On a 30-minute call between Geneva and Ulaanbaatar, Dr. Socorro Escalante, the WHO Representative in Mongolia (https://www.who.int/mongolia/about-us/head-of-who-office ) discussed ongoing Pandemic Fund initiatives with Tushita Basu, from WHO Health Emergencies. The interview conducted on 23rd August 2024 centered on the breadth of projects undertaken in Mongolia as part of the ongoing Pandemic Fund projects. As one of the first countries to receive funding from the Pandemic Fund during its first round, Mongolia is making significant strides in pandemic prevention, preparedness, and response (PPR). In this interview, Dr. Escalante provides insights into the progress achieved thus far and the future vision for strengthening Mongolia's capacity to tackle health emergencies.
The Pandemic Fund project in Mongolia is supported by WHO, under the leadership of the Government and in partnership with UNICEF.
- Could you please tell us about the Pandemic Fund project in Mongolia?
The Pandemic Fund project in Mongolia is founded on the continuum of prevention, preparedness, and response. It aims to build strong systems for public health and health emergencies through the One Health approach, because threats of pandemics exists in the inter-connected world of humans, animals and the environment.
Mongolia is a landlocked country with a vast land area. Geographically, the population is dispersed, especially in the provinces, which creates a unique situation in terms of overall service delivery, particularly during public health emergencies. As reaching populations in the countryside is challenging, we aim to make the public health system resilient on the ground. Additionally, there are at least 30 zoonotic diseases monitored in Mongolia. The risk of zoonosis and reemerging infections is significant due to the large animal livestock population—around 70 million—compared to 3.5 million people. Many Mongolians are nomadic and live in close interaction with nature. Therefore, the One Health approach, along the prevention, preparedness and response continuum is a compelling strategy for the Pandemic Fund in Mongolia. - For the next three years, what improvements would you like to see in the pandemic prevention, preparedness, and response national capacities in Mongolia?
The Joint External Evaluations (JEEs) in 2017 and 2023 helped us analyze Mongolia’s capacity for health security including surveillance, laboratory capacity, human resources, biosafety, and biosecurity. In the next 3 years we will focus on the following:
Surveillance: We have recognized challenges, including a less optimal coordination of the human and animal surveillance systems. Mongolia has strong centers for zoonotic diseases in addition to the national center for communicable diseases. In order to move toward a more coordinated and integrated system we are now focusing to build collaborative surveillance, investing in a stronger network, and enhancing surveillance and laboratory capacities at the sub-national level. Our goal is for the surveillance system to be sustainable, functioning consistently, even without an active event.
Strengthening laboratory capacity for public health: The Ministry of Health is in the process of developing a stronger laboratory network to ensure rapid and effective detection of diseases and emerging infections at an early stage, ensuring that the network will be closely connected to the surveillance system. Of key importance is designing a national system with a centrally strong governance mechanism and a strong network at the national level. Laboratory capacity is key not only for public health emergencies, but also for other infectious diseases, including for those which are of heavy burden to Mongolia, such as TB, hepatitis and vaccines-preventable diseases. Laboratory capacity will contribute over-all to public health security.
The third focus is on building human resources for public health and emergencies and broadly for the entire health system. We begin by assessing Mongolia’s actual needs and their future vision, informed by various country strategies. The government is looking at building human resources within the health and other sectors which can scale up a nation-wide response and fill-up surge capacity when needed while ensuring equitable access to service delivery accessible for the entire population. - What are the 3-5 ingredients to ensure a successful Pandemic Fund project in Mongolia?
The most important factor is learning, especially from how the country responded during the last pandemic. Learning entails a deep understanding on how the system can respond and be resilient to the scale and spread of infectious diseases. Our experience in the COVID-19 has shown that engaging the entire system, including those outside the health sector is essential. The second key element is accountability for improvement. I would like to use the term accountability in the context of a collective commitment to bring the system from where it was pre-pandemic to a stronger, more responsive, and resilient system for the future. Accountability should rest not only with the government but also with public health professionals and even the whole society, ensuring that lessons from the previous pandemic are applied as foundation for continuous improvement of the country’s capacity for health security.
The third is capacity building. During COVID-19, we learned that we need more than just epidemiologists - laboratory specialists, scientists, doctors. The workforces in health and those in other sectors are all crucial. With investment from the Pandemic Fund, we hope to enhance scientific, technical, and research capacities. Fourth is stakeholder collaboration. The government of Mongolia has passed the Law on Public Health in 2023 which provides the legal environment for multi-sector engagement and institutional arrangements. With support of the Pandemic Fund, we will aim to operationalize multi-stakeholder collaboration effectively.
- What role do increasing investments play in strengthening national capacities for pandemic prevention, preparedness, and response (PPR)?
The first role of investments is to drive a change for the future, bringing us to a stage where we are better prepared than now. Investment should not just be about infrastructure, training, buying equipment, and setting up laboratories – the bigger role for investments is about the change it will make to to bring our systems better than now and make them more resilient for the future. Investments should also aid the in the achievement of broader public health goals, in addition to raising the country’s capacity for health security.
The second role is to drive systems operationalization consistently, in addition to supporting transformation through the adoption of new technologies and scientific advancements. Mongolia has a robust collaboration with the scientific and research community at the regional and global level. It will be important to sustain this, and we would like to see Mongolia playing a more active role in contributing to scientific and technological advancements that will shape systems for emergencies in the future.
- What are some lessons learned from past outbreaks that Mongolia that could be applied to the implementation of the Pandemic Fund project in Mongolia (particularly looking at the areas of surveillance, laboratories and health workforce)
The biggest lesson of the past outbreak is that it takes a whole nation and the solidarity of the whole world to prevent the serious impact of any health emergency. We need strong institutions as well as a system that make these institutions work. Institutions in Mongolia have strong capacity, but they still meet challenges in responding to large-scale outbreaks – institutions alone cannot respond, that is why it's very important to develop the system at a national scale.
The interconnectedness at the regional and global level is necessary, not only for information exchange, but also in the co-creation of knowledge, scientific evidence and novel tools to respond to emergencies. I am very hopeful that the Pandemic Fund will provide the much-needed resource and support in advancing the strong efforts and the vision of the government to strengthening and scaling up of the health emergencies capacity for the whole country as well as its readiness to support a regional and global collaboration for health security. - Is there anything you want to share before we conclude the conversation?
We're currently experiencing a measles outbreak in Mongolia. While it's not large-scale, the government has put in place all the elements of the response in a very timely manner.
The risk of a large-scale transmission is there but this situation proves that the priorities the government planned and carefully considered, to be included in Pandemic Fund proposal are indeed the right ones.
Since COVID-19, there has been a significant shift in perspective among governments and societies, recognizing that any public health emergency can cause massive social and economic disruption and deepen inequities. This has brought about a new and deeper understanding of the impact of public health emergencies to the health of populations. This impetus makes the timing of the Pandemic Fund investment crucial. We are very pleased that Mongolia was able to secure funding in the first round.
There are tough questions that remain, such as could the country sustain investments from the Pandemic Fund. The government continues to design policies, strategize, and build a strong foundation for domestic investment in the long term. The Pandemic Fund could support the country to set all these ambitions on a solid path.
The Pandemic Fund is contributing to a meaningful and safer future—not only for Mongolia but for many countries around the world.