A global food systems framework for pandemic prevention, response, and recovery

COVID-19 has highlighted the dynamic relationship between pandemic threats and global food systems. Despite important connections, research and policy-making on food systems and pandemics largely operate in silos. We propose a framework that integrates food systems and pandemic planning and response, exploring the role of the food system in shaping pandemics and, consequently, the role of JAFSCD Responds to the COVID-19 Pandemic a * Corresponding author: Anastasia S. Lambrou, PhD, Department of International Health, Johns Hopkins Bloomberg School of Public Health; 615 North Wolfe Street; Baltimore, MD 21205 USA; anastasia.lambrou@jhu.edu b Isha Berry, PhD Candidate, Dalla Lana School of Public Health, University of Toronto; 155 College Street; Toronto, ON, M5T 3M7, Canada. c Amelie A. Hecht, PhD Candidate (now PhD), Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health; 624 North Broadway; Baltimore MD 21205 USA. d Alain B. Labrique, Professor, Department of International Health, Johns Hopkins Bloomberg School of Public Health; 615 North Wolfe Street; Baltimore, MD 21205 USA. Funding Disclosures Training support for ASL and AAH was provided by the Johns Hopkins Center for a Livable Future-Lerner Fellowship. IB is funded through a Vanier Canada Graduate Scholarship. Acknowledgments The authors thank Roni Neff, Erin Biehl and Michael Milli of the Johns Hopkins Center for a Livable Future for their feedback on the manuscript and help with graphic design of the framework. Journal of Agriculture, Food Systems, and Community Development ISSN: 2152-0801 online https://foodsystemsjournal.org 304 Volume 10, Issue 2 / Winter 2020–2021 pandemics in disrupting a now global food system. This framework highlights important connections between food production, distribution, and consumption at each stage of the pandemic cycle: prevention, response, and recovery. We use recent experiences with COVID-19 to illustrate vulnerabilities in systems interaction during the prevention and response phases. Over the long term, in the recovery phase, food systems must transform, adopting an enhanced level of functioning to improve resilience. To reduce population health risks and promote sustainable food systems, we call for implementation of surveillance systems for both emerging infections and food systems functioning in order to strengthen global food supply chains, create stakeholder resource coordination mechanisms, and address underlying socioeconomic vulnerabilities. Multidisciplinary global actors should draw on lessons from the COVID19 pandemic to prevent the inevitable next one.


Introduction
COVID-19 has highlighted the dynamic relationship between pandemic threats and global food systems. The emergence of SARS-CoV-2 is not only linked to food markets, but its widespread and facile transmission has also disrupted global food supply and demand (Ivanov, 2020). Despite important connections, research and policy-making on food systems and pandemics largely operate in silos (Chaudhary, Gustafson, & Mathys, 2018). We propose a framework that integrates food systems and pandemic planning and response, exploring the role of the food system in shaping pandemics and, consequently, the role of pandemics in disrupting a now global food system (Figure 1). This framework highlights several important connections between food production, distribution, and consumption at each stage of the pandemic cycle: prevention, response, and recovery. We use recent experiences with COVID-19 to illustrate vulnerabilities in systems interaction during the prevention and response phases. We provide recommendations for the recovery phase, calling on actors at the center of this framework-including national and international government organizations, private industry, and researchers-to integrate these systems to reduce population health risks and ensure sustainable food systems.

Prevention
Food production operations impact the emergence of pathogens with pandemic potential. Current food production intensification practices, which prioritize volume and cost over quality and safety, promote increased human-animal and inter-species interactions (Benatar, 2007). Furthermore, changes in consumer demand and diets globally have led to increased deforestation and encroachment on animal habitats (Thornton & Herrero, 2010). These practices create opportunities for zoonotic pathogens to recombine and spillover into human populations (Wolfe, Daszak, Kilpatrick, & Burke, 2005).
A community's ability to prepare for and withstand pandemic threats is also a function of its food system, particularly its distribution operations. Food supply chains have increasingly moved towards consolidation, just-in-time delivery, and reduced redundancy in order to decrease costs and optimize efficiency (Food and Agriculture Organization of the United Nations [FAO], 2020a). This evolution has created choke points in the supply chain that make it ill-suited to respond to unexpected shocks.
On the consumption side, growing socioeconomic inequities, demonstrated by extreme poverty and under and overnutrition, put many populations at greater risk of food insecurity. Nearly two billion people, or 26% of the world's population, currently experience moderate or severe food insecurity (FAO, 2019). The bidirectional relationship between food insecurity and other infectious diseases has been wellestablished: food insecurity, exacerbated by pandemics, may also serve to propagate pandemics (Weiser et al., 2011). Populations experiencing food insecurity do not have the resources to stockpile food and water in preparation for, or in response to, an emergency. Further, chronic diseases associated with food insecurity, such as obesity, may place food insecure populations at greater risk of pandemic-related morbidity and mortality (Kass, Duggal, & Cingolani, 2020).

