Taken from pp. 314–318 of Preventable: How a Pandemic Changed the World & How to Stop the Next One by Devi Sridhar published on March 21, 2022 by Penguin Books. Copyright © 2022.This article is part of a series in which OECD experts and thought leaders—from around the world and all parts of society—address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.
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One of the most frequent questions I get is, will there be another pandemic? Of course there will. The world will face a virus similar to SARS-CoV- 2, and, while we cannot prevent these challenges emerging, we can change how we respond and learn from past mistakes. How much suffering can be prevented the next time around?
As countries now look towards rebuilding and healing, they must also think longer term about the mistakes made, the gaps exploited by the virus, and how best to prepare and respond the next time.
As we reflect on the past eighteen months, the words that come to mind are ‘never again’. Never again should millions of lives be lost to a new virus, a number that would have been unthinkable before COVID-19, when we thought infectious diseases that wiped out millions were consigned to history. Never again should children be taken out of school, unable to learn in classrooms or socialize with their peers, and sometimes even forced into marriages, employment and caring roles because of the need to earn for their family or the loss of caregivers to COVID-19. Never again should the unemployment rate soar, as small businesses close and larger ones make sweeping redundancies. Never again should over a hundred thousand health workers die, many of whom lacked adequate protective equipment, clothing and priority access to vaccines. Never again should we endure months and months of lockdowns, death and pain.
As countries now look towards rebuilding and healing, they must also think longer term about the mistakes made, the gaps exploited by the virus, and how best to prepare and respond the next time. We have already seen in this book that countries that learnt from their previous experiences in SARS, MERS and Ebola did better with COVID-19.
What will be the cause of the next pandemic? WHO has identified priority diseases such as Crimean-Congo haemorrhagic fever, Ebola, Marburg, Lassa fever, MERS, SARS, Nipah and Zika; some of these you may recognize, others you may not. Scientists can make educated guesses about disease types we are already familiar with, but there could be others that we don’t yet know about: ‘Disease X’. What particularly concerns me is MERS mutating into a form that is more transmissible and that then has pandemic potential.
Dr John-Arne Rottingen, a global health expert from Norway, said, ‘History tells us that it is likely the next big outbreak will be something we have not seen before’ and ‘It may seem strange to be adding an “X” but the point is to make sure we prepare and plan flexibly in terms of vaccines and diagnostic tests. We want to see “plug and play” platforms developed which will work for any, or a wide number, of diseases; systems that will allow users to create countermeasures at speed.’ What he means is tests, vaccines and systems of public health response that are built, and then can be deployed quickly once a specific pathogen is ‘plugged’ into that platform.
And pandemic influenza is always lurking as well. Early 2021 saw reports from Russia of the two first humans infected with avian influenza (H5N8) at a poultry plant, a stark warning for governments to prepare and to work together to build on COVID-19 structures and establish robust response systems. These include mass investment in testing, protocols for rapid research in hospitals, processes for fast-tracking public health research in communities and approval of vaccines, and, in some cases, strengthening local public health response structures such as testing sites, contact tracing and isolation facilities.
OECD leaders have the ability to end the worst of COVID-19—and a responsibility to reform the weak and outdated system meant to prevent the next pandemic by Helen Clark, Co-chair, Independent Panel for Pandemic Preparedness and Response
Throughout 2021 I have been Vice-Chair of the National Academies of Sciences, Engineering, and Medicine commission tasked with advising the US Department of Health and Human Services on how to prepare best for a future influenza pandemic, with a specific focus on vaccines. The first thing to clarify is the difference between seasonal and pandemic flu. Seasonal flu already causes roughly half a million deaths worldwide and largely affects young children under the age of five, pregnant women and elderly individuals. Annual flu epidemics occur worldwide every winter.
By contrast, pandemic flu is a global outbreak of a new influenza virus (likely from an animal) against which we have no previous immunity. Because it is a new virus with no immunity built up in the population, even healthy and young adults could be at risk of becoming seriously ill and dying. The 1918 flu pandemic, for example, infected one third of the world’s population and killed 50 to 100 million people worldwide out of a total population of 1.8 billion. The death rate for 15–34-year-olds was twenty times higher in 1918 than in previous years. Since then pandemic flu has been seen as unstoppable, with countries’ pandemic flu planning built around rapidly building enough hospitals to ensure no one dies from being unable to access care.
