Pandemics Mitigation: Building Emergency Surge Capability (ESC)

Pandemics are low-probability high-consequence events that inevitably occur, confirming Murphy’s Law: If something can go wrong, it will. It is difficult, if not impossible, to anticipate when a pandemic will strike and how it will unfold.

The COVID–19 pandemic in the winter and spring of 2020 started in China and quickly spread into almost every country causing illness, deaths and disruptions to the world economies costing trillions of dollars. It is not possible at this time to make an assessment of the economic cost.

This brief editorial, written for the Canadian Science Policy Centre, focuses on what I believe is the main lesson learned: it is important to build Emergency Surge Capability (ESC) into the system by selective stockpiling of critical equipment and by contractual arrangements with selected companies to manufacture such equipment early in the crisis.

A brief incident between US President Donald Trump and US-based company 3M provides an example of dysfunctional relations between government and business during a crisis. When it became apparent that 3M was exporting N95 respirators to foreign countries, including Canada, when there were critical shortages within the USA, President Trump intervened requesting that 3M halt all exports and re-direct supplies to domestic needs. It was further requested that 3M will supply 150 million medical masks for domestic US distribution. This incident shows that Canada cannot rely on imports of critical supplies during an international crisis. We need to secure domestic supplies of critical equipment during an emergency.

Canadian Prime Minister Justin Trudeau said in early April that more than 11 million face masks had arrived in Canada in recent days. He said workers were trying to quickly assess that they met the needed standards and that 10 million masks were already being distributed to provinces and territories. He also said the government had ordered hundreds of thousands of face shields from Bauer, the company that normally makes hockey equipment. “We need to make sure that equipment that is destined for Canada gets to and stays in Canada,” he said, noting that’s a concern the government is working to address.

This brings up two important issues that are central to the development of the ESC plan.
1. No time should be lost during the crisis in ensuring that the standards are adequate. This will have been ascertained through the ESC contractual agreements with the selected manufacturers.
2. ESC contracts must be made with Canadian companies to ensure they will not be subject to crisis emergency regulations of a foreign country.

A stockpiling program is also necessary to ensure the availability of critical supplies during the first few days of the crisis, while the ESC program is being activated. The size and scale of the stockpiles will depend on the lead time required between ESC activation and availability of ESC-produced supplies. A short lead time is economically advantageous in order to minimize the scale of the stockpiles.

In addition to ESC, the overall strategy must include the ability to maintain critical services at normal levels. Agricultural production, for example, could be impacted by illness of personnel working in close proximity, causing ripple effects forward and backward along the production chain and leading to shortages in food supply. The security of food supply must be integrated as top priority in the preparedness plan.

As school closures may become necessary, schools must take steps now to integrate online education as a complementary element of regular education. In situations of pandemic or other national crisis, the education system will be ready to cope without shutting down the educational process.

This editorial has not addressed the important issue of federal/provincial administration of ESC and the more general issue of federal/provincial coordination during the crisis. These matters will certainly need to be defined in detail based on pre-established agreements between the federal government and the provinces.

Emergency preparedness is about saving lives and reducing the economic consequences of a crisis. The best response is a good plan.