Four years on from the first Covid lockdown, life feels to be largely back to normal, although legacies of the pandemic remain. Collective amnesia seems to have set in. Politicians seem eager to move forward and not relive the decisions, delays and deaths that characterised public policy and press briefings. Yet we can’t forget such a brutal event, when Covid is estimated to have killed nearly 16 million people worldwide in 2020 and 2021, and caused life expectancy to decline in 84% of countries, including Britain. Pandemics aren’t a one-off event. There’s still a risk of another happening within our lifetimes.
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 advancing 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 with the Lancet Covid-19 taskforce, which brought together global experts to look at how to improve on the Covid response, and what challenges there were going forward. 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 towards the 100-day challenge: that is, how to contain a virus spreading while a scientific response, such as a vaccine, diagnostic or treatment, can be approved, manufactured and delivered to the public. In the US, the suggested timeframe is 130 days from detecting a pathogen until the entire US population is offered a vaccine, and 200 days until there’s enough of a supply for the entire world. The strategic learning here from Covid-19 is to plan for maximum suppression of a new disease until there’s a tool to make it less deadly, and also faster and wider delivery of treatments. I often wonder how many could have survived had governments 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 mean new medical products are pretty much 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 go, and is simply waiting for the new cartridge (the specifics of the pathogen) to be inserted. Influenza already works like this, with existing vaccine platforms ready to be tweaked to address a new strain relatively quickly. To make this faster, 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 need to work out how to keep the rigour of clinical trials, which test for safety, efficacy and optimal dosage, while moving fast enough to approve treatments that can affect the trajectory of a pandemic. Going too fast can undermine trust in a medical product, which is why there’s a strict approval process by government agencies, which require phase 1, 2 and 3 trials to ensure safety, identify side-effects and the impact of the intervention on immune response, and ensure hundreds of people are 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 to plan on the scientific side, trying to delay a virus – especially one that is respiratory – spreading from human to human 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 healthcare collapse. We now have time to develop better ways of containment and examine how to safely keep schools and businesses open using more precise public health interventions, including on knowledge of transmission (such as more ventilation), diagnostics (testing for infectiousness) and better data (surveillance on prevalence in the community).
These are the challenges facing experts as we try to plan for a future pandemic. However, progress is stalling. In the meetings I’ve 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 engaged in global health security, and his secretary of state, Antony Blinken, invited several experts – including myself – to brief him directly on post-Covid-19 response. However, Biden now faces re-election and a fight against Donald Trump, who did not show any interest in this issue during his presidency. Here in the UK, it feels difficult to make the case for a potential pathogen that could affect the country, when the NHS is falling apart.
It reminds me of a meeting we held in 2019 at Edinburgh University on how best 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 with getting basic healthcare to their populations rather than face up to the prospect of existential threats. Sadly the UK is falling into this camp: it’s hard to make convincing arguments about investing to protect against risks in the future when people are today facing delays in life-saving cancer treatment, long waits for ambulances and inaccessible GP appointments. But pretending we won’t face another pandemic threat in our lifetimes is naive at best. Surely there must be a way to do both.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
