📰New Study🔬 out in @TheLancet!

By building a moment by moment chronology, we analyze how an outbreak became a pandemic & priorities for international reform.

So excited to share this huge team effort led by the amazing @sudhvir!

Link: thelancet.com/journals/lance…

Explainer🧵1/8 Image
2/8
In this paper, we:
1⃣ build a 50pg moment by moment chronology from outbreak to pandemic
2⃣ identify & analyze 5 key phases of events
3⃣map actions against IHR obligations under international law
4⃣propose 5 key areas for #GlobalHealthLaw reform, inc. IHR & #PandemicTreaty
3/8
1⃣ the chronology was built using:
💠systematic review of peer-reviewed articles & public reports w author follow up for preprints & additional lit
💠systematic review of internal WHO correspondence & documents
💠validation from experts inc. at WHO
It's incredibly detailed:
4/8
2⃣ we identified the below five key phases of events, and detail and evidence each stage where available, from likely spillover to clinical detection, domestic assessment, reporting to WHO, WHO assessment, and international response. Image
5/8
3⃣we mapped actions of States, WHO & other actors against their international legal obligations under the International Health Regulations.

Despite the "fog of an outbreak", the time from clinical detection to international reports was a matter of days: ie relatively fast
6/8

For the IHR wonks out there, the role of "other reports" (Art 9) and WHO's power to verify information (Art 10) was useful. Given how quickly everything progressed, if comparing to Art 6, we're talking days to hours, not days to weeks. This means a rethink of "rapid".
7/8
4⃣We propose five key areas for reform, which involve:
🌏 amend IHR to bring into the 2020s, eg immediate notify high impact respiratory pathogens (like novel influenzas now)
🌍adopt #PandemicTreaty for many critical matters that go beyond IHR legal scope, w equity at centre Image
8/8
There are a lot of assumptions about the early days of the pandemic, inc. what actually needs to be reformed to stop an outbreak from becoming a pandemic.

I encourage you to read the whole paper @TheLancet & explore our interactive chronology at: …commendations.theindependentpanel.org/public-chronol…

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More from @alexandraphelan

1 Apr
Some of the big questions we try to teach in Epidemiology for Lawyers, whether students go to a firm, the Hill, WH, judiciary or elsewhere: what principles & processes help us make decisions on limited data & how do we change decisions (but keep trust) as evidence evolves?
Two quick examples:

for the first question,
1) what is the quality of the evidence (systematic review, cohort, case study)
2) is better evidence possible
3) could it do harm to wait or act (e.g. should we apply a precautionary approach)
for the second question, using clear risk communication strategies early on can help minimize damage to public trust. Tell public:
1. what we know (how we know)
2. what we don't know
3. what we're doing to find out more
4. when we'll give our next update
Read 4 tweets
20 Feb
Unofficial reports so far state that the subtype is H5N8 – this would be a novel influenza subtype in humans.

The IHR require immediate reporting of *any* novel human influenza subtypes as potential PHEICs, no matter how serious.
Since 2020, there has been a global H5N8 outbreak among bird populations – wild birds and poultry. Cases have been reported in Saudi Arabia, Russia, Kazakhstan, Netherlands, Germany, Denmark, UK, France, Sweden, India, Japan, Norway, South Korea.

e.g. Estonia's 17 Feb OIE report
We may have just seen the leap occur from animals to humans here because of the nature of the human/animal interactions in this poultry farm, or there may be something genetically distinct. We need sequencing to know this.
Read 6 tweets
20 Feb
Russian has reported seven human cases of avian influenza to @WHO

No confirmation of subtype yet.

No evidence yet of human to human transmission: all cases reported are workers in a poultry plant.

reuters.com/article/us-hea…
There have been a few highly pathogenic avian influenza infections (HPAI) across Europe recently in wild birds (@OIEAnimalHealth – WAHIS appears to be down this morning?)
Under the International Health Regulations (2005), countries must report any cases of a novel influenza subtype in humans as a potential PHEIC.

This is the first cluster in humans of an HPAI in Europe reported this year. It is not yet up on WHO DONs or promed.
Read 9 tweets
29 Jan
*Public health actions to control new SARS-CoV-2 variants*

Our paper just published in @CellCellPress w wonderful co-authors @NathanGrubaugh @firefoxx66 @JosephFauver & @mugecevik

We describe actions govts should urgently take to protect health.

🧵1/7

cell.com/cell/fulltext/…
New SARS-CoV-2 variants of concern will continue to emerge: exacerbating already crippling outbreaks & potentially reducing efficacy of some vaccines, cause increased rates of reinfections and prolonging the pandemic.

2/7
As SARS-Cov-2 variants of concern to date have shown: these are global issues. There must be urgent multilateral cooperation between countries to:
– build local sequencing capacities
– rapidly share sequence data globally
*and separately*

3/7
Read 7 tweets
29 Jan
Today, @ThinkGlobalHlth is celebrating its one year anniversary. @RebeccaKatz5 & I were fortunate enough to be invited to write a piece for this new @CFR_org blog, led by @TomBollyky.

Some reflections from that piece on why global governance matters.
thinkglobalhealth.org/article/why-gl…
From the outset, it was obvious that global governance was about to be seriously tested. Unfortunately, over this pandemic we've seen that play out to be the case – not only globally but also national governance.
There was a huge risk that WHO would be sidelined because states rejected WHO advice (for a range of reasons), but also because it has been woefully underfunded for years.
Read 6 tweets
22 Dec 20
I disagree with folks dismissing the implications of the UK variant of concern.

While individual behaviors to avoid transmission may not change, the impact at the population level is serious: hospitals are already at capacity.

Quick thread
/1
Any factor that ramps up transmission (biological or behavioral) amplifies cases, and as a result, severe cases and deaths. When hospitals hit capacity, cases that could have been treated successfully will be triaged along increasingly stringent crisis standards of care.
/2
At the population level, this also impacts government responses about control measures, which impacts now & future justifications
Short thread on that here:
/3

Read 6 tweets

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