“It’s not about health, it’s about society”: A Qualitative Analysis of Multilateral Leaders’ Perceptions of Opportunities and Challenges to Multisectoral Collaboration for Pandemic Prevention, Preparedness, Response, and Recovery

Abstract

Background: The COVID-19 pandemic affected all sectors of society. It demonstrated not only its multisectoral consequences but also the importance of and challenges to meaningfully incorporating sectors and stakeholders beyond human health, such as education, agriculture, animal heath, and the environment, into pandemic preparedness, prevention, response, and recovery (3P2R). While it revealed systemic issues in 3P2R, it also presents an opportunity to reflect and reimagine a more multisectoral and collaborative global health security future. Methods: This qualitative study used key informant interviews with leaders of multilateral institutions to elicit their perspectives and experiences related to lessons learned from the pandemic and prior pandemics, the roles and responsibilities of different sectors for 3P2R, and opportunities for and challenges to multisectoral strategies for 3P2R. A total of 16 interviews were conducted with leaders representing the human health, animal health, agriculture, education, and environment sectors. Results: The interviews revealed key insights related to: 1) lessons learned for 3P2R; 2) multisectoral roles and relationships; and 3) challenges, opportunities, and recommendations for multisectoral mechanisms. The interviews reveal the importance of prior experience, pre-existing relationships between sectors, leadership, pre-existing capacity of all sectors, and communication and trust for 3P2R. The interviews also reveal a disconnect between sectors in their understanding and perception of other sectoral counterparts, further contributing to difficulties establishing relationships across sectors. While participants had few concrete recommendations for a multisectoral mechanism, they pointed to the importance of creating a platform which would be politically empowered, integrated within existing systems, and adaptable to different types of health emergencies. Conclusion: This study provides an intimate portrait of multilateral leaders’ belief in the importance of growing from the successes and challenges revealed by the pandemic and their simultaneous fear that the world is intent on forgetting. These interviews reveal widespread agreement as to the importance of multisectoral collaboration but a dominating and persistent lack of clarity as to how to operationalize it within bureaucratic systems that do not reward nor encourage multisectoral relationships. Moving forward, we need to better understand what operationalizing multisectoral collaboration means if we are to make it a reality.