FSince the first coronavirus lockdown, our lives have largely returned to normal, although the effects of the pandemic remain. A collective amnesia appears to have begun. Politicians seem eager to move forward and not repeat the mistakes, delays and deaths of public policy and press conferences. However, we cannot forget such a cruel event. It is estimated that the new coronavirus has killed nearly 16 million people around the world in 2020 and 2021, and caused a decrease in life expectancy in 84% of countries, including the UK. A pandemic is not a one-time event. There is still a possibility that another scenario could happen in our lifetime.
Fortunately, how to deal with the next pandemic remains at the top of the global health agenda. In 2021, I was invited to serve as co-chair of the National Academy of Sciences Committee on Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response. The group is sponsored by the U.S. 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 am also involved in The Lancet Covid-19 Working Group, which brings together global experts to look at how to improve the Covid response and what challenges lie ahead. These groups represent some of the world’s best thinkers on global health and pandemic preparedness. This is what I learned.
First, most governments are grappling with the 100-day challenge: how to authorize, produce and make scientific responses such as vaccines, diagnostics or treatments available to the public while containing the spread of the virus. In the United States, the recommended timeframe is 130 days from detection of the pathogen to vaccine delivery to all Americans, and 200 days to enough vaccine for the world. The strategy learned from Covid-19 is to develop a plan to maximize the suppression of a new disease until a tool is found to make it less lethal and provide faster, more widespread treatment. I often wonder how many people would survive if the government found a way to buy time and delay infection in the population until mass vaccination.
But such a plan is easier said than done. The first requirement is to invest in and create a “plug-and-play platform,” meaning that new medical products can be created once a pathogen’s genetic sequence has been determined. Think of it like a video game console that’s ready to go, just waiting for a new cartridge (specific information about the pathogen) to be inserted. Flu already works this way, and existing vaccine platforms are ready to adapt to respond to new strains of the virus relatively quickly. To achieve this faster, we need appropriate surveillance around the world to detect whether new viruses are spreading and genetically sequence them. In 2014, Ebola circulated in Guinea for several months before it was known that it was Ebola and not some other virus.
Second, we need to figure out how to maintain the rigor of clinical trials to test safety, efficacy and optimal dosing while approving treatments quickly enough that could impact the trajectory of the pandemic. Moving too quickly can undermine trust in medical products, which is why government agencies have rigorous approval processes that require Phase 1, 2 and 3 trials to ensure safety, determine side effects and the impact of interventions on the immune response, ensuring Hundreds of people were included, with a range of characteristics including age, gender, physical health and ethnic background. These trials often take months or even years.
Even if everything goes according to scientific plan, trying to delay the spread of a virus (especially a respiratory virus) from person to person for 100 days is not an easy task. Shutdowns are an extreme policy response and the tactic used by many governments in 2020 when faced with the collapse of health care.We now have time to develop better containment methods and look at how to safely keep schools safe Businesses open with more precise public health interventions, including dissemination of knowledge (e.g. enhanced ventilation), diagnostics (infectiousness testing) and better data (community prevalence surveillance).
These are the challenges experts face as we try to plan for future pandemics. However, progress is stalling. The mood at the meetings I attended was one of frustration that political priorities have shifted away from public health. In the United States, President Joe Biden has been active in global health security, and his Secretary of State Antony Blinken has invited several experts, including me, to brief him directly on the post-Covid-19 response. However, Biden now faces re-election and a fight against Donald Trump, who has shown no interest in the issue during his presidency. In the UK, when the NHS collapsed, it was difficult to prove a potential pathogen that could affect the country.
This reminds me of a conference we held at the University of Edinburgh in 2019 on how best to persuade low- and middle-income countries to take pandemic preparedness seriously. The response from these countries’ ministers was that they were more concerned with providing basic health care to their people than with the prospect of facing an existential threat. Sadly, the UK is falling into this camp: when people today face delays in life-saving cancer treatments, long waits for ambulances and the inability to get appointments with their GPs, it is difficult to make a convincing argument for investing in protection against future risks. But pretending we won’t face another pandemic threat in our lifetime is naive at best. Surely there must be a way to do both.
