Five things that need to be done before the next pandemic

Robert Langreth, with contributions from James Paton and Riley Griffin, considers how five steps could help us handle the potential arrival of another pandemic. The original English text was published by Bloomberg Businessweek. The summary is meant to prepare us for the fact that further pandemics will undoubtedly come, but that they need not be as dramatic if we plan our steps in advance.

In January 2017, a document describing a strategy for stopping future pandemics appeared in the offices of the Biomedical Advanced Research and Development Authority in Washington. It outlined a range of vaccination approaches and recommended assembling a team of 180 scientists, physicians and other experts. Estimated cost: 595 million dollars over 10 years. By the end of 2019 every infectious disease expert knew that sooner or later something like the new coronavirus would arrive, just as it is known today that Covid-19 will not be the last pandemic. Shortly before his inauguration, President Biden proposed spending 20 billion dollars to speed up the rollout of vaccination. That is a start. But a plan that can protect the United States from mass death, catastrophic economic damage and incompetent political leaders will have to be more comprehensive. It will probably involve at least five separate areas of research and investment. Above all, it will require careful preparation.

1. Pathogen surveillance

The world cannot eliminate emerging diseases. Too many people live close to animals and there are too many international flights. In the 21st century alone humanity has faced the SARS outbreak in 2003, H1N1 in 2009, MERS in 2012, Ebola in 2014 and now Covid. Looking ahead we can expect highly virulent filoviruses, which include the Ebola and Marburg viruses; fast-spreading mosquito-borne flaviviruses such as those causing Zika and dengue fever; and bat-borne paramyxoviruses such as Nipah and Hendra. It is estimated that there are around 1.7 million unknown mammalian viruses in the world, many of which could also jump to humans. Identifying two thirds of these pathogens would cost a little over 1 billion dollars. That would give scientists clues about which viruses pose the greatest risk to humans, allowing communities in potential hotspots to focus on reducing that risk and helping governments and research institutions allocate resources for further study. In fact, many experts predicted a pandemic for years, but could not persuade anyone to do anything about it.

2. Expanding the WHO

Pandemic surveillance has to be a worldwide effort. Which means it is time to consider a new global partnership to oversee it. The structural shortcomings of the World Health Organization have been well documented. The United States and other countries are criticised for being too deferential towards China and for being slow to declare an outbreak a global emergency. Early last year China was slow to admit the seriousness of the problem in Wuhan and did not immediately allow international health experts into the city to assess the threat. In the United States, President Trump met the looming crisis by assuring Americans that Covid would simply go away. Thomas Bollyky, who runs the global health programme at the Council on Foreign Relations, stresses that none of this is new. "This is a recurring problem," he says. China was slow to acknowledge the SARS outbreak in 2003, and in 2014 it took officials in West Africa months to recognise that the mysterious illnesses in remote areas were caused by the Ebola virus, which allowed the virus to spread.

3. Genetic sequencing and contact tracing

Tracing a virus is a demanding process that involves compiling lists of patients' contacts and then calling those people to find out who else might have been infected. Gene sequencing, by contrast, offers the tempting possibility of tracking a virus's spread with molecular precision. Frequent and intensive viral sequencing would help answer questions such as how widely a given strain is spreading in a community such as a school, and whether the strain might mutate to become resistant to existing vaccines.

Thanks to the ubiquity of high-speed gene sequencing machines, sequencing a virus's entire genome costs only about 50 dollars. That information makes large-scale mutation tracking possible. Unfortunately, in the United States virus samples were sequenced for only about 3 in 1,000 Covid patients. Biden acknowledged the problem and announced plans to build sequencing capacity dramatically.

4. Faster vaccine development

Vaccines have so far been the most remarkable success story of the current pandemic. Two highly effective options are already on the market in the United States and a third vaccine, from Johnson & Johnson, is awaiting final approval. Early US government investment in mRNA technology helped Moderna Inc. bring a vaccine candidate to human trials in a record 66 days. Even so, more than four months of phase I and phase II trials were still needed to confirm safety and find the right dose before the decisive phase III study could begin at the end of July.

5. Sorting out distribution and logistics

Getting tests and vaccines to people quickly. But adapting the logistics of a medical system as large and complicated as that of the United States can take months of advance planning and coordination, and databases have to be developed to keep track of everything. In 2020 that did not happen, because the Trump administration insisted that state governments carry out testing, procure and distribute personal protective equipment and implement vaccine distribution protocols. In hindsight this was probably the most unfortunate and the most easily avoidable failure. Biden's plan for the federal government to set up mobile clinics and community vaccination centres in gyms and stadiums could speed things up.