Just where and when will the next pandemic strike?
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In the midst of yet another wave of the two-year-long coronavirus pandemic, global health officials are busy thinking about how to avert the next emergency.
The Coalition for Epidemic Preparedness Innovations — a Norway-based vaccine project at the heart of the response to the current virus — hopes to raise $3.5bn to cut the development time for future jabs. It aims to make vaccines for the next pandemic pathogen possible in just 100 days.
But, as governments and philanthropic organisations get out their cheque books, scientists and public health experts are trying to predict what exactly the next pandemic disease will be.
“The problem is not infinite,” says Dr John Mascola, director of the vaccine research centre at the National Institute of Allergy and Infectious Diseases, an agency of the US Department of Health. He explains that there are only 26 virus families that can infect humans.
Of these, the “most dangerous threat” comes from the fast-spreading respiratory viruses, but he stresses that health officials must stay open-minded about which type will lead to the next pandemic.
“The number of concerning possibilities is still high,” he says. The coronavirus pandemic “has told us . . . that we should not underestimate the ability of a virus to emerge and change and adapt” from within a single virus family.
Nevertheless, Jonathan Quick, adjunct professor of global health at the US Duke Global Health Institute, says RNA viruses should be treated as “the inner circle of pandemic threats”. This was because they “don’t have very good ‘autocorrects’ in their genetics” — and are therefore more likely to mutate than DNA-based viruses.
The list of viruses that encode their genome in RNA includes coronaviruses, influenza and HIV.
Matthew Bayliss, a Liverpool University professor and the director of the city’s new Pandemic Institute, says history shows that preparedness should be based on “expecting and rigorously planning for the expected”. Of the five pandemic events since 1900, all have been linked to either a flu virus or a coronavirus.
Bayliss adds that there is a “reasonably high probability” that another novel coronavirus will follow in the footsteps of Sars-Cov-1, Mers and Sars-Cov-2. All of these have emerged in the last two decades alone.
He says the prospect of a flu pandemic as severe as that caused by Spanish influenza a century or so ago has also “simply not gone away in the slightest”.
Bayliss draws attention to the Swine flu outbreak in 2009, as well as the current avian flu outbreak in the UK’s bird population. These are proof, he says, of the “lingering” possibility that a flu virus could evolve to jump from animals to humans.
However, Richard Hatchett, CEPI’s chief executive, warns against a narrow focus in this area. He argues that preparation for the present, Covid-19 pandemic was “extremely limited by those whose imagination of pandemic threats only extended to flu”.
Hatchett fears the next pandemic could emerge from a family of viruses with highly contagious and deadly pathogens within it. Both fast-spreading measles, where each case generates 12-18 further infections, and Nipah, with a death rate of 40-70 per cent, fall under the category of paramyxoviruses.
Hatchett is concerned such a virus could emerge “that combines those attributes”.
He also warns of the impact of regional, epidemic threats — including malaria, dengue and chikungunya. “These are not necessarily diseases that have global pandemic potential but that can be highly disruptive and impose extreme costs on affected societies,” he says.
Much of the concern over the next pandemic threat relates to the speed with which scientists can deliver an effective vaccine. There are vaccines for 15 of the 26 viral families, but for only one of those is there a vaccine “platform” that permits a shot to be developed and deployed rapidly, says Hatchett.
“One lesson from the response to the Covid pandemic is that we were well prepared to quickly design and develop a vaccine to coronavirus,” says Mascola. But he points out: “If it were a virus in a different family, we wouldn’t have known how to design a vaccine upfront.”
Hatchett says a rapid response vaccine “platform”, combined with an early detection system, could give humanity “a fighting chance of preventing a future pandemic altogether, keeping it contained and extinguishing it before it becomes a global cataclysm”.
Hence, CEPI’s ambition to bolster its coffers, to support investment in other vaccine platforms. So far, the organisation has raised $500mn, thanks in large part to a joint donation from the Bill & Melinda Gates Foundation and the UK’s Wellcome Trust. In early March, the fundraising effort will come to a head at CEPI’s replenishment conference in London.
However, Hatchett worries that, while the Covid pandemic is a monumental event in modern history, its ability to rally investors may be fading. “I am concerned that people are tired of it, there’s fatigue, treasuries are depleted and there will be a desire to turn away from it,” he says. “But the risks aren’t going away.”
“If we want to get back to something that looks like the normal before Covid, we’ve got to make these investments.”