FYears after the first Covid lockdown, life feels largely back to normal, although the legacy of the pandemic remains. Collective amnesia seems to have set in. Politicians seem eager to move forward and not relive the decisions, delays and deaths that have characterized public policy and press briefings. Yet we cannot forget such a cruel event, when Covid was estimated to have killed almost 16 million people worldwide in 2020 and 2021, and caused life expectancy to decline in 84% of countries, including Britain. Pandemics are not a one-time event. There is still a risk that another will happen in our lifetime.
Fortunately, what to do about the next pandemic is still very much at the top of the global health agenda. In 2021, I was asked to co-chair the US National Academy of Sciences’ committee on promoting pandemic and seasonal influenza vaccine preparedness and response. This group was sponsored by the US government to provide recommendations on how to improve preparedness for influenza, which is seen as one of the most likely candidates for the next pandemic. I was also involved in the Lancet Covid-19 task force, which brought together global experts to look at how to improve the Covid response, and what challenges lay ahead. These groups represent some of the world’s best thinkers on global health and pandemic preparedness. Here’s what I learned.
First, most governments are working toward the 100-day challenge: that is, how to contain a virus that is spreading while a scientific response, such as a vaccine, diagnosis, or treatment, can be approved, produced, and delivered to the public . In the USA, the proposed time frame is 130 days from the detection of a pathogen until the entire US population is offered a vaccine, and 200 days until there is enough stock for the entire world. The strategic lesson here from Covid-19 is to plan for maximum suppression of a new disease until there is a tool to make it less lethal, and also faster and wider delivery of treatments. I often wonder how many could have survived if governments had found a way to buy time and delay infections in their populations until mass vaccination.
But this kind of plan is easier said than done. The first requirement is to invest in and create “plug-and-play platforms”, which means that new medical products are quite ready to be created once the genetic sequence of a pathogen is identified. Think of this like a video game console that is ready to use, just waiting for the new cartridge (the details of the pathogen) to be inserted. Influenza already works this way, with existing vaccine platforms ready to be adapted to address a new strain relatively quickly. To speed this up, we need appropriate surveillance in all parts of the world to determine if a new virus is spreading, and to sequence it genetically. Ebola has spread in Guinea for several months in 2014 before anyone knew it was the Ebola virus and not something else.
Second, we need to work out how to maintain the rigor of clinical trials, which test for safety, efficacy and optimal dosage, while moving quickly enough to approve treatments that can affect the trajectory of a pandemic. Going too fast can undermine confidence in a medical product, which is why there is a strict approval process by government agencies, requiring phase 1, 2 and 3 trials to ensure safety, identify side effects and the impact of the intervention on immune response, ensuring that hundreds of people were included, with a range of characteristics such as age, gender, physical health and racial background. These trials usually take months, if not years.
Even if all goes according to plan on the scientific side, trying to slow down a virus – especially one that’s respiratory – from spreading from person to person for 100 days is no easy task. Shutdowns are an extreme policy response and a lever that many governments used in 2020 when faced with the collapse of health care. We now have time to develop better ways of containment and explore how to keep schools safe and businesses open using more precise public health interventions, including knowledge of transmission (such as more ventilation), diagnostics (testing for contagiousness), and better data (surveillance of community prevalence).
These are the challenges experts face as we try to plan for a future pandemic. However, progress is faltering. In the meetings I have attended, the sentiment is one of frustration as political priorities have shifted away from public health. In the US, President Joe Biden has been actively involved in global health security, and his Secretary of State, Antony Blinken, has invited various experts – including myself – to brief him directly on post-Covid-19 response. However, Biden now faces re-election and a battle against Donald Trump, who has shown no interest in this issue during his presidency. Here in the UK it feels hard to make the case for a potential pathogen affecting the country when the NHS is falling apart.
This reminds me of a meeting we held at the University of Edinburgh in 2019 on how best to convince low- and middle-income countries to take pandemic preparedness seriously. The response of ministers in these countries was that they were more concerned with getting basic health care to their population rather than facing the prospect of existential threats. Unfortunately, the UK falls into this camp: it is difficult to make a convincing case for investment to protect against risks in the future when people today face delays in life-saving cancer treatment, long waits for ambulances and inaccessible GP appointments. But to pretend that we won’t face another pandemic threat in our lifetime is naive at best. Surely there must be a way to do both.
