Emily Headrick, MSN, FNP, Clinical Technical Advisor, FHI 360
Andrea Surette, Technical Advisor for Knowledge Management, FHI 360

Featured image: Dr. Luis Bayo shares approaches to increasing COVID-19 vaccination coverage in Uganda at a meeting convened by FHI 360 and the EpiC project in Bangkok, Thailand. Photo credit: EpiC

After COVID-19 was declared a pandemic in early 2020, FHI 360 partnered with more than 60 countries to mount an emergency response. Throughout the effort, FHI 360 has applied best practices in prevention, detection, and response based on the organization’s work on HIV and other emerging infectious diseases. As COVID-19 evolves from pandemic to endemic, efforts should leverage lessons learned and focus on the critical components of a sustainable, long-term response.

In September 2022, FHI 360 and the Meeting Targets and Maintaining Epidemic Control (EpiC) project co-convened a series of regional technical meetings in Thailand and Guatemala with technical and programmatic leaders from USAID/Washington, EpiC, FHI 360 country programs, and local implementing partners. The purpose was to advance planning for a sustainable, long-term response to COVID-19 by sharing lessons learned, evidence-based practices, and ways common challenges have been addressed. In addition, these meetings provided a platform for South-South collaboration with thought leaders from around the world to foster learning, inspiration, and a commitment to action. These key takeaways emerged from the meetings:

  1. There is an unprecedented window of opportunity to re-envision, reconstruct, and redefine our health systems, but it will not be open for long. We must seize this moment to harness political will, scientific innovation, and decades of public health knowledge to transform our health system into one that keeps everyone healthy and safe.

  2. Coordination, collaboration, and communication are non-negotiable components of a sustainable, long-term COVID-19 response. Governments, ministries of health, development partners, the private sector, community-based organizations, and the scientific community must have the willpower—as well as the platforms and mechanisms—to effectively coordinate, collaborate, and communicate.

  3. Locally led development must remain a collective priority. With effective coordination, best practices, evidence, and innovations can spread around the globe faster than any virus. However, regional or national COVID-19 response plans may require different approaches than a global strategy, and donors and governments should be free to exercise flexibility to tailor the response to befit the local context. These local solutions must be financially and politically supported.  

  4. Risk communication, social and behavioral change efforts, and community engagement are crucial components of any public health effort—particularly at a time when trust in societal institutions has been eroded. However, these cannot continue to operate as top-down approaches and must instead involve a bidirectional flow of communication, with integrated mechanisms for social listening. An approach that equally incorporates both the social and physical sciences is needed to truly engage with and listen to the communities we seek to protect and serve.

  5. As COVID-19 is likely to remain an endemic respiratory illness, safe and effective integration of COVID-19 care into routine clinical service delivery is critical. However, this will require intentional commitment to strengthen the continuum of COVID-19 care—from primary and community care to acute and critical care—including all of the pathways populations use to navigate their health care system. The primary care system will not only become the “front line” of ongoing COVID-19 case management but will also be called on to handle the significant health consequences of multiple years of interrupted preventative care, family planning/reproductive health services, and noncommunicable disease management. While all levels of the continuum of COVID-19 care must be strengthened, the primary care system in particular requires dedicated investment to sustain the backbone of basic public health.

  6. Vaccination, including boosters, remains our top tool to curb COVID-19, yet countries continue to face challenges with vaccination efforts. Increasing COVID-19 vaccine coverage requires continuous planning, coordination, and innovation from multiple stakeholders to reduce morbidity and mortality from current and future variants of COVID-19.

  7. The need for long-term, sustainable investments in the oxygen ecosystem is a critical lesson from the COVID-19 pandemic. Countries must invest now in sustainable oxygen ecosystems to prevent future shortages due to COVID-19 and other respiratory conditions and surgical or obstetric emergencies. Ensuring that patients have access to medical oxygen when they need it requires a robust and functional oxygen ecosystem, including physical infrastructure at facilities, a stable supply of oxygen, trained clinical and nonclinical staff, and government commitment to investments in medical oxygen. Stakeholders must work with national and subnational health departments to plan for oxygen infrastructure projects, including considering current, future, and past oxygen demand when finalizing system specifications.

  8. The health and safety of an already strained health care workforce was severely tested by the pandemic. Without immediate commitments for comprehensive support for health workers, our health care systems and our populations are at imminent risk. Workforce protections go beyond ethical or human rights considerations. Health care workers worldwide were asked to put their physical and psychological well-being at risk given the pervasive shortages in personal protective equipment and necessary medical equipment, unsafe levels of staffing, and poor staff access to mental health services. Ultimately, many dedicated health workers walked away from the front line. Such workforce attrition has profound implications for the ability of the health care system to sustain the current COVID-19 response and to effectively respond to future crises.

  9. As COVID-19 response planning pivots from epidemic to endemic disease considerations, the components of a sustainable, long-term effort should align with central tenets of the Global Health Security Agenda. Strengthening the systems that largely failed us during the pandemic will not only serve as preparation for future regional or global public health emergencies but will also improve access to high-quality health care, thus improving health outcomes in periods of relative stability.
  10. COVID-19—as a disease and a collective trauma—illuminated the pervasiveness of inequities and inequality around the world. Equity, as a value and a concept, must be at the center of every effort to re-envision, reconstruct, and redefine our civil institutions, including the health care system; however, we must go beyond values and concepts. We must hold ourselves, each other, and our leaders accountable to a commitment to equity by using science, data, and unwavering leadership to ensure continual progress toward equal outcomes, regardless of the population or intervention.  

  11. While the ability to work remotely has been integral to continuing our work during the pandemic, there is no true replacement for in-person connection and collaboration. For many, the regional COVID-19 technical meetings were the first large, international, in-person events they had attended in more than two years. They provided much-desired opportunities for country representatives and FHI 360 leadership to meet, share stories, and build upon existing connections to find renewed joy in our work. We have considerable work yet to do, but we are confident that we are on the right path. We look forward to meeting our teams face-to-face again soon.