Reflection on the history of pandemics correctly shows human foot prints in their development and spread. This forms the basis of collectively, preventing or mitigating pandemics globally in future. Tracking the early co – existence of humans with animals shows that around 12 000 years ago some families of humans abandoned nomadic hunting and gathering and settled in stable locations, cultivating crops, and rearing domestic animals for food, labour and clothing. This was known as the Noelithic revolution. Congregation of humans and domestic animals in villages and cities, like the current live – animal markets in China (Morens et al, 2020), provided opportunities for ancestral organisms to switch their hosts to humans and cause human diseases (Dobson and Carper, 1996; McNeill, 1976). Under conditions of intense human – animal proximity and environmental alteration due to human activities like deforestation, agricultural intensification, urbanization, and ecosystem disruption through mismanagement, enzootic and zoonotic diseases emerged (Morens, Daszak, Markel & Taubenberrger, 2020). Trend analysis shows that pandemics have challenged human existence well before COVID – 19 (Morens, Folkers, & Fauci, 2008). In distant times back in history pandemics have been separated by centuries, but recently they have started to be relatively frequent. For instance, influenza pandemic H1N1pdm (2009), chikungunya pandemic (2014), Zika pandemic (2015), and widespread pandemic – like extension of Ebola over five African countries, with cases exported globally (2014 to 2015) (Morens et al, 2020). Chikungunya and Zika are associated with human crowding, peri – domestic water storage, exportation of vector mosquitoes, and human development of novel mosquito breeding sites, such as discarded rubber tires (Morens and Fauci, 2014). Bird flu which is a poultry – adapted influenza caused by viruses known as H5N1 proved ability to infect humans, by causing outbreaks in Hong Kong SAR, China, in 1997. The re – emergence of this avian virus in 2003 – 2004 resulted in millions of poultry infections and severe human illness and death. Also previously known animal influenza viruses to attack people include avain H7 and H9 subtypes and swine influenza virus. The H2 subtype which caused 1957 pandemic has not circulated for decades, but has potential to cause a pandemic should it return (WHO, 2010).
Most influenza viruses do not normally infect humans but naturally infect and circulate among a variety of avian and mammalian species. (WHO, 2010). However, influenza virus to which humans have no immunity, has potential to cause a pandemic when it acquires the ability to cause sustained human to human transmission which lead to community wide outbreaks (WHO, 2010). As an example humans can acquire a zoonotic H5N1 infection with the primary risk factor as direct contact or exposure to infected poultry. Therefore, from this it is clear that to reduce the risk of human infection by viruses from animals, long term commitment from countries and strong coordination between animal and human health authorities is required (Morens, Folkers, & Fauci, 2004; Allen et al, 2017).
With the globalized economy of the world depending on international trade, (Jones et al, 2008), it is evident that ultimate cause of pandemics are humans as they travel. Even a way back in time international travel is illustrated by the historian Alfed Crosby making reference to what he terms “Columbian Exchange”. For instance, Syhilis was brought back to Europe after the first voyage of Columbus to the Americas in 1492. Europeans brought back smallpox, measles which killed millions of natives. For instance the infamous hueyzahuatl epidemic of 1520 killed an estimated 3, 5 million people. In 1700s explorers to the Pacific Islands imported diseases that caused near extinction of natives, such that the age of exploration might more appropriately be called the age of global microbial devastation (Morens et al, 2020).
