Local to Global
During a Pandemic
All Pandemics are Local, All Pandemics are Global
From his unique perch as the lead for the COVID-19 response at the Bill & Melinda Gates Foundation, Scott Dowell had a bird’s eye view of the emerging pandemic in Washington state and around the world. Based near Seattle, Dowell was pulled into regular briefings
with local leadership, as well as foundation and global leadership. While the United States struggled with how to allocate resources across states, tribal nations, and territories, Dowell and others worked to connect those concerns with efforts to address a spreading pandemic that also was affecting every country on Earth.
“It’s true that people experience pandemics at the community level, and community engagement is really important. But, you cannot address a pandemic community by community. You can’t address a pandemic country by country. There has to be coherent coordination, whether you are a leader at the state or city level.”
We absolutely have to find ways to knit the community response together – to have all states respond together and whole countries respond together. Otherwise, there’s no hope of comprehensively addressing or stopping it. We will be left with just trying to mitigate as best we can. Your eyes might be focused on what is happening around you. But, you will get hit with the consequences of what’s happening in your neighboring state, your neighboring countries, and the other side of the world.
“That means, even at the local and state level, leaders need access in real time to the best global information to make their own decisions. And they need to have a sense of how to coordinate with other states and other countries around the world.”
There’s a difference between stopping the pandemic versus mitigating its effects. If there is a really bad pandemic, with high mortality, we won’t have any choice. People will say we have to stop this thing, and if you’re satisfied with just mitigating this thing, then it is going to sweep across us.
Fit for purpose pandemic response structures
Dowell was well-placed to watch not only which decisions were made during the COVID-19 pandemic but also to note who was making them. During the pandemic, because the outbreak was evolving regularly, endangering lives in every country, engendering massive societal shifts, and driving implications for economic and national security, decisions were made at higher levels – often by heads of state – and usually by people with a remit broader than public health.
While Dowell allowed that the displacement of usual public health structures was necessary, he also highlighted the confusion it caused and, in some cases, the lack of data to drive decisions that were made. The goal, he stressed, is to expect the displacement and to plan for structures that support good decision-making based on the best available data and modeling – and to start that now.
This was a broad societal pandemic. The pandemic affected economies in ways that normal epidemics and outbreaks do not. Therefore, it was completely logical that the response was multi-sectoral, went beyond public health, and required additional layers to deal with that. And that was true in many, many places, certainly in Washington State.
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I think a challenge for public health in the next response is to recognize that, in the event of another pandemic that really threatens lives and economies, not only is it not surprising to see the displacement of usual public health structures, we should entirely expect and plan on it.
“Given that is going to be the situation, we need to determine the best we can do for decision-makers. How can we get them the best information, the best plans, and common information so that they can make the most sensible decisions? How can we make sure that we don’t have 194 different countries making 194 different decisions based on different information – multiplied by the number of states or provinces in those countries?”
“In the case of the COVID-19 pandemic, decisions that were usually made by Ministers of Health often instead went straight up to the head of state, and the head of state may have, in some cases, turned to their public health authorities, but in other cases they turned straight to governors and those governors turned to their own network of individuals. “
Once a large number of lives and economies are at risk, then you get a lot of other voices necessarily involved. We need to anticipate that and put in place the kinds of structures that are likely to stand up and not completely displace the value of the public health expertise that we have, but instead include perspectives from economists, educators, and others who need to have a voice.
Data Drives Cohesive Decisions to Stop Global Diseases
The Bill & Melinda Gates Foundation provided support for COVID-19 modeling in Washington, across the United States, and around the world so decision-makers would have the best and fastest information about what interventions were working and under what circumstances. That information was essential for making critical decisions at the local level about major issues like closing schools and mask mandates, but also needed to be connected to global data to be able to predict what was ahead.
One of the things that made the decisions particularly and consistently good in Washington state was access to the best information as the pandemic was unfolding. There is an increased role for modeling, and a lot of disease-modeling groups happen to be based in Seattle. That data was particularly used by Governor Inslee and the folks in Washington state to make the best decisions, and other modeling groups were used in various places.
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There were large parts of the world and states across the United States that didn’t have access to the kind of outbreak modeling resources that Washington State had. If they did have access to it, they didn’t know it or didn’t use it.
“One thing that’s needed is access in real-time to the best information from around the world to make decisions. The second thing that’s needed is access to modelers or quantitative public health people in your local area who can take the data, interpret them, and apply them to the questions that they’re struggling with at the local level.”
You can’t predict ahead of time what the exact question may be, but Washington State, like many other places, struggled with the issue of school closures. You can’t sit in your own place and think that you’re going to be able to make decisions based on your own data. You need access to the world’s best data. And then you have to apply that data to make decisions about whether to close schools in the Seattle area or in rural areas. Those are different decisions. You need to be able to model those data with your local context in mind.
“The pandemic unfolded too quickly for the traditional public health institutions to absorb and disseminate the data. I think we each had favorite websites. Whether the Johns Hopkins map gets resurrected the next time, or some other version of it, there will be unofficial and official sources of big data.”
“We also are learning, as I’ve alluded to earlier, just how bad and misleading some of those official data were, especially for trying to get information from large parts of the world, Africa in particular.”