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The pandemic challenge

Over recent decades, thanks to better vaccines and strategic interventions, the world has seen incredible progress in reducing child mortality and tackling infectious diseases. Yet there is one area where the world isn’t making much progress and that is pandemic preparedness, but it is no less important. This failure should concern the entire international community, because history has taught us that there will undoubtedly be another deadly worldwide pandemic. There is no way of predicting when, but given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and the ever-increasing connectedness of our world, there is a significant probability that a large and lethal modern-day pandemic will occur in our lifetime.

Several events in the past decade have warranted close attention to the risk of future pandemics. One was the outbreak of swine flu (H1N1) in 2009. Although H1N1 influenza wasn’t as lethal as people initially feared, it called attention to our inability to track the spread of disease, and the need to develop new tools for public-health emergencies. The more recent outbreaks of Ebola in Africa were another wake-up call. As the number of confirmed cases climbed, the death toll mounted, and health systems local to the outbreak collapsed. Again, the world was much too slow to respond. What the world needs is a coordinated global approach to pandemics that will work regardless of whether the next pandemic is a product of human intervention or of nature itself.

The 1918 influenza epidemic killed an estimated fifty million people. Today, many countries have life-saving interventions that weren’t available at that time, such as the seasonal influenza vaccine. Although, this isn’t always fully effective, and must be taken each year, it represents an enormous step forward. There are also now antibiotics that help with secondary infections from bacterial pneumonia. Yet despite such advances, a simulation by the Institute for Disease Modelling shows what would happen if a highly contagious and lethal airborne pathogen, like the 1918 influenza, were to appear today. Nearly thirty-three million people worldwide would die in just six months.

The next threat, however, may not be influenza at all. It may well be an unknown pathogen seen for the first time during an outbreak, as was the case with SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and other recently found infectious diseases. The world took a step to begin addressing this risk with the launch in 2017 of a public–private partnership called the Coalition for Epidemic Preparedness Innovations (CEPI). With funding commitments of more than US$630 million, CEPI’s first job is advancing the development of vaccines for three of the priority diseases on the World Health Organization (WHO) list for public health research and development: Lassa fever, Nipah virus, and MERS.

CEPI will also be working on rapid-response platforms to produce safe, effective vaccines for a range of infectious diseases. Later this year, the coalition will announce grants to several companies, working with a variety of technologies, including nucleic acid vaccines, viral vectors, and other innovative approaches. The goal is the capability to develop, test, and release new vaccines in a matter of months rather than years. But vaccines can’t be the only answer when immediate response is vital to a rapidly spreading infectious disease. Not only do vaccines take time to develop and deploy, they also take at least a couple of weeks after vaccination to generate protective immunity. So investment is needed in other approaches, such as antiviral drugs and antibody therapies that can be stockpiled or rapidly manufactured to stop the spread of pandemic diseases or to treat people who have been exposed.

At a recent international security conference, world leaders were asked to imagine that somewhere in the world a new weapon exists or could emerge that is capable of killing millions of people, bringing economies to a standstill, and casting nations into chaos. If it were a military weapon, the response would be to do everything possible to develop countermeasures. In the case of biologic threats, that sense of urgency is sadly lacking. But the world needs to prepare for pandemics in the same serious way it prepares for war. This preparation includes staging simulations, war games, and preparedness exercises to increase understanding of how diseases will spread and how to deal with responses such as quarantine and communications to minimise panic. Such a clear road map for a comprehensive pandemic preparedness and response system is imperative, because lives, in numbers too great to comprehend, depend on it.