When COVID-19 hit in 2020, the world went into shock at how fast it spread, how difficult it was to treat, how many died from it, and its long-term health effects (long COVID). UN Secretary-General António Guterres called it a “once-in-a-lifetime pandemic.”
Since then, many governments have taken note of the deficiencies COVID-19 exposed and started fixing them. In May, Director-General Tedros Adhanom Ghebreyesus, the head of the World Health Organization (WHO), said that while “there continues to be major progress in global health [since COVID], we must remember how fragile [that] progress can be.”
On the other hand, “we’re creating a situation that is rife for outbreaks,” Nathalie MacDermott, a clinical lecturer in infectious diseases at King’s College London, told Sky News in March. “The next pandemic is around the corner — it might be two years, it could be 20 years, it could be longer.”
“Another pandemic is absolutely inevitable,” Patrick Vallance, the UK government’s former chief scientific adviser, told the media in May. “We are not ready yet … We need to be much faster, much more aligned … at getting rapid diagnostic tests, rapid vaccines, rapid treatments so you don’t have to go into the extreme measures that took place during the COVID-19 pandemic.”
Disease X
Coined by the WHO in 2018 to denote a hypothetical virus, Disease X is a “priority for … research and development investments,” the Coalition for Epidemic Preparedness Innovations (CEPI), a research entity created in 2016, said in a January paper.
The most famous Disease X to date was the SARS-CoV-2 virus that causes COVID-19. “Because we were not properly prepared to defend ourselves against it, COVID-19 swiftly spread and caused a deadly pandemic, killing millions worldwide,” CEPI said.
The next global medical emergency will likely come sooner than later. “Recent history shows us that outbreaks of pathogens capable of causing severe disease and death in people are becoming increasingly frequent,” said the CEPI. “There have been outbreaks of SARS-CoV-1 [from 2002 to 2004], MERS [in 2012], Zika [from 2007 to 2017], and many other new and re-emerging viral diseases.”
Micheal Peel, Financial Times science editor, said new international health emergencies are inevitable because “there are more people in the world, living more densely and in a more mobile way,” resulting in easier and faster transmission.
Another factor is “increasingly intensive livestock agriculture and poorly regulated trading in animals, …. increasing the dangers of zoonotic diseases, where pathogens transmit from animals to humans,” Peel noted.
Meanwhile, the “changing climate is only [raising] the risk … a new Disease X will spill over from animals and spark a deadly novel outbreak,” CEPI said in an undated note. That risk is accelerating as “environmental change is happening at a much higher speed,” Anne Spurkland, a molecular immunologist and professor of anatomy at the University of Oslo, told the CEPI.
Identifying a virus that might cause the next pandemic is difficult. “While it’s likely that the next pandemic threat could emerge as a novel Disease X, there’s also a risk of already known pathogens mutating or re-emerging and then spreading into international disease epidemics.”
An example of the latter is the re-emerging MonkeyPox virus in the Democratic Republic of the Congo, detected in January 2023. According to the WHO, the virus had spread to Burundi, Kenya, Rwanda and Uganda as of Aug. 22. One week later, Sara Reardon, a journalist for Nature Portfolio, a health research platform, reported “two people traveling to Africa—one from Sweden and one from Thailand—have become infected.”
Doubtful cooperation?
To protect from the next pandemic, the CEPI, supported by G7 and G20 nations, announced in July the “100 Days Mission” program that “seeks to develop vaccines, diagnostics, and therapeutics against [any] novel viral threat in just over … three months.”
To realize the program’s goal, “global partnerships are key,” said Brazil’s Minister of Health, Nísia Lima, at the announcement event. “Post-COVID, we’ve learned that equitable R&D, investment and access are crucial for public health. We cannot work only within our countries; we must think beyond borders.”
Securing such cooperation can be difficult. In August, Precious Matsoso, co-chair of the Intergovernmental Negotiating Body created in April, said, “Countries are trying to find a middle ground on what would work best to help prepare and prevent (pandemics) … It’s a matter of emphasis [on] equity or … prevention.” The former approach would ensure all countries have vaccine doses, even if they aren’t enough to prevent the virus from spreading within their borders. The latter option would see countries prioritize protecting their own populations.
Geopolitical fractures are also an issue. “Growing geopolitical tensions between powerful countries and political changes within some of them threaten to derail [pandemic-related] treaties,” said FT editor Peel. “[Those fallouts] must be overcome, or at least managed if [any] pandemic [cooperation] treaty and wider preparedness efforts are to succeed.”
A prime example is Western advanced nations’ perception of China as an uncooperative government. “One festering controversy is over the continued mystery about how exactly COVID-19 emerged in China in late 2019,” Peel said. Another potentially uncooperative nation might be the United States if former president Donald Trump is elected again. Peel recalled how he, in July 2020, wanted to pull out of the WHO, only for President Joe Biden to reverse that decision.
That reclusive attitude also is evident among low and middle-income nations. WHO Assistant Director-General Chikwe Ihekweazu singled out “Nigeria, Pakistan and Egypt, [which] are preoccupied with financial crises.”
Private sector isolation?
An uncooperative attitude could spread to medicine producers. “The pharma industry wants to avoid waiving intellectual property rights on vaccines, as exclusive rights to drugs are the foundation of their business model,” Thomas Cueni, former head of the International Federation of Pharmaceutical Manufacturers and Associations, told The Financial Times in April.
However, Cueni noted companies would likely sign “binding commitments” to allocate products to multilateral organizations like the WHO and UNICEF. He added that while some would donate their medicines, others would sell them at discounted prices to low and middle-income nations.
Another option for pharma companies is to build manufacturing facilities in less fortunate regions to meet demand. In December, BioNTech, which used mRNA technology to make its COVID vaccine, said it will construct a $150 million mRNA production facility in Rwanda that should be operational in 2025.
Making things right
Ultimately, governments need to use the knowledge they acquired from COVID-19 to prepare for the next health emergency. “I hope the experience of the pandemic reminds people that when these events happen, … they do truly become global security concerns,” Richard Hatchett, CEPI’s chief executive, told the Financial Times in April. “Health security, economic security and even national security are imperiled when infectious diseases spin out of control.”
Ihekweazu stressed that trust among nations is critical to protecting everyone. “[During COVID-19] you had universal access to information but no access to vaccines,” he explained. That is at the “heart of the trust deficit” between countries that produce the vaccines and those with insufficient resources to buy enough of them quickly.
Hatchett of CEPI is optimistic. “It is clear that pandemic preparedness and health security are now very salient for senior officials and governments,” he said. “There are still opportunities for collaboration and cooperation, even in a fragmented world.”
This article first appeared in October’s print edition of Business Monthly.