2.1 From Epidemic to Pandemic: Contributory Factors
Transmissibility and severity are the two most critical factors that determine the effect of an epidemic. Neither the 2009 pandemic influenza A(H1N1) virus ([H1N1]pdm09) pandemic or the severe acute respiratory syndrome coronavirus (SARS – COV) or the Middle East respiratory syndrome coronavirus (MERS – CoV) epidemics had the combination of both high transmissibility and severity, like COVID – 19, hence it has been declared a Public Health Emergency of International Concern (PHEIC) (David et al 2020). Formerly referred to as ‘2019 novel coronavirus’ disease or ‘2019 nCoV’, COVID – 19 disease is caused by a most recently discovered new strain of coronavirus, belonging to the family of viruses as Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). ‘CO’ stands for corona, ‘VI’ for virus, and ‘D’ for disease (Bender, 2020; WHO, 2020). First experienced in Wuhan, China in late December 2019 (Shereen et al., 2020), the first coronavirus mortality outside China was reported in February 2020, on 11 March 2020, the World Health Organization announced COVID–19 as a pandemic spreading to countries in different continents (Secon et al, 2020 in Cahapay, 2020), with the greatest impact felt in developed countries like the US UK, and Italy (Jadhav, Bagul, and Aswale, 2020). Amid rapidly spreading COVID-19 ravaging many countries in the world (Sintema, 2020; Jadhav, Bagul, and Aswale, 2020), it is clear COVID – 19 pandemic is an unprecedented danger which does not differentiate on any basis be it borders, ethnicities, disability status, age or gender (Bender, 2020). This justifies a united global approach to similar future pandemic outbreak.
A multimillion dollar question to ask is: “Through a united global response could the devastating rapid spread of COVID– 9 not have been reduced or avoided in the first place?
In attempting to answer this question the response to COVID–19 pandemic needs discussion focussing on factors which might have contributed to the development from an epidemic to a world pandemic. Although countries have been sharing information on COVID–19 on its control through the World Health Organisation (WHO), but each country has been implementing measures according to its discretion. For instance, some countries went into lockdown some did not. When some started to relax lockdown restrictions some did not.
Again these responses to mitigate spreading of COVID–19 came rather late, when COVID–19 had already been exported to, and imported from many countries, over the world, and local country transmissions occurring. This suggests that in future once high transmission and severity of any disease have been established, through early warning signs, development into a pandemic could be prevented by implementing a global approach to mitigating the disease is coordinated by WHO.
For instance, unlike in the case of COVID – 19, if in future a similar pandemics breaks out, all countries would do lockdowns and restrictions at the same time, guided by WHO assessment based information. There should be rules or framework which empowers WHO to ensure disease mitigating measures against development of a disease into a pandemic are abide by, or else working against this may be regarded as threatening world peace and stability, which may attract punitive measures. Such an approach will act as a deterrent measure against abetting development of pandemics by countries.
2.2 Impact of COVID – 19 on Education
Education is the goose that lays the golden eggs, since every sector of society depends on education, for the provision of school leavers who will join various socio–economic sectors of any country for national development. Be it health, industry or commerce, education is the foundation for the development of manpower for the sustenance of these sectors. Although education has such an important role, unfortunately it is suffering from negative impact from COVID–19. For instance in trying to reduce development of COVID–19 pandemic, countries swiftly closed schools and universities (Jadhav, Bagul, and Aswale, 2020; OBESSU, 2020; TUAC, 2020), affecting more than 1 billion and 575 million students in approximately 188 countries around the world. (UNESCO, 2020; Duraku and Hoxha, 2020). Therefore COVID–19 has become an education crisis (OBESSU, 2020). School closures are likely to have a major negative effective on learning, physical, social and mental health, as well as threatening the well–being of hard–won educational achievements for years to come. Existing vulnerabilities and inequalities among children, especially girls, children with disabilities, orphans and vulnerable children, are likely to exacerbate (Zimbabwe Education Cluster, 2020).
In mitigating the development of COVID–19 social distancing through online learning substituted face – to – face from the learning environment, making ICT the most appropriate alternative to keep educational systems functional in many parts of the world. (Duraku and Hoxha, 2020; Sintema, 2020). It is important to note that similarly in future, development of a disease into a pandemic may be so fast such that educational institutions will have very little time to prepare for appropriate teaching and learning approaches. This entails making teaching and learning changes intended to occur over months or years to be implemented in a few days (Daniel, 2020). Obviously they are attendant challenges to such abrupt changes. For instance in the case of COVID – 19 concerns of teachers in conducting online learning due lack of skills and access to internet at – home isolation have been observed particularly in countries where there was low use of classroom technology for teaching and learning prior to the COVID – 19 pandemic (UNESCO, 2020). While control and eliminative measures are being taken globally against COVID – 19 to preserve life because it is sanctity, but education is needed to sustain it. Premised on this, through UNESCO and UNDP, there is need for development and implementation of a global educational framework which prepares education systems for future pandemics.
