Is it possible to prepare for a pandemic?

How effective were investments in pandemic preparation? We use a comprehensive and detailed measure of pandemic preparedness, the Global Health Security (GHS) Index produced by the Johns Hopkins Center for Health Security (JHU), to measure which investments in pandemic preparedness reduced infections, deaths, excess deaths, or otherwise ameliorated or shortened the pandemic. We also look at whether values or attitudinal factors such as individualism, willingness to sacrifice, or trust in government - which might be considered a form of cultural pandemic preparedness - influenced the course of the pandemic. Our primary finding is that almost no form of pandemic preparedness helped to ameliorate or shorten the pandemic. Compared to other countries, the United States did not perform poorly because of cultural values such as individualism, collectivism, selfishness, or lack of trust. General state capacity, as opposed to specific pandemic investments, is one of the few factors which appears to improve pandemic performance. Understanding the most effective forms of pandemic preparedness can help guide future investments. Our results may also suggest that either we aren't measuring what is important or that pandemic preparedness is a global public good. © 2022 The Author(s). Published by Oxford University Press.

COVID in the nursing homes: the US experience

The death toll in nursing homes accounted for almost 30 per cent of total Covid-19 deaths in the US during 2020. We examine the course of the pandemic in nursing homes focusing especially on whether nursing homes could have been better shielded. Across all nursing homes the key predictor of infections and deaths was community spread, i.e. a factor outside of the control of nursing homes. We find that higher-quality nursing homes, as measured by the CMS Five-Star Rating system, were not better able to protect their residents. Policy failures from the CDC and FDA, especially in the early stages of the pandemic, created extended waiting times for Covid-19 tests and slowed attempts to isolate infectious residents. But once infections were widespread, testing would have had to have been much greater to have had an appreciable effect on nursing home deaths. We find, however, that starting vaccinations just 5 weeks earlier could have saved in the order of 14,000 lives and starting them ten weeks earlier could have saved 40,000 lives.

Vaccines and the Covid-19 pandemic: lessons from failure and success

The losses from the global Covid-19 pandemic have been staggering-trillions in economic costs, on top of significant losses of life, health, and well-being. The world made significant and successful investments in vaccines to mitigate the pandemic, yet there were missed opportunities, as well. We review what has been learnt about the value of vaccines, the speed at which vaccines can be developed, and the optimal and ethical approaches to vaccine distribution, as well as other issues related to pandemic and emergency preparedness. Surprisingly, spending on vaccines remains far below that which would be justified by the social return. We remain poorly prepared for future pandemics and other emergencies.

Is it possible to prepare for a pandemic?

How effective were investments in pandemic preparation? We use a comprehensive and detailed measure of pandemic preparedness, the Global Health Security (GHS) Index produced by the Johns Hopkins Center for Health Security (JHU), to measure which investments in pandemic preparedness reduced infections, deaths, excess deaths, or otherwise ameliorated or shortened the pandemic. We also look at whether values or attitudinal factors such as individualism, willingness to sacrifice, or trust in government-which might be considered a form of cultural pandemic preparedness-influenced the course of the pandemic. Our primary finding is that almost no form of pandemic preparedness helped to ameliorate or shorten the pandemic. Compared to other countries, the United States did not perform poorly because of cultural values such as individualism, collectivism, selfishness, or lack of trust. General state capacity, as opposed to specific pandemic investments, is one of the few factors which appears to improve pandemic performance. Understanding the most effective forms of pandemic preparedness can help guide future investments. Our results may also suggest that either we aren't measuring what is important or that pandemic preparedness is a global public good.

Covid in the nursing homes: the US experience

The death toll in nursing homes accounted for almost 30 per cent of total Covid-19 deaths in the US during 2020. We examine the course of the pandemic in nursing homes focusing especially on whether nursing homes could have been better shielded. Across all nursing homes the key predictor of infections and deaths was community spread, i.e. a factor outside of the control of nursing homes. We find that higher-quality nursing homes, as measured by the CMS Five-Star Rating system, were not better able to protect their residents. Policy failures from the CDC and FDA, especially in the early stages of the pandemic, created extended waiting times for Covid-19 tests and slowed attempts to isolate infectious residents. But once infections were widespread, testing would have had to have been much greater to have had an appreciable effect on nursing home deaths. We find, however, that starting vaccinations just 5 weeks earlier could have saved in the order of 14,000 lives and starting them ten weeks earlier could have saved 40,000 lives.

Could vaccine dose stretching reduce COVID-19 deaths?

We argue that alternative COVID-19 vaccine dosing regimens could potentially dramatically accelerate global COVID-19 vaccination and reduce mortality, and that the costs of testing these regimens are dwarfed by their potential benefits. We first use the high correlation between neutralizing antibody response and efficacy against disease (Khoury et. al. 2021) to show that half or even quarter doses of some vaccines generate immune responses associated with high vaccine efficacy. We then use an SEIR model to estimate that under these efficacy levels, doubling or quadrupling the rate of vaccination by using fractional doses would dramatically reduce infections and mortality. Since the correlation between immune response and efficacy may not be fully predictive of efficacy with fractional doses, we then use the SEIR model to show that fractional dosing would substantially reduce infections and mortality over a wide range of plausible efficacy levels. Further immunogenicity studies for a range of vaccine and dose combinations could deliver outcomes in weeks and could be conducted with a few hundred healthy volunteers. National regulatory authorities could also decide to test efficacy of fractional dosing in the context of vaccination campaigns based on existing immune response data, as some did for delayed second doses. If efficacy turned out to be high, the approach could be implemented broadly, while if it turned out to be low, downside risk could be limited by administering full doses to those who had received fractional doses. The SEIR model also suggests that delaying second vaccine doses will likely have substantial mortality benefits for multiple, but not all, vaccine-variant combinations, underscoring the importance of ongoing surveillance. Finally, we find that for countries choosing between approved but lower efficacy vaccines available immediately and waiting for mRNA vaccines, using immediately available vaccines typically reduces mortality.