DESIGNING A GLOBAL PANDEMIC INTELLIGENCE SERVICE

Just over a year into the world’s greatest human security threat in nearly 100 years, the World Health Organization and Germany have committed to building a pandemic and epidemic intelligence hub in Berlin¹. As part of the WHO Health Emergencies Programme, this collaborative effort will aim to enhance global health security by providing World Health Organization member states and other key stakeholders with timely access to high-value data and predictive models. In addition to scaling up early warning surveillance and interdisciplinary risk analysis, the World Health Organization is banking on its enhanced ability to predict, prevent, and respond to pandemic and epidemic threats. However, standing-up a civilian intelligence network in the middle of a deadly pandemic poses a formidable challenge that should not be underestimated. Closing international knowledge and capability gaps in a realistic time frame could test the strategic and operational limits of the World Health Organization, which has received repeated criticism for its delayed response to fast-moving infectious disease outbreaks². Ultimately, the success of the new multilateral institution will be judged on its ability to delivery a public health intelligence service that is effective, responsive, and proportionate to the threat. 

Background 

Global security threats like the COVID-19 pandemic are not new. Historically, pestilence has claimed more lives than the combined forces of famine and violent conflict³. The growth of international trade networks, and large-scale cities linked by them, are a recent phenomenon enabled by revolutionary medical discoveries such as public hygiene, antibiotics, and vaccination. Ironically, these scientific and technological advancements created the conditions for new and more lethal disease outbreaks. In today’s hyperconnected world, the cascading effects of a global disease pose a considerable danger to at-risk populations everywhere. Other examples of serious health risks include drug-resistant and disease-causing pathogens as well as the accidental release, theft, or illicit use of dangerous pathogens⁴.

The velocity, magnitude, and global impact of the COVID-19 pandemic differentiate it from other disease outbreaks and respiratory infections in recent history. As of 30 June 2021, there have been over 181 million confirmed cases of COVID-19 and 3.9 million deaths in more than 200 countries, territories, and areas⁵. Many illnesses and deaths around the world could have been avoided. The unfortunate paradox of the current public health emergency is that it happened despite the repeated and credible warnings of public health specialists⁶, intelligence agencies⁷, security practitioners⁸, and investigative journalists⁹. Recent analysis has shown that many countries were completely unprepared for the pandemic even though maintaining such a capacity is a legally binding requirement of the International Health Regulations (2005). According to the 2019 Global Health and Security Index (GHSI) which assessed the health security and capability of 195 countries across six categories, the average readiness score was 26 out of 100¹⁰. It seems that one of the biggest vulnerabilities in the global health security network is the overreliance on voluntary reporting from individual governments. Even the World Health Organization has been scrutinized for its hesitancy to declare a global pandemic in early 2020¹¹. Likewise, the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme noted that it is unable to address a global pandemic while also responding to other global emergencies simultaneously¹². More recently, the Independent Panel of Experts for Pandemic Preparedness and Response concluded that the International Health Regulations (2005) are a less than satisfactory policy instrument that inhibits rather than facilitates proactive action¹³. 

The consensus view among international observers is that the COVID-19 pandemic has exacerbated global inequality, with the impact being hardest on the world’s most vulnerable populations. Importantly, the COVID-19 pandemic has created radical uncertainties that challenge the ability of local governments to deliver local public health services when and where they are most needed. In some countries, the pandemic preparedness deficit even required that the armed forces assume non-military roles which undermined their operational readiness¹⁴. These shortcomings highlight the challenge of strengthening global health security, especially when large-scale population movements are likely to remain a vector for infectious disease transmission. Perhaps the biggest “wildcard” facing the World Health Organization’s intelligence facility is the emergence of new COVID-19 variants and infectious clusters with no apparent connection to current “hotspots.” 