2.3 Future Pandemic Control through Education
First steps in pandemic control even in the modern era of drugs and vaccines, are prevention and education. At the onset of a pandemic outbreak, infection specific drugs and vaccines are rarely available, and like the HIV, may not be available for a long time which can range to years.
When drugs and vaccines become available, they may not be enough especially in developing countries. Also, medical providers and facilities may be few (Navarro, Kohl, Cetron, & Markel, 2016). In this context how can a united global fight against future pandemics be enhanced through education? Education can be used as a tool for preventing infection, and spreading of a pandemic. The Centre for Disease Control (CDC) for each country globally, working with the respective ministry of education, can find ways of including in the curriculum compulsory basic education, pandemic prevention and management. Critical components of early responses to a pandemic are public health efforts, among them those organized by local and state health departments, industry, and non – governmental organizations (NGOs). Also NGOs can be involved in providing awareness campaign about pandemic preparedness and management to the community through informal education. These efforts should be made consistent with World Health Organisation (WHO). Currently, WHO standards are followed based on countries respecting ethics which some may not do, hence posing the risk of spreading the pandemic (Navarro, Kohl, Cetron, & Markel, 2016). In dealing with future pandemics, there is need for global compliance mechanisms, which WHO should use. The issue of compliance should not be left to individual countries, because those non complying countries can still be epicentres of pandemics, hence through export of the pandemic, put at risk all countries including those complying.
Tight measures taken to fight a pandemic like confinement, isolation, social – distancing and wearing face masks in the fight against COVID – 19, have psychological consequences like anxiety, depression, fear for ourselves and for our loved ones, stress (European Civil Society for Education, 2020). The attendant induced economic recessions cause inequalities, with the wider gap between learners as most tangible incontrovertible evidence. Even in Europe, the wealthiest region in the world, there remain thousands of learners who cannot afford online learning because of unsupportive home environments. Therefore inclusive education is at stake, as learners with physical or cognitive disabilities are denied equal learning opportunities (European Civil Society for Education, 2020). The UNESCO should find ways of involving countries in contributing towards a fund that will be used to support countries in preparing education systems in countries to use ICT for teaching and learning both in good times and in times of pandemics like COVID – 19. Also the UNDP can be involved in community projects in the world to involve nationals of each country in being ready to respond positively in mitigating effects of a pandemic. The importance of this is illustrated by the resistance which has been reported on nationals of certain countries who violated lockdown restriction measures like staying at home, wearing a mask in public, ban on consumption of alcohol and social distancing. In some cases military support was sort, but which resulted in loss of life as the army used excessive force. This suggests that the army of each nation should also, through appropriate educational programmes consistent with WHO developed guidelines, be provided with knowledge and skills to enforce the pandemic mitigating measures, without violating human rights as prescribed by international law. The education which is given when a specific pandemic has broken out should be there to augment pandemic awareness and preparedness which will be on going before the pandemic. There is need for civic education in the school curriculum globally, to bring awareness to citizens and knowledge on how to mitigate pandemics at community level.
Education systems in some countries (Zimbabwe Education Cluster, 2020), were already stretched before the COVID – 19 pandemic as a result of multiple crises, including the impact of natural disasters like cyclones, and hyperinflation.
Therefore the combined effects of the humanitarian crisis and the pandemic will have far–reaching implications for the demand and supply of education services (Zimbabwe Education Cluster, 2020). Reports have also been made of, during efforts to mitigate COVID – 19, of people who refused to implement mitigating measures basing on their religious and cultural beliefs, thereby accelerating the spread of the pandemic. For future pandemics, this can be reduced through implementing appropriate community awareness campaign in mitigating pandemics before any has broken out. This implies countries should be proactive rather reactive in pandemic management.
