Will we be better prepared for a future pandemic after COVID-19?
Writer: Niru Varma
Editor: Skyla Siu
Artist: Grace Gu
In the wake of the 2015 Ebola crisis, then Prime Minister David Cameron used the G7 summit as an opportunity to call on Britain and the world to “wake up to the threat” of disease outbreaks, and laid out a plan to ensure the UK was as prepared for a future pandemic as possible. This included investments in drug research and development, greater transparency in research, and improved protocols and dedicated staff for rapid response to outbreaks. Looking back almost six years later, amid the very crisis anticipated, it is easy to question how effective these measures really were. Cameron himself admitted earlier this year that much of their planning relied on the assumption of an influenza outbreak, with insufficient attention being paid to other possibilities, saying that “More should have been learnt from the experience with SARS and respiratory disease in terms of our own preparedness.” Indeed, the success of many Asian countries in controlling the spread of COVID-19 has been attributed to protocols already established following previous respiratory disease epidemics.
The flaw in the pandemic preparation strategy of countries like the UK and the US is that respiratory diseases, like SARS and COVID-19, require vastly different mitigation measures to influenza. Quarantining and contact tracing those with symptoms and the people they come into contact with is an effective way of controlling respiratory diseases. It is less effective for influenza, which has a highly infectious period that precedes the symptomatic period ‒ the only possible response is mitigation, not full suppression. It is believed that the UK Government’s initial COVID-19 pandemic response was informed by their influenza preparedness strategy; they were not prepared for the measures required to suppress the virus rather than simply mitigate transmission. Meanwhile, countries like Singapore and South Korea had far lower rates of infection and disruption as a result of the pandemic, having prepared for the correct scenario.
With the frequency of pandemics likely to increase as human behaviour makes us more susceptible to them, Cameron’s call to increase our preparedness only becomes more relevant. As World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus states, “For too long the world has operated on a cycle of panic and neglect. We throw money at one epidemic and when it’s over, we forget about it and do nothing to prevent the next one.”
When looking into future pandemic mitigation, it is important to understand the causes. Human behaviour is one large driver; as the world becomes more global, with ever increasing rates of transport of people and cargo, the risk of an outbreak turning into a worldwide pandemic always rises. The outbreaks themselves can also be attributed to human intervention. The vast majority of new disease outbreaks occur as a result of zoonoses – animal diseases that make the jump to infect humans. The COVID-19 pandemic was transmitted from a bat, the natural host. Nipah virus from bats, swine flu from pigs, and MERS from camels are three other zoonotic diseases on scientists’ watchlists of future epidemic and pandemic concerns. Inevitably, the chance of zoonotic transmission of a disease increases greatly with the amount of contact humans have with animal carriers – invasion and destruction of habitats and livestock farming all contribute to this. Movement of livestock around the world also facilitates spread. Monitoring of animal populations, identifying routes of transmission, and screening animals for new diseases and variants play a vital part in preventing outbreaks that may lead to pandemics. Eventually, another pandemic outbreak is almost inevitable – however, identifying these outbreaks early can still help with early management and mitigation.
If the next pandemic turns out to be another respiratory virus, we would hope our government at the time would be somewhat better prepared simply from experience. Turning back to SARS, it is easy to praise the performance of the governments who apparently learnt their lessons from this disease. However, the fact that they were prepared for the right pandemic does not mean that they would necessarily be better prepared for a different pandemic. The seemingly obvious lesson to be observed here: any future strategy must account for more than one possible disease scenario, and must not assume that strategies are interchangeable.
But of course, ‘prepare better’ is easier said than done. The details of how exactly to prepare better, especially for different pandemic scenarios, is less clear. Breaking the so-called ‘panic-then-forget’ cycle is a topic of acute interest to the WHO and many world leaders. In October 2020, the UK Health and Social Care and Science and Technology Select Committees launched a joint inquiry into the lessons learnt from the COVID-19 response. The inquiry considered, amongst other things, the UK’s prior preparedness for this pandemic, and the effectiveness and deployment of interventions and management strategies. Publication of a final report is still pending, but whatever the outcome is, preparedness for a future global health emergency will involve more than just planning for specific pandemic scenarios. Many argue that COVID-19 simply shone a light, in the most disruptive way, on existing flaws in our infrastructure, healthcare, and general way of life. Papering these cracks will require long term preparation – something our political system is not catered to. Our governments are not used to thinking beyond the short term – or, more accurately, the five year term. The ‘panic-then-forget’ cycle seems like an inevitable constant, the question of lessons we can learn a bleak one. All we can do is take advantage of pandemic prevention being in the public eye to push for greater funding into public health, infectious disease research, and healthcare, as well as much needed healthcare and social care reform.