Learning from COVID-19: Refining health policies for effective Mpox control

The global response to Mpox presents a critical opportunity to apply lessons learned from the COVID-19 pandemic, particularly in federated healthcare systems. This insight emerged from a recent dialogue with a close friend and mentor—a professor at the forefront of health policy leadership in a prominent university in the global north. His experience navigating the complexities of healthcare delivery in a federated system, where subnational entities wield autonomous powers, offers valuable perspectives on ensuring equitable healthcare during public health crises. 

As the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (CDC) declare Mpox a public health emergency, the relevance of these insights becomes increasingly apparent. This blog explores how the challenges and successes observed during the COVID-19 response can inform and enhance our approach to managing Mpox, especially within the context of federated healthcare systems. 

By examining the interplay between centralised guidance and localised implementation during COVID-19, we aim to extract key lessons applicable to the ongoing Mpox situation. This analysis will shed light on strategies for balancing autonomy and coordination, ensuring equitable access to healthcare, and effectively managing public health emergencies in diverse governance structures. 

The two events span two continents and two different countries, focusing on subnational responses occurring almost simultaneously at opposite ends of the world. Problems know no boundaries, and the actions taken to address them often have both intended and unintended consequences. 

Country Experiences 

In country #2, global south, the COVID-19 response brought about a new way of working. For the first time, all parts of the country had to set up special centres (called Emergency Operation Centres, EOCs) at the same time. These centres were used to manage both national and local efforts to fight the virus. 

Before COVID-19, EOCs, where they existed, were only used for smaller outbreaks of diseases that can be prevented by vaccines and other public health measures. The centres work using a system called the Incident Management System (IMS). This system helps organise public health responses efficiently, which allows health organisations to change their plans as the situation changes. 

In this system, people have different jobs. Some make significant decisions, some plan day-to-day work, and others execute the plans. Disease experts, called epidemiologists, usually do the planning in local areas and report to leaders in the health ministry. 

During the COVID-19 response, these experts were in charge of tracking the disease. They also had to manage money given by outside groups to help fight the pandemic. But something unexpected happened. Once this money was received, many of the experienced experts were either fired or moved to other jobs and subsequently replaced by new bosses or people who didn't have much experience in handling such big health problems. 

These decisions had serious effects on public health work. They made people feel unsure about their jobs and less motivated to work hard. They also damaged the way people work together and made it harder for health organisations to become stronger and better prepared for future problems. 

This situation shows how health policies can have unintended consequences, even when they're meant to help. This is another example of how complex managing a health crisis can be. 

Based on these vivid experiences, I share a few reflections:

1. Values-based leadership: Effective leadership grounded in strong values is crucial for fostering organisational resilience and embedding a culture that ensures all components of an organisation’s value chain are aligned. Leaders must demonstrate courage when needed, but they should also lead through enablers like policy frameworks or existing service charters. Accountability is paramount for sustaining trust and integrity in leadership. 
2. Partnerships and collaboration: Healthcare delivery requires collaboration beyond the health sector alone. Maintaining public health security is not solely the responsibility of ministries of health. As seen in country #1, additional security was necessary to protect civil servants to ensure they could continue fulfilling their roles in healthcare delivery. This underscores the importance of partnerships with agencies trained in maintaining law and order, highlighting the essential role of collaboration to safeguard peace and public health. 
3. Organisational alignment and process adherence: Success in any organisation, especially in public service, hinges upon clear processes that are consistently followed in both stable times and during crises. Global health security frameworks like the WHO International Health Regulations Monitoring and Evaluation Framework (IHRMEF) advocate for simulation exercises (SimEx) to ensure procedural alignment through drills and rehearsals. However, when changes are necessary, they should be carefully integrated within established policy guidelines rather than driven by short-term benefits. Addressing vulnerabilities promptly is vital to prevent similar issues from occurring in other contexts and setting a precedence for unwanted outcomes.