2.4 Pandemic Preparedness
Control strategies are driven by a combination of Ro, the basic reproduction number, which is the number of additional persons one case infects over the course of their illness. This a commonly used measure of transmissibility. An R0 of less than 1 indicates the infection will die out “eventually.” An Ro of greater than 1 indicates that the infection has the potential for sustained transmission. (David et al 2020). Researchers suggest that transmissibility of COVID – 19 is very high (Diaz – Quijano et al 2020), as indicated by a reproductive number (Ro) of the order of two to four for the coronavirus (meaning that each infectious individual may directly generate two to four others) (Tuite and Fisman, 2020; Kuniya, 2020; Fang , Nie, & Penny, 2020). While travelling and trade are responsible for pandemic outbreaks through increasing Ro, they cannot be stopped because they sustain the world economy as a global village. Countries should collectively put in place strategies which enhance their preparedness of pandemic outbreaks, since COVID – 19 has demonstrated that in most countries if not all, pandemic preparedness is incomplete notwithstanding that an influenza pandemic can occur any time. The World Health Organisation (WHO) (2010) notes that such unpreparedness will result in:
- rapid spread of pandemic disease leaving little time to implement ad hoc mitigation measures;
- medical facilities struggling to cope with a possible large surge in demand;
- potentially serious shortages of personnel and products resulting in disruption
- of key infrastructure and services, and continuity of all sectors of business and government;
- delayed and limited availability of pandemic influenza vaccines, antivirals and antibiotics, as well as common medical supplies for treatment of other illnesses;
- negative impact on social and economic activities of communities which could last long after the end of the pandemic period;
- intense scrutiny from the public, government agencies, and the media on the state of national preparedness; and
- A global emergency limiting the potential for international assistance (WHO, 2010).
In order to improve pandemic preparedness WHO has developed some guidelines. Disease transmission patterns, precise symptoms, epidemiology, and virology cannot be known in advance of a pandemic. However, based on past pandemics, assumptions are made to facilitate pandemic preparedness planning activities. To assist countries WHO developed WHO Pandemic Preparedness Guidelines which is updated by the WHO Secretariat to keep it abreast with time (WHO, 2010).
Much remains to be done, but these efforts provide the first steps to what may one day become a preventive approach to pandemic emergence. Steps to develop a preventative approach to pandemics are being taken.
Lowering the risk of a pandemic and predicting its emergence is becoming increasingly possible with the advent in advancement of technology. Underlying causes of emerging diseases and hotspots where they are mostly to originate can be identified by tracking past pandemic origins. Wildlife species that carry the highest risk of as-yet-undiscovered viruses, can be identified by analysing host – virus relationships (Allen et al, 2017). Once novel diseases have gained a foothold in the human population, analyses of air travel pathways provide real-time data to anticipate the likely spread. Land use, which reduces human – animal contact, reduce the risk of pandemic emergence (Morens et al, 2020).
A whole society approach should be used, to mitigate effects of a pandemic so that individuals, families, non – governmental organizations, and communities are involved. In this context the task of the government is to:
- identify, appoint, and lead the coordinating body for pandemic preparedness and response;
- enact or modify legislation and policies required to sustain and optimize pandemic preparedness, capacity development, and response efforts across all sectors;
- prioritize and guide the allocation and targeting of resources to achieve the goals as outlined in a country’s Pandemic Influenza Preparedness Plan;
- provide additional resources for national pandemic preparedness, capacity development, and response measures; and
- Consider providing resources and technical assistance to countries experiencing outbreaks of influenza with pandemic potential (WHO, 2010).
The whole society approach does not work without rules and a framework to guide. Through WHO, a framework which helps countries to quickly respond appropriately to future pandemics should be made available.