Five clear lessons have emerged from the COVID-19 pandemic on how best to prepare for the next one. First, the biggest public health risk that we face is an animal virus jumping to humans. Every time a virus circulates among animals, particularly bats, rodents, livestock and birds, and then comes into contact with humans, there’s a chance that one of those viruses will infect humans and lead to human- to-human transmission. If that virus spreads through breathing or droplets of moisture, it becomes extremely difficult to stop.
Ever increasing international travel and global trade have connected the world and created new opportunities for diseases to spread. This is why we need global cooperation and surveillance to identify disease risks. We must invest in a Global Virus Surveillance Network (almost like a weather service) to scan for new pathogens of concern, as well as identify spillover risks (when animals and humans come in contact) and mitigate them. Currently the process is more bottom-up, with either countries reporting to WHO that they have an outbreak, or scientists and doctors in a country reporting to a website called ProMed, the largest publicly available system for the global reporting of infectious disease outbreaks. We need more.
It would have been more productive to focus less on ‘Is it flu?’ and more on ‘What can be done to stop, or at least delay, spread?’
Second, governments must invest in the resources necessary to rapidly sequence new viruses. It is not only new pathogens that pose a problem of course, but, as we have seen with SARS-CoV-2, new variants can emerge as a result of uncontrolled spread, such as happened in England, Brazil, India and South Africa. Most countries do not have the capacity or facilities to sequence the genomes of virus samples to detect new strains or even new pathogens. The UK, US, Denmark and a select few others are outliers in being able to do the amount of sequencing they’ve done over the course of the COVID-19 pandemic.
Why is sequencing important? It is crucial in developing testing and vaccines within weeks and manufacturing and distributing enough doses within months. Three scientific tools through a pandemic are testing, therapeutics and vaccines. While the COVID-19 vaccine development has been remarkable, as described in Chapter 9, we need to be even faster next time to avoid the disease, death and restrictions COVID-19 has brought. One hundred days has been cited by scientists such as BioNTech CEO Uğur Şahin as a realistic target for getting some kind of scientific breakthrough, most likely a vaccine, ready for mass distribution. With COVID-19 it took just under a year, 365 days. But developing the vaccine was only half the battle, as we have learnt.
Third, countries should now be thinking about their manufacturing capacity regionally, so as not to rely on other parts of the world, as Africa has seen first hand, as well as coordinating worldwide to have these hubs ready to mass produce. Getting enough supply to the world is not only about IP waivers, or tech transfer, or donations, or building more factories. It is about all of that, together. And African countries are tired of relying on the goodwill of rich countries to donate doses. Rich countries will never give valuable doses overseas if their citizens are waiting. Not even a pandemic treaty can overcome issues of sovereignty and state self-interest.
Instead the challenge is to create regional hubs with enough supply, so that it is about mass market production everywhere, and not just charitable donations of leftovers from the West. Countries will need financial and technical support to do this, which points to the key role of the World Bank in providing funding for infrastructure.
Fourth, given that we know that a pandemic influenza is on the horizon, we should already be focusing on a universal influenza vaccine (as the next big push after COVID-19 efforts). Our current flu vaccines are given annually, with experts predicting which strain will become the most common. In some years these guesses are off, resulting in a vaccine that isn’t effective for the circulating strain. To boost effectiveness against all strains, our ambition should be for a one-dose universal vaccine that provides immunity over several years and against various influenza strains. The first human clinical trial of a universal flu vaccine has been completed using a new technology that mixes different pieces of flu strains; it was successful. We must accelerate this progress now.
Finally, governments need to carefully examine their ‘flu pandemic’ playbook on how we respond to any incoming acute respiratory pathogens based on what we’ve learnt from the COVID-19 experience. Much of the early COVID-19 debate fixated on whether it was like flu, or like SARS, or something entirely different. It would have been more productive to focus less on ‘Is it flu?’ and more on ‘What can be done to stop, or at least delay, spread?’
In the process of managing COVID- 19, countries unintentionally eliminated seasonal flu and other respiratory infections. For countries the question is: should governments ever move into the mitigation phase (where they accept spread) before a vaccine is rolled out, rather than containment? How many could have survived COVID-19 had we found a way to buy time and delay infections until a life-saving vaccine could have been given to them? Can we plan for pan-coronavirus and pan-influenza vaccines so that we have the scientific solutions in place? And then can we focus on rapid manufacturing and distribution? How can we build on our seasonal flu infrastructure and move towards a global pandemic flu response infrastructure?