Are We Ready for the Next Pandemic?

Are We Ready for the Next Pandemic?

Taking precautions: Instructions displayed for customers at a shop in Pune | Wikimedia

Just before the Christmas break of 2032, there was a surge in the number of people dying after getting sick with severe cough, cold, and respiratory stress. Rapid genome sequencing from several isolates confirmed that a new type of influenza virus was in the air, mutating at an alarming rate. Experts, unsure of the origin of the virus, could not foresee a vaccine or an antidote.

Health officials sounded the alarm, but the general populace was in no mood to heed the warnings. Influenza was, after all, an annual occurrence, killing millions of people every year, But this virus was different: its infectivity appeared to be 10 times higher than the normal flu variants. With the impending holiday travel and large family gatherings, experts feared the new flu would rapidly cause a pandemic worse than the Covid-19 pandemic from the previous decade.

How could this happen again? Why were we not prepared?

This is not just science fiction— it could very well be fact unless we are prepared to tackle the next pandemic. The World Health Organization (WHO), the World Bank, and Johns Hopkins Bloomberg School of Public Health, forecast that the next pandemic could occur within a decade or two and possibly be caused by a new type of influenza virus. If this virus is zoonotic, then it could potentially become even worse.

Scientists and public health officials have continuously warned that pandemic outbreaks will be more frequent and probably more dangerous in the coming years. Even the source and types of these pandemics are being predicted with fair accuracy. But these warnings have fallen on deaf ears. Political landscapes in influential countries, and not real-time scientific information, are shaping public perception and hence public health responses.

Most governments, with a few exceptions, do not allocate enough resources to combat existing and emerging pathogens, including antibiotic-resistant microbes. With an ever-increasing urban population density, contributed by permanent residents and migratory daily workers, any emerging infectious agent finds a haven in cities. Combined with enhanced ease of travel amongst rapid globalisation, it is a recipe for a looming pandemic like the one we are experiencing with Covid-19.

[I]t is no longer a debate whether there will be another pandemic. The only question is when it will hit us.

If the infectious agent is a virus with high infectivity, the more it infects and replicates within human hosts, the more it mutates. Although many, if not most, mutations are ineffective, once the mutations reach the infectious domain of the virus, the variants could morph to become more infectious (like the SARS-CoV-2 Delta variant) or evade the host immune system and any immunisation altogether.

Given that trends in urbanisation are not likely to change anytime soon, what are the steps necessary to combat the next pandemic? We could be forgiven for being weary and reluctant to talk about the next pandemic — after all, the current pandemic is still far from being over. But unfortunately, it is no longer a debate whether there will be another pandemic. The only question is when it will hit us.

One of the central pillars of public health is uniformly channelled information, guidance, and public education. This is essential not only for accurately informing the public about the emerging health dangers, but also to combat misinformation, fake “news”, and propaganda.

Having robust and well-orchestrated public health communication and corresponding education for the masses are critical. These must be in place and from time to time tested for preparedness. Proper communication will enhance public trust and ensure timely delivery of accurate information and follow-up steps necessary to prevent the spread of infection. In this age of the internet and with widely available cell phone connectivity, there could be no excuses for not having such a system in place.

The second pillar of robust public health is having a widely available and affordable health care system. Healthcare must be for all, not just for a privileged few. Man-made conflicts worldwide and increasingly unpredictable, dangerous weather patterns from climate change are leading to shifting populations and increasing income inequality. Together, they contribute to uneven and often unavailable health care for many.

In addition to having an affordable national healthcare system, one major solution is to have heavily subsidised regional (rural and suburban) hospitals with modernised health care and computerised health records, where treatment would be free or for nominal fees. In addition, local clinics and mobile clinics with appropriate primary care triage systems, along with computerised health records would ensure that proper steps could be taken to treat patients at the local level or if necessary, send them to the regional hospitals. Mobile clinics in rural areas could be particularly effective both in assessing medical needs and tracking the disease and infection path. Not having affordable health care for all to prevent pandemics could have ramifications far beyond just the public health realm — it could well become a national security threat.

A third major pillar of an effective public health system is a process to accurately trace and track the source of existing and emerging pathogenic agents. The WHO in recent times has become less effective in this regard, partly due to the extreme politicisation of health issues by large and powerful nations The WHO needs to be independent but strongly supported by all nations. This would allow for an international team of scientists, epidemiologists, biostatisticians, and public health experts under the aegis of WHO to monitor, track, and trace existing and emerging pathogens anywhere in the world. The field data so collected could be used to computationally build disease path models and predictive algorithms and shared with all participating nations in real-time. People travelling to and from regions of concern could be alerted and tracked accordingly.

All of this will require strategic coordination and cooperation amongst all nations, for information to flow from international institutions to federal to state to local governments and ultimately to local health departments. Necessary steps should then be taken to alert the communities for precautionary and preventive measures. Many of these protocols and standard operating procedures exist already but may need to be revisited or revised and modernised. In reality, though, it would require enormous political will to implement them.

The fourth pillar of good public health is rigorous scientific research. A coordinated research effort to genetically analyse emerging pathogens and subsequently to develop vaccines or preventive medicines continually is essential to tackle future pandemics.

In addition, developing alternatives to existing antibiotics, which might be ineffective against emerging drug-resistant microbes, should also be carried out in full force. There should be an international forum of scientists tasked with these and the corresponding funding coming from most major nations.

We have the technical know-how and expertise to carry on this research. The vaccines against SARS-CoV-2 were possible to be marketed in record time simply because of already ongoing research in developing next-generation vaccines.

A virus does not care about geographic boundaries or nationality, it is simply looking for a live human host.

But along with developing vaccines and next-generation preventive medicines, we should also have a system in place to manufacture these at an industrial scale when required. A national stockpile of vaccines, medicines, oxygen cylinders, and personal protective equipment (PPE) should also be in place for all countries.

All of this requires international collaboration. As we have learnt, a pandemic is not a regional problem: it quickly becomes an international crisis. A virus does not care about geographic boundaries or nationality, it is simply looking for a live human host. We must realise that we are all in this together, or we will all suffer and many will perish.

Although many of these recommendations are generally applicable in most situations, they could be modified to fit the specific needs of a given country. But what is more important to consider is that these proposed measures will come with a hefty price tag. Are we willing to invest in such measures, which might ultimately require public-private partnerships?

Pandemic preparedness is expensive and therefore from a political perspective, might not be the most convenient sell to the public. This is further complicated by misinformation, propaganda and fake news continuously circulating in the social media echo chamber. Given the price tag as well as the national political landscape, many countries either cannot afford the cost and simply ignore such measures.

But we saw the alternative scenario being played out during the Covid-19 pandemic: great loss of life and livelihood, a massive economic burden, and an upending of any sense of normalcy. Life came to a standstill and the regular world stopped functioning. We still do not know the complete fallout and the extent of the loss.

Are we willing to go through this once again or worse, every 10–20 years, and accept this as a new ‘normal’?

We are standing at the crossroads. But if we care about ourselves, our loved ones, and especially about the future generations, the path is clear for us. Future pandemic preparedness will depend on our collective will and response.

Ananda L. Roy is a biomedical scientist based in Bethesda, United States of America.

Ananda L. Roy
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