Response
Government and community responses to reduce disease transmission, which have included forced closures of nonessential businesses, travel and stay-at-home restrictions, and worker safety regulations at essential businesses, have had downstream implications for the health and livelihoods of those employed along the value chain.
Food producers, including farms and processing plants, have been closed or strained due to illness among their essential workers, who by nature of their work, are at high risk of infection. For example, meat processing plant workers have experienced particularly high rates of infection due to lack of workplace distancing policies, insufficient personal protective equipment, and inadequate disinfection of high- Figure 1. A global food systems framework for pandemic prevention, response, and recovery highlighting connections between food production, distribution, and consumption at each stage of the pandemic cycle.
Vulnerabilities in the prevention and response phases inform recommendations for actors at the center of the framework. touch surfaces (Dyal et al., 2020). Additionally, in many countries, global migrant farm workers who have experienced job loss and are unprotected by occupational and migration policies, have been forced to repatriate, making unsafe journeys that put them at high risk of disease exposure (FAO, 2020b).
On the distribution side, crop destruction and excess milk disposal have been reported in some countries due to an overdependence on complex intermediate systems between the farm and table (Yaffe-Bellany & Corkery, 2020). Panic buying and consumer stockpiling has further strained some supply chains (Sim, Chua, Vieta, & Fernandez, 2020). Essential workers employed in food distribution, including restaurants, retail outlets, and food delivery services, have also been at increased risk of infection.
The pandemic has had severe consequences for food access and affordability. Forced closures of non-essential business has led to widespread unemployment, leaving many consumers with reduced incomes to purchase groceries and prepared foods. Many critical feeding sites such as schools, senior centers, and emergency food providers have been closed to limit community transmission (Van Lancker & Parolin, 2020). Estimates suggest that prevalence of global chronic hunger could double due to COVID-19 (Food Security Information Network, 2020).

Recovery and Recommendations
Restarting economic and social activity inevitably introduces new risks to food systems workers and consumers. As pandemic response restrictions ease, actors must both address short-term risks and pursue long-term food systems transformation-promoting an enhanced level of systems functioning by reducing vulnerabilities and improving resilience. We identify four key recommendations for priority action to integrate global food systems and pandemic planning and response efforts. These recommendations include both long-term goals and short-term action steps to achieve these goals. These recommendations should be tailored to socio-political contexts. We note that these recommendations are not comprehensive, but rather serve as examples for how actors can engage in systems integration.

Implement and strengthen surveillance systems for both emerging infectious diseases and
food systems functioning: Production and distribution factors that play a role in pandemic emergence, such as intensified animal production and wet markets, should be addressed in ways that decrease risk and ensure sustainability. In the short term, enhancing surveillance systems for early detection of pathogens will be critical. Stakeholders should identify high-risk human-animal interfaces and implement evidence-based pandemic prevention strategies combined with early warning surveillance. In the longer term, real-time monitoring and evaluation platforms for food system functioning and value chains should be implemented. Drawing on lessons from infectious disease surveillance systems, metrics for evaluating food system function should include assessments of flexibility, representativeness, stability, simplicity, and acceptability. These tools should further draw on existing resources developed by the United Nations (UN), such as the Food Security Information System (FSIN), Vulnerability Analysis and Monitoring Unit (VAM), and Agricultural Market Information System (AMIS), which support rapid assessment and monitoring of food value chain functioning at all levels of the global economy (UN, 2020).

Strengthen global food supply chains:
In the short term, innovations are needed that facilitate direct-to-consumer delivery by leveraging evolving mobile and transport technologies. Over the longer term, global public-private partnerships must diversify and create redundancy within supply chains, while minimizing waste. Improving traceability of resources and products along the supply chain can strategically inform restructuring systems. Regionally, supply chains can be strengthened by