The Present Situation 

Assuming that the WHO Health Emergencies Programme is sufficiently funded, the World Health Organization has an unprecedented opportunity to advance global public health security in a positive direction. The world has greater awareness about the threat of severe acute respiratory viruses and is better educated about the public health benefits of COVID-19 prevention measures such as mask wearing, hand washing, physical distancing, staying at home, and reasonable restrictions on non-essential travel. Another welcome development is the commitment to knowledge diplomacy and public health security embraced by a growing network of global leaders, corporate boardrooms, and civic organizations. Tangible improvements to public health security can also be measured in the millions of daily vaccinations distributed in hospitals, community clinics, and makeshift medical facilities around the world. While these factors have contributed to recent declines in cases counts and deaths globally, there is considerable variation both within and among countries. Much more work is needed if the world is to complete an equitable transition to a post-pandemic reality. This work needs to be precipitous given that 2021 has been a more deadly year than 2020. On 11 May 2021, the World Health Organization identified a new variant of concern (B.1.617.2 or Delta) believed to be 55% more transmissible than the Alpha variant¹⁵. It is circulating in at least 96 countries and could become the dominant variant before the end of 2021. The situation is further complicated by the fact that nine out of 10 African countries are unlikely to meet their urgent vaccination targets¹⁶. Because of these access barriers many low and middle-income countries may not inoculate their at-risk populations until 2023¹⁷, creating a divide between those who can travel internationally and those who cannot. The uneven distribution of COVID-19 vaccines worldwide and the shapeshifting nature¹⁸ of the pandemic mean that the World Health Organization must pivot quickly to establish a baseline intelligence capacity in three mission-critical areas: early threat warning and strategic analysis, emergency response situations, and recovery operations.  

1. Early Threat Warning and Strategic Analysis: 

The experience of the COVID-19 pandemic has sensitized multilateral, national, and business leaders about their responsibility to better anticipate low-frequency, high-impact threats emerging almost anywhere in the world. These foresight activities will need to evolve rapidly as the COVID-19 emergency shifts to places with pre-existing insecurities and low performing healthcare systems. 

Early Threat Warning (and foresight)

Global public health security depends on the early identification of abnormal trends or events which may suggest an unusual occurrence is emerging or has already emerged. Public health intelligence involves the systemic collection, analysis, and communication of positive or negative changes in health conditions (accidents, natural hazards, deaths), locally and globally. The World Health Organization is uniquely placed to serve as a broker of early threat warning and foresight analysis²⁰, in contrast to the short-term thinking that tends to dominate national policy making. In general, early warning indicators should provide strategic planners with sufficient time to mobilize response mechanisms and devise contingency strategies (ie., pre-positioning of mission-critical resources). However, establishing a consensus view among member states about the appropriate time horizons to adopt might prove to be difficult due to the complex interaction of global change drivers. Early warning indicators may also have to reflect the unique circumstances of infectious disease outbreaks (ie., “super spreader” events).  

Strategic Analysis 

Strategic analysis refers to the process of researching external and internal changes that could impact organizational performance over the medium to long-term. Strategic analysis usually involves analytical choices regarding the internal and external environment, the collection and analysis of relevant data, and a selection of structured analytic techniques (ie., SWOT Analysis). Like early threat warnings, strategic analysis encourages policy makers to consider a longer time horizon. Done well, strategic analysis reduces the uncertainty about high probability, low-impact events that often get overlooked by managers pre-occupied by pressing operational demands. Strategic analysis also provides more context around the decision-making process and a better understanding of the underlying planning assumptions (ie., institutional biases) which, if not properly acknowledged, can generate suboptimal outcomes (ie., group think). In that regard, the civilian intelligence hub will have to form strategic partnerships and collaborations with other international multilateral bodies (ie., G7 100 Days Mission). Proactive information sharing is another precondition of strategic analysis and intelligence tradecraft. A default position which privileges secrecy (ie., need to know principle) over transparency (ie., need to share principle) is likely to be counterproductive since global pandemic threats cannot be effectively contained in the absence of synchronized coordination across multiple jurisdictions. A full-spectrum threat assessment produced annually would help foster anticipatory thinking, strategic agility, and informed public dialogue.  

2. Emergency Response Situations:

Public health intelligence supports emergency response operations by providing crucial insights about the type of interventions required to address emerging threats (ie., natural disasters, large-scale chemical spills, nuclear reactor incidents, humanitarian emergencies) or major changes in underlying health conditions (ie., social inequities, barriers to health care, housing, education, and food security). In a time-compressed decision-making environment, operational intelligence reporting helps operations managers mobilize and allocate resources in an efficient and cost-effective manner. This may extend to surge capacity elements that facilitate field intelligence reporting when a crisis strikes unexpectedly. With the proliferation of open-source intelligence (OSINT), it is easy become overwhelmed by digital information sources that need to be analyzed. Turning an abundance of qualitative and quantitative information into “actionable” intelligence always starts by asking relevant questions about data collection and ensuring analysts have the access they need. Additionally, the insatiable demand for public health intelligence is likely to raise the premium on working smarter and more intelligently (ie., data collection along the entire travel route). In that regard, the civilian intelligence hub will have to establish clear intelligence collection priorities (see Annex A), roles and responsibilities, and operational guidelines. This will help to mitigate the risk of “mission creep.” Since public health security is an interdisciplinary profession, individual analysts must demonstrate exceptional understanding of global mega-trends, population mobility dynamics, and contemporary urbanization¹⁹. 

