We may already be falling into the same trap of pandemic unpreparedness

Preparing for the next pandemic at Ars Frontiers. Click here for transcript.

Though the COVID-19 pandemic is not yet over, fatigue from the global public health emergency has surged to levels only an omicron subvariant could rival. We’re all eager to move on. But for scientists and public health experts, that means preparing for the next inevitable pandemic and dealing with the aftermath of this one.

Ahead of Ars Frontiers, I connected with virologist Angela Rasmussen to talk about pandemic preparedness: what went well in this pandemic, what didn’t, what we learned—and what lessons we already seem to be ignoring.

Rasmussen brought a lot to the conversation. She’s a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan and an affiliate at Georgetown University Center for Global Health Science and Security. She has long studied highly pathogenic emerging viruses—including coronaviruses, Ebola, and influenza viruses—focusing on host responses to those viral infections. Currently, she’s working with the Coronavirus Variants Rapid Response Network, a research network funded by the Canadian government, to surveil and characterize SARS-CoV-2 variants that could spill over and spill back between animals and humans.

Think global

We started our discussion with the mammoth questions: What should we do to prepare for the next pandemic—and are we doing those things? Her answer, basically: We need to be thinking globally and long-term. We’re doing some of that now, but we also seem to be falling into a common pattern that could leave us unprepared.

Some things went well in this pandemic, Rasmussen said, highlighting the speedy sharing of genomic sequences that paved the way for the equally speedy development of highly effective vaccines. She also noted the impressive stand-up of genomic surveillance around the world. But on many other fronts of pandemic prevention and response, we failed, she said.

“And one of the biggest reasons that I think we failed is that a lot of the pandemic responses have really been nationalized,” she said. “This is a global problem that is facing all of us, and if we really want to be prepared and more capable of responding to the next one, we need to be looking for global solutions… We need to be focusing on solutions that rely on global cooperation, that rely on surveillance programs that transcend national borders, and that provide a fair and equitable exchange of scientific knowledge and collaboration across borders, particularly in the global south and in low- and middle-income countries that are likely going to be more profoundly affected should an epidemic or pandemic occur.”

The World Health Assembly and the World Health Organization have been raising these points and scientists are hearing them, she said. But the funding and focus need to be long-term. Invariably, when new threats arose in the past—such as the original SARS outbreak in 2003 or the emergence of the related MERS in 2012—there was an initial burst of funding to research and prepare for outbreaks. But then, when the threat subsided, interest faded, and the funding dried up.

“When those grants came up for renewal, a lot of them were not renewed because that was no longer considered an important investment,” Rasmussen said.

Familiar patterns

Rasmussen calls this the boom-bust cycle. It not only causes research progress to falter, but it thwarts international collaborations. “There’s still quite a bit of what we would call ‘parachute science,’ people kind of going in to low- and middle-income countries, demanding samples and access, and then really not helping to build out the infrastructure, not helping to support the scientists in those countries to continue that work… We really do need to have sustainable investment, both in terms of collaborating and developing these international collaborations, as well as funding researchers who are already working on this.”

Yet, while this is a clear lesson from the near-miss pandemics of the past, it still seems like we’re falling short of making those sustainable investments. Testing and genomic surveillance are being pulled back around the world. In the US, the Biden administration’s requests for continued pandemic aid, which includes funding for second-generation vaccines and genomic surveillance, remain unanswered by Congress, and the Senate’s bipartisan $10 billion deal may need to be renegotiated.

“It does worry me quite a bit,” Rasmussen said. We need to have robust, continued genomic surveillance and early warning systems set up all over the world “not just for [SARS-CoV-2] and tracking its trajectory now, but for new pathogens that might emerge in the future,” she said. Otherwise, with SARS-CoV-2 spreading in people and other animals, potentially becoming more pathogenic, “we’re going to be playing sort of variant whack-a-mole.”

Outcomes

In addition to sustained surveillance and threat assessment research, scientists are also tasked with understanding the aftermath of a pandemic that sickened hundreds of millions of people worldwide, many with long-term symptoms.

Host responses are a major determinant of COVID-19 and other complex diseases, Rasmussen said. This includes everything from genetics and epigenetic differences to a person’s underlying medical conditions, where they live, their diet, and behavior.

When you have so many people infected with a given virus, you see a diverse range of clinical outcomes, and even rare outcomes or post-responses that lead to rare outcomes occurring in a lot of people, she said. “That’s also why we probably see many different manifestations of long COVID, which we still actually don’t even really have a good handle on, I think, in terms of how many people get it, how profoundly it affects their lives, how long it lasts, and how we should be treating it.” These are questions that researchers are going to be puzzling over for some time, she said, because that type of research just takes a lot of time to do. But, “clearly, long COVID is something that’s now affecting millions and millions of people. It potentially is a mass disabling event… and I don’t think we have a very good understanding of its pathogenesis at all.”

Listing image by Science Photo Library / Getty Images

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