There is little time to lose to better prepare the world for the next pandemic

6 June 2023 – Mukesh Kapila

First published 6 June in The National News

“It was the best of times, it was the worst of times,” said Charles Dickens in his 19th-century classic A Tale of Two Cities. He was writing around the French Revolution but his words are apt for the Covid-19 age: “It was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”

When the World Health Organisation declared last month that Covid-19 was no longer a global health emergency, there were no celebrations. How could there be with about 770 million confirmed coronavirus infections and 7 million recorded deaths? These underestimate the pandemic’s toll which caused excess mortality of about 15 million, and premature deaths equating to 337 million years of life lost up to the end of 2021 alone.

The WHO declaration was a surrender to the reality that we must live with Covid-19 continuing to claim a life every three minutes. Meanwhile, there is little good to say about the pandemic’s management. Although this triggered remarkably speedy digital adaptations, and vaccine and therapeutic advances, the benefits were not shared equitably. The business opportunities offered by lockdowns, travel and other restrictions brought whirlwind profits for some while devastating the livelihoods of many others.

Many historic pandemics such as the 14th-century Black Death (bubonic plague) or early 20th-century Spanish Flu were associated with epoch-shaping societal shifts. Perhaps that is how Covid-19 will be remembered, its biggest impact being the curbing of human liberties on a grand scale and a calamitous breakdown of trust between communities and nations. Whether that signals the end of globalisation or the birth of a new world order is too early to say.

Strangely for all its significant impacts, there is no formal definition of a pandemic. Outbreaks of infectious disease are common but when they occur across a community or region, they become epidemics and, when widespread across several regions or the world, they are termed pandemics.

There have been at least 250 major pandemics – and countless lesser ones – over 3,000 years of recorded history. Infectious pathogens have wiped out more lives than famine and violence. Their costs are somewhere between staggering and incalculable.

Hundreds of organisms can harm humans, and at least three new pathogens with pandemic potential are identified annually. Our fate is intertwined with them as we know from longstanding battles with smallpox, cholera, malaria and tuberculosis, and recently with HIV, Ebola, Sars, Mers, and various swine and avian influenzas.

Serious disease outbreaks are increasing and projected to accelerate three-fold over coming years due to climatic and environmental changes. These increase contact between animals and humans and enable viruses to jump across species. Consequently, we are highly likely to experience several more pandemics of Covid-19 magnitude within our own lifetime.

Pandemics are, therefore, an existentialist threat to humanity, alongside risks from nuclear conflict, climate crisis, and unregulated artificial intelligence. Are we ready to tackle future disease threats? No, according to the Independent Panel for Pandemic Preparedness and Response. Debates at the recent World Health Assembly illustrate how we are failing on systematic prevention, preparedness, and response efforts.

Pandemic prevention aims at reducing zoonotic spill-over from animals to humans. With global temperatures likely to exceed 1.5°C, the depleting environment is already taking revenge on human societies through cataclysmic events to which we are not adapting sufficiently.

The global health sector mindset is especially backward as it remains centred on traditional human-centric health care while the one-health paradigm requires a major re-balancing to optimise the inter-connected health of people, animals, plants, and the planet.

With prevention lagging, pandemic preparedness gets urgent via a significant upgrading of WHO’s global surveillance and alert system. This provides early warning by monitoring how existing pathogens shift form and function as the coronavirus did, and detecting emerging micro-organisms that are potentially dangerous. The WHO already has a list of about 25 organisms with pandemic potential including, an alarmingly designated “Disease X” to recognise unknown bugs.

The International Health Regulations (IHR) are a legally binding agreement of 196 countries to co-operate with WHO in doing that. But states are often reluctant to notify new outbreaks to WHO because they fear travel, trade, political and economic repercussions as West Africans found with Ebola in 2014. Proposals for strengthening IHR enforcement have not gone anywhere because some countries fear losing sovereignty if subjected to some international authority in this area.

Besides, there is little investment in the system of laboratories and other core capacities that poorer nations cannot afford. Nor also in health systems for universal health coverage that prevent and treat underlying conditions that increase vulnerability to potentially lethal infections.

More broadly, there is little money for aiding pandemic preparedness in developing countries. About $10.5 billion is needed annually, but the World Bank’s Pandemic Fund has barely received 10 per cent of that so far.

It is probable, therefore, that the next pandemic will, yet again, surprise us. And nations will recall Covid-19 where despite slogans around “no one is safe until all are safe”, they were largely on their own. Established public health practices were turned upside down when countries closed themselves off, although we know that viruses know no borders.

It is unsurprising that pandemic response is contentious as nations scramble for essentials: affordable personal protective equipment, diagnostics, medicines and vaccines. Covid-19 has taught them that when the chips are down, they should not rely on the uncertain mercies of others. That includes unreliable global institutions that disappointed them in their hour of greatest need.

Such disquiet is at the core of disagreements around a proposed Pandemic Treaty to foster multilateral and equitable co-operation. But that is being watered down through interminable inter-governmental negotiations.

Why can’t the world agree on what is of obvious mutual benefit? That is because health is no longer seen as a shared good. Instead, leaders speak openly about national health security. Under prevailing geopolitics, this is a weaponisation of health because healthy populations are building blocks for strong nations that compete with others. Countries that recover first from a pandemic get an obvious advantage over stragglers.

An accompanying fear is about the governance of any new world order for pandemic management. Will wealthy, technologically advanced nations monopolise intellectual property innovations in health care to secure themselves behind strong sanitary borders while excluding the rest or sending charitable sums to them?

The securitisation of health in this way is a political choice, and so is pandemic-proofing the world. We can hope that countless preventable pandemic deaths will eventually trigger a new moral conscience to drive more effective global co-operation. But this cannot be taken for granted. Meanwhile, the clock towards the next pandemic is ticking.