3. Recovery Operations:

Ideally, public health intelligence should support global recovery operations and facilitate a coordinated transition to a threat prevention posture. In practice, however, the transition to a post-pandemic is unlikely to be smooth and predictable. The transition process will be complicated by asynchronous political and public health decisions, creating the conditions for new COVID-19 variants and potential “super spreader” events. Moreover, health intelligence solutions (ie., after action reviews) that work in one region may not be fully translatable in another due to rising geopolitical tensions, policy incoherence, and dissimilar risk perceptions. Undoubtedly, emerging stronger and more resilient from the pandemic emergency is going to require a more sophisticated model of capability building which enables the absorption and advancement of knowledge exchanges across the global public health network. As the COVID-19 pandemic has shown, an abundance of scientific knowledge and academic research does not always translate into effective policy responses. In fact, a recurring theme of the COVID-19 pandemic is that poor judgements persist despite the availability of expert advice. Therefore, special attention must also be directed at developing a multilayered knowledge infrastructure within the pandemic intelligence hub that matures as global and institutional conditions change (ie., onboarding new staff, repurposing assets). A well-designed knowledge mobilization strategy supports a more holistic understanding of the operational and strategic environment through a critical analysis of what we currently know (ie., lessons learned from intelligence failures), what we do not know (ie., intelligence gaps), and what we will need to know in the near-term future (ie., foresight analysis). Regardless of the specific techniques or development model that is chosen, knowledge mobilization is most effective when relevant products and services are accessible, timely, clear, and meaningful for the end-user. 

The Next Pandemic

A key lesson of the COVID-19 pandemic is that an overconfidence in short-term policy prescriptions and incremental “best practices” can create the conditions for strategic surprise unless corrective action is taken. It also reinforces the urgency of developing a global mindset to better prepare for emerging threats. Beyond incapacitating fiscally challenged governments, the COVID-19 pandemic has the potential to undermine decades of multilateral investments in sustainable development. Furthermore, as difficult as the COVID-19 pandemic has been, more dangerous public health threats could be lurking in the near-term future. For example, the Review on Antimicrobial Resistance (2016) cautioned that by 2050, the rise of antimicrobial resistant infections could result in 10 million annual deaths and a cumulative US $100 trillion in economic losses²¹. Essentially, the COVID-19 pandemic is a preview of a more uncertain future defined by hard to predict emergencies that are distinguished by their scale and intensity. 

Conclusion

The COVID-19 pandemic presents an ever-changing threat to global health security. This uncertainty explains why the recovery process is likely to be asymmetric and prolonged, especially in countries with low performing health care systems. The pandemic experience of the last 15 months highlights the demand for public health intelligence and the importance of working smarter and more intelligently. To that end, the WHO pandemic and epidemic intelligence hub in Berlin must quickly establish a baseline intelligence capacity in three mission-critical areas: early threat warning and strategic analysis, emergency response situations, and recovery operations. The scope and scale of this challenge should not be underestimated which is why the value of a fit-for-purpose public health intelligence capability that promotes interdisciplinary risk analysis and collaborative networking has never been more apparent. 

¹ World Health Organization (WHO), “WHO, Germany Launch New Global Hub for Pandemic and Epidemic Intelligence,” Joint News Release (05 May 2021). https://www.who.int/news/item/05-05-2021-who-germany-launch-new-global-hub-for-pandemic-and-epidemic-intelligence. 

² Laurie Garret, “Ebola’s Lessons: How the WHO Mishandled the Ebola Crisis,” Foreign Affairs (September/October 2015); Jennifer Nuzzo, “To Stop a Pandemic: A Better Approach to Global Health Security,” Foreign Affairs (January/February 2021). 

³ Charles Kenny, The Plague Cycle: The Unending War Between Humanity and Infectious Disease (2021). New York: Simon and Schuster. 

