**1. Introduction**

*"This is like a world war, except in this case, we're all on the same side" (Gates 2020)*

In spite of skepticisms at various levels including by scientists, the COVID-19 pandemic is spreading at unprecedented speed across borders severely impacting global health and economy [1–3]. Globalization, which has often been celebrated for interconnecting countries, has now offered much more space and opportunity for the pandemic to easily cross boundaries and has seemingly 'tipped the scales in favor of pathogens' [4, 5]. The pandemic is still unchecked with thousands of life lost every day. Although the highly severe projections have yet to materialize [6, 7], COVID-19 is now well established in Africa [8, 9]. Estimates of future deaths projected to be in millions, in Africa, because of general poverty, malnutrition, prevalence of diseases such as HIV and TB, constrained health services etc. [6, 10]. While the potential role of climate, demography, BCG and other vaccines, and weakness in the reporting system including low rate of testing could not be ruled out [10–16], the relatively low number of cases seem to be in part because many African countries have taken swift, progressive, and adaptable responses despite resource limitations. Some studies indicate that, having garnered experience from several recent epidemics, Africa might have got it right after all [17] even though there is 'no room for complacency' [15, 18, 19].

Lockdown and social/physical distancing has been imposed in several countries. These and pandemic related pressures on the health system could have potentially unintended consequences including disruption of routine health services; widespread economic challenge and hunger; worsening food insecurity; and increased violence with major impact on health/mortality [20, 21]. Even though the basic principles of infection control are universal, their concrete applications should be context specific [22]. Decisions must be based on risk sciences and as thorough risk and cost–benefit analyses [23, 24]. There are indications that early interventions could avert substantial number of infections and deaths [25, 26]. Thus, governments and public health authorities must play a balancing role as the evidence does not indicate a simple trade-off between lives lost to the pandemic and economic recession related to response [27]. The bottom line is policies must be internationally coordinated, as WHO has called for since the disease has first appeared, and must recognize that neither abandoning control nor eternal lockdown are healthy options [10, 28, 29].

The Director General of the World Health Organization (WHO) indicated that the outbreak is a test of political, financial and scientific solidarity for the world to fight a common enemy that does not respect borders… what matters now is stopping the outbreak and saving lives [30]. However, this solidarity has failed to materialize to date because the pandemic has highlighted weaknesses in both 'authoritarian' and 'democratic' states with all trying to trade blames or downplay the danger for various reasons [4, 31, 32]. As compared to the previous pandemics, the current one shock the fabrics of society and threatens to change the course of history. As in previous pandemics, 'public hysteria, fear, and conspiracy theories tend to derail public health responses' [5]. 'We Are Living in a Failed State' – for USA no less [33] but also the world order is being seriously tested [34], with some predicting revolutions 'reinventing Communism' or 'a new barbarian capitalism' [35]. The post-pandemic is going to be tough although it is considered as an opportunity to re-evaluate what we want to prioritize as a civilization [36]. Therefore, it is imperative that we prepare for it as we struggle through the current one.

Most predictions of the next pandemic had influenza in mind, even though other catastrophe such as asteroids, mega volcanic eruptions or coronal mass ejection (CME) cannot be ruled out. Influenza is a truly universal disease. No virus poses a greater threat to more people [37, 38]. It is only good fortune that we haven't seen another pandemic as severe as 1918 [39]. It is almost a certainty that there will be another influenza or other (of the some hundreds of new coronavirus species and the 10,000 potentially zoonotic mammalian viruses) [40] pandemic of one magnitude/ type or another [30, 37]. The world is more interconnected. Global travel, internal

#### *Evidence-Based Preparedness for Post COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.96931*

migration; and large-scale population displacement following natural disasters or conflicts has increased tremendously [41]; humans have seemingly 'tipped the scales in favor of pathogens' [5]. Ethiopian Airlines alone transported more than 10 million passengers in 2018, 21% more as compared to 2017 [42].

Bearing in mind that rarely has scientific provisions been as challenged as it is now even in the most developed countries, it is advisable to remember that medical scientists in general and tropical medicine specialists in particular ignore history at their peril [35, 39, 43]. So we should, as we struggle to control the current one, do so with preparation for the future in mind and hopefully break 'the cycle of panic then forget' since the first recorded pandemic [5, 44].

To date we have more tools at our disposal: better surveillance and diagnostic systems, stronger frameworks and regulations, such as the Global Health Security Agenda and Joint External Evaluations (JEE), and a deeper understanding of how diseases spread and what is needed to stop the spread of the virus [38, 41, 45]. So, what led to the near global chaos in the current pandemic was that, in spite of repeated warnings, the global community was ill prepared including the fact that lifesaving innovations are not reaching those who need them [29, 38, 41]. If the virus continues to spread throughout 2020, it will demonstrate in a very cruel way how well the public health systems of individual countries are functioning. These will be very important lessons in preparation for a future pandemic, which could be even more dangerous [46]. Already, attempts are being made to draw lessons from the various country experiences [47, 48]. Evidently, there is a political/economic dimension to pandemic preparedness. Epidemic preparedness is not beyond any country's capacity although take proactive action remains a matter of political choice [38]. Uncannily, the COVID-19 pandemic began a few weeks after the end of PREDICT-2, the last-standing United States Agency for International Development (USAID) Emerging Pandemic Threats funding program, which supported a decade of virology, ecology, and epidemiology around the world [40].

As all low-income countries (LIC), Ethiopia is predicted to be heavily impacted by the current pandemic [49]. However, the force and united action garnered to fight the virus to recover from the COVID-19 economic losses and address the plethora of challenges that are impeding progress and sustainable development [50].

A global 'governance crisis is unfolding' [18]. While adjustments to the Public Health Emergency of International Concern (PHEIC) declaration process might be warranted [51], the rule, as advised globally, should be to follow World Health Organization's advice, end secrecy in decision-making and cooperate globally [24, 29, 52].

This should be done while resisting undue biologicalization/biomedical tunnel vision" (Thorp HH, 2020) of the disease or seeing the goal of containing COVID-19 as a purely technocratic or law-and-order problem and developing context-specific, ethical approach to physical distancing [8, 22].

This rapid review was undertaken to articulate ways to support the current efforts to mitigate COVID-19 pandemic, leverage current efforts to strengthen the health system including monitoring and surveillance systems for early detection, management of future such pandemic and leverage current effort to strengthen research and evidence generation.
