How can we prevent the next pandemic?

Having just lived through a pandemic is no guarantee that we won’t face another similar crisis. The consensus is that another pandemic is highly likely. The inaugural Rhodes policy summit aimed to bring together leading experts from around the world to consider what we should do to identify and prevent pandemics before they occur. This is a take on some of the things we learned.

We should assume the next pandemic is coming – and it might be much more likely than many realise

Modelling suggests that there is a 27.5% chance of a new pandemic similar in scope to our experience with Covid-19 hitting the world within the next decade. This eye-catching and troubling statistic was developed by data analytics specialists Airfinity, who have helped model Covid-19 and other public health risks. This analysis has a number of underlying assumptions and uncertainties but the presentation at the summit by Airfinity CEO Rasmus Bech Hansen is compelling. Modelling suggests that the number of pandemic related excess deaths could have been far higher had we been presented by the highly transmissible omicron variant of Covid-19 first, before the wild type variant. Furthermore, Airfinity’s analysis also suggests that pandemic episodes are becoming more frequent – as international travel, climate change and other social conditions contribute to this risk.

Rasmus said: “If you look at the number of outbreaks we are seeing over time…there is a case to be made that these high risk outbreaks that could potentially become pandemics are more frequent than they ever have been before.

 “Lack of data, lack of evidence and lack of a precedent is no longer an excuse for inaction.”

There has been huge progress, but we need to build on what we have achieved

Covid-19 has advanced our understanding and capacity in many areas, from vaccine development to scaling up vaccine production and distribution, to disease surveillance and monitoring and even how we communicate about risk (think for example how the R number became part of the public vocabulary). But there is a risk of gains being lost, or at least not being consolidated.

Sir John Bell, (Alberta & Magdalen 1975) Regius Professor of Medicine at the University of Oxford, argued that a “massive flood” in vaccine technologies that could target common diseases, low cost and portable genomic sequencing technology and greater research capabilities had great potential to prevent disease now and improve our resilience to future threats. “What we can do today looks completely different from what we could do 10 years ago, ” he said.

We need systems that are “always on” and can support better healthcare in the here and now, while being able to switch quickly to tackling a future pandemic

Sir John made a powerful case for pivoting healthcare systems to increase pandemic preparedness while also improving healthcare outcomes in the short run. “If you think about all the things we did in the last four years, these are all things we could have to do again,” he said. “But the intention is not to start these things from scratch but to have things that are operating and support a wide heath agenda that can be pivoted into that space.”

Former Prime Minister of the United Kingdom, Tony Blair, Executive Chair of the Tony Blair Institute for Global Change, told delegates: “We are standing at a frontier of a very rich and diverse medical science which potentially revolutionises global healthcare, savings lives and trillions of dollars in lost output, quite apart from a positive impact on stretched government budgets.”

Equity is crucial

Both in vaccine and treatment rollout and in research capability, the world suffered inequality. Discussions focussed on the need to create systems that could combat pandemic spread in North America, the UK and Europe, but also provide vaccines, testing apparatus and treatments which could operate in environments where refrigeration, power and transport were not available.

Sir John argued that “One of the problems about the inequity of the last pandemic was where the northern economies did well and the global south was in many cases left behind was the unavailability of clinical research capabilities in different parts of the world. That is clearly inappropriate and needs to be fixed”. Several key players in strengthening clinical research infrastructure in low- and middle- income contexts provided insights on what best practices look like.

In one example, Professor Glenda Grey, President and CEO of the South African Medical Research Council, pointed towards the way in which investments in infectious disease infrastructure for HIV and TB in the country could pivot and support the COVID-19 pandemic response. “One of the take-home lessons from Covid was that the investments we made in HIV and TB, both on the clinical side and on the laboratory side, were pivotal” she said

New innovations in wastewater surveillance and monitoring excess deaths helped to inform national policy. Keeping this infrastructure in place is critical to ensure we can detect a new outbreak, anywhere in the world.

It’s vital to show the value of this work in the short run.

Tony Blair told the conference that it was vital for politicians to see the value of pandemic preparedness “in the here and now” – supporting improved health outcomes and economic returns in the present as well as guarding against future unknown threats, a theme that was echoed by participants throughout the event, and the policy discussions that followed.

Sir Andrew Pollard, Director of the Vaccine Group at the University of Oxford, said: “We put a lot of money into defence against military threats which, hopefully, are not going to happen too regularly. We are prepared to invest in warships, nuclear submarines and fighter jets. The numbers we are spending on global health get nowhere near the numbers we spend on that threat.”

Epidemiologist Prabhat Jha (Prairies and Magdalen 1987) argued there was a false dichotomy between pandemic preparedness and action to tackle known diseases which kill millions today. Vaccination programmes had potential to tackle both, he said: “The fully vaccinated child is quite resilient to a range of infections,” he said. “I believe with more evidence …we can make the case that the fully vaccinated adult will be resilient.” Creating mechanisms to make sure that essential pandemic response tools such as vaccines, diagnostics and therapeutics are available at scale was also explored in-depth.

Technology and techniques to combat pandemics exist now, or can be developed if we invest in the future

Life course vaccination, developing a vaccination programme for adults as well as children to tackle routine disease, new technologies to allow pathogens to be identified at hospital bedsides and greater research and knowledge sharing around the world, are at the centre of the “always on” concept.

But the summit did hear warnings that long-term investment in research was needed to ensure fast access to vaccination and treatment in the future. Sir Andrew told delegates that 20 years of research underpinned the rapid development of Covid-19 vaccines, research that needs to be done for other pathogens.

Misinformation is toxic; building trust is crucial

Pandemics make everything move much faster and we need to involve partners to communicate effectively, the summit heard, but there are fundamental lessons about ensuring different communities are listened to and served.

“There are some fundamentals that don’t ever change in this trust business: it’s always about the messenger; ideally it’s peer-to-peer, we see that in our own social networks,” said Eloise Todd, co-founder of the Pandemic Action Network. She added: “The ‘always on’ concept needs to apply to hesitancy and trust.”

There were also lessons about making information accessible and understandable - from trusted sources, whether that is the media, influencers, community leaders or the public. Mia Malan, founding editor of Bhekisisa Centre for Health Journalism emphasised, "consistency as the currency of trust".

There’s huge power in bringing people together

The depth of experience and expertise gathered at the summit from around the world was exceptional, and reflects the commitment of people and their organisations to translate the experience gained during the Covid-19 pandemic into action that can mitigate the risks of such an event happening again.

For the Rhodes Trust, a philanthropic organisation committed to investing in lifelong fellowships of people committed to tackling the world’s great challenges, this was an opportunity to ignite the power of convening across traditional boundaries and to drive collaboration for impact. This was the first event of this type convened by the Lifelong Programmes team at the Rhodes Trust that engaged the Rhodes scholar-in-residence and alumni community and a broader global health audience. The quality of the outputs and conversations indicated that this is an excellent platform for future initiatives.

Dr Helene-Mari van der Westhuizen (Paul Roos Gymnasium, Stellenbosch & Green Templeton 2018) is a Global Health Fellow working with the Rhodes Trust and Global Health Security Consortium on policy relating to pandemic preparedness

Ben Russell is a former journalist and a member of the Rhodes Trust communications team