⁴ United States Centers for Disease Control and Prevention (CDC), “Global Health – CDC and the Global Health Security Agenda,” (8 January 2021). https://www.cdc.gov/globalhealth/security/. 

⁵ World Health Organization (WHO), “WHO Coronavirus (COVID-19) Dashboard,” (accessed 30 June 2021).  https://covid19.who.int/. 

⁶ Michael T. Osterholm and Mark Olshaker, Deadliest Enemy: Our War Against Killer Germs (2017). New York: Little, Brown Spark Publishing. 

⁷ United States Government, National Intelligence Council (NIC), “Mapping the Global Future.” (2004). https://www.dni.gov/files/documents/Global%20Trends_Mapping%20the%20Global%20Future%202020%20Project.pdf. 

⁸ Richard A Clarke and R.P Eddy, Warnings: Finding Cassandras to Stop Catastrophes (2017). New York: Harper Collins Publishing. 

⁹ Sonia Shah, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond (2017). New York: Sarah Crichton Book Publishing. 

¹⁰ Elizabeth E. Cameron, Jennifer B. Nuzzo, Jessica A. Bell, “Global Health Security Index 2019,” John Hopkins University, Centre for Health Security (October 2019). https://www.ghsindex.org/wp-content/uploads/2020/04/2019-Global-Health-Security-Index.pdf.

¹¹ Jennifer Nuzzo, “To Stop a Pandemic: A Better Approach to Global Health Security,” Foreign Affairs (January/February 2021).

¹² World Health Organization, Seventy-fourth World Health Assembly, “Report of the Independent Oversight and Advisory Committee for the WHO Health Emergency Programme,” A74/16 (05 May 20210). https://cdn.who.int/media/docs/default-source/dco/independent-oversight-and-advisory-committee/a74_16_e.pdf?sfvrsn=3bd1929d_1&download=true. 

¹³ Ellen Johnson Sirleaf and Helen Clark, “Report of the Independent Panel for Pandemic Preparedness and Response: Making COVID-29 the Last Pandemic,” The Lancet (12 May 2021). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01095-3/fulltext. 

¹⁴ International Institute for Strategic Studies (IISS), “Asia-Pacific Regional Security Assessment 2021,” (June 2021). https://www.iiss.org/publications/strategic-dossiers/asia-pacific-regional-security-assessment-2021; Murray Brewster, “Military Confirms 40 Percent of COVID-Positive Troops Deployed to Long-Term Care Homes Were Asymptomatic,” CBC News (26 June 2020).  https://www.cbc.ca/news/politics/coronavirus-pandemic-military-long-term-care-quebec-1.5629067. 

¹⁵ World Health Organization, “COVID-19 Weekly Epidemiological Update,” Edition 46 (29 June 2021). https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—29-june-2021. 

¹⁶ United Nations World Health Organization, Regional Office for Africa, “Nine in 10 African Countries Set to Miss Urgent COVID-19 Vaccination Goal,” (10 June 2021).  https://www.afro.who.int/news/nine-10-african-countries-set-miss-urgent-covid-19-vaccination-goal. 

¹⁷ Larry Brilliant et al., “A Strategy for the Long Fight Against COVID-19,” Foreign Affairs Magazine (July/August 2021). https://www.foreignaffairs.com/articles/united-states/2021-06-08/coronavirus-strategy-forever-virus. 

¹⁸  Vancouver Strategic and Integrated Research, “The Global Knowledge Mobility Nexus 2021,” Strategic Intelligence Series (March 2021). https://vancouverstrategicresearch.ca/product/the-global-knowledge-mobility-nexus-transitioning-from-the-tactical-present-to-the-strategic-future-2021/. 

¹⁹ Vancouver Strategic and Integrated Research, “The Global Knowledge Mobility Nexus 2021,” Strategic Intelligence Series (March 2021). https://vancouverstrategicresearch.ca/product/the-global-knowledge-mobility-nexus-transitioning-from-the-tactical-present-to-the-strategic-future-2021/.

²⁰ Vancouver Strategic and Integrated Research, “Developing a Global Mindset: Adopting a Strategic Approach to Knowledge Mobilization,” Accelerator Series (April 2018). https://vancouverstrategicresearch.ca/product/developing-a-global-mindset/. 

²¹ The Review on Antimicrobial Resistance, “Tackling Drug-Resistant Infections Globally: Final Report and Recommendations.” (May 2016). https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf.