FYears after the first Covid lockdown, life largely feels back to normal, even as the legacies of the pandemic remain. There appears to be collective amnesia. Politicians seem eager to move forward and not relive the decisions, delays and deaths that characterized government policies and press conferences. Yet we should not forget such a brutal event, in which Covid is estimated to have claimed the lives of people almost 16 million people worldwide in 2020 and 2021, causing life expectancy to fall in 84% of countries, including Britain. Pandemics are not a one-time event. There is still a risk that something will happen in our lifetime.
Fortunately, the question of what to do about the next pandemic is still high on the global health agenda. In 2021, I was asked to co-chair the committee of the U.S. National Academy of Sciences promoting vaccine preparedness and response against pandemics and seasonal influenza. This group was sponsored by the US government to make 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 experts from around the world to discuss how to improve the response to Covid-19, and what challenges lie ahead. These groups represent some of the world’s top thinkers on global health and pandemic preparedness. This is what I learned.
First, most governments are working on the 100-day challenge: that is, how can we stop the spread of a virus while allowing a scientific response, such as a vaccine, a diagnosis or a treatment, to be approved, manufactured and delivered to the public? can be offered. In the U.Sthe proposed time frame is 130 days from detection of a pathogen until the entire US population is offered a vaccine, and 200 days until there is sufficient supply for the entire world. The strategic lesson to be learned from Covid-19 is to plan for maximum suppression of a new disease until there is a tool to make it less deadly, as well as to provide faster and broader treatments. I often wonder how many people could have survived if governments had found a way to buy time and delay infections among their populations until mass vaccination.
But this kind of planning is easier said than done. The first requirement is to invest in and create ‘plug-and-play platforms’, meaning that new medical products are virtually ready to be created as soon as the genetic sequence of a pathogen is identified. Think of this as a video game console that is ready to go and just waiting for the new cartridge (the specifics of the pathogen) to be inserted. Influenza already works this way, with existing vaccine platforms ready to be adapted to tackle a new strain relatively quickly. To speed this up, we need appropriate surveillance in all parts of the world to detect if a new virus is spreading and to genetically sequence it. Ebola spread in Guinea for several months in 2014 before anyone knew it was the Ebola virus and not something else.
Second, we must figure out how to maintain the rigor of clinical trials that test safety, efficacy, and optimal dosing, while moving quickly enough to approve treatments that could influence the trajectory of a pandemic. Going too fast can undermine confidence in a medical product. Therefore, there is a strict approval process by government agencies, which requires phase 1, 2 and 3 studies to ensure safety, identify side effects and the impact of the intervention on the immune response. and ensuring it involves hundreds of people, across a range of characteristics including age, gender, physical health and racial background. These investigations usually take months, if not years.
Even if everything goes according to plan scientifically, slowing the spread of a virus — especially a respiratory virus — 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 as they faced the collapse of the healthcare system. We now have time to develop better containment methods and explore how we can keep schools safe and businesses are opening their doors using more precise public health interventions, including knowledge of transmission (such as increased ventilation), diagnostics (testing for infectivity) and better data (monitoring community prevalence ).
These are the challenges experts face as we try to plan for a future pandemic. However, progress is stagnating. At the meetings I have attended, there is a sense of frustration as political priorities have shifted away from public health. In the US, President Joe Biden is actively involved in global health, and his Secretary of State, Antony Blinken, has invited several experts – including myself – to brief him directly on post-Covid-19 responses. However, Biden now faces re-election and a battle against Donald Trump, who showed no interest in this issue during his presidency. Here in Britain, it feels difficult to make the case for a potential pathogen that could hit the country as the NHS falls apart.
It reminds me of a meeting we held at the University of Edinburgh in 2019 about the best way to convince low- and middle-income countries to take pandemic preparedness seriously. The response from ministers in these countries was that they were more concerned about getting basic health care to their populations than facing the prospect of existential threats. Unfortunately, Britain falls into this camp: it is difficult to make convincing arguments about investing to protect against future risks, when people today face delays in life-saving cancer treatment, long ambulance waits and inaccessible GP appointments. But pretending that we won’t face another pandemic in our lifetime is naive at best. Surely there must be a way to do both.