Predicting and Preventing the Next Pandemics

COVID-19 has revealed at least ten major global health problems. As painfully demonstrated during the pandemic, the devolving health threats endanger lives, disrupt families and societies, and wreck havoc on economies. A strategic path is set forth within a coordinated global framework for predicting and preventing the next pandemics.

Alain L Fymat, International Institute of Medicine & Science

Problems with global health

While a full analysis of each such problem would require separate presentations, here is a brief overview:

1. An unruly world of nearly eight billion people (and growing) who are not easily managed.

2. Glaring inequities among nations, particularly poor or less-developed ones, with insufficient or/and inadequate health infrastructures that precluded the local productions of medicines and vaccines.

3. A plethora of international organisations forming a complex and fragmented legal and institutional landscape. They continued to focus on their limited individual agendas, do not operate cooperatively or in synchrony, do not coordinate their respective programs, and have no enforcement power over individual nations.

4. Notwithstanding its otherwise great work, during COVID-19, the WHO was dilatory in not heeding the early signs of the coming pandemic and took three or more critical months to declare a pandemic.

5. National decisions continue to be most often politically driven, international commitments are barely honoured, and no international consequences are levied for non-compliance.

6. There is an almost universal short memory regarding the past history of epidemics and pandemics.

7. The early signs of nascent epidemics / pandemics were not heeded despite reports, briefings, and warnings about viruses bearing traces of their animal origins.

8. The cardinal socio-economic factors of epidemics/pandemics have not heretofore been fully identified.

9. Regarding potential future epidemics / pandemics, the cause(s) have not been fully identified and strategies for their prediction / prevention have not been devised.

10. Enabling technologies for epidemiological / biological modelling have not been sufficiently developed to allow appropriate policy decisions.

Aa a consequence, nations and the world remain under-prepared to predict, detect, respond, and even less prevent infectious disease outbreaks and a fortiori pandemics.

Facing future health threats and pandemics

The required measures to allow effective detection and response to emerging zoonotic threats and ultimately predict and prevent pandemics are:

• Highlighting global health security.

• Promoting multidisciplinary engagement.

• Strengthening multi-sectoral coordination.

• Emphasising the importance of financial preparedness.

• Creating and strengthening necessary mechanisms.

• Improving early warning and detection.

• Collecting and sharing data in a timely manner.

• Conducting laboratory testing.

• Developing joint outbreak response capacities.

• Taking appropriate science-based actions.

Root causes of pandemics

From the ancestral domestication of plants and animals to the present times, we live on a microbially-unified planet.

The root causes of pandemics are ten intertwined socio-ecological cardinal factors that need to be remedied:

• Rapid growth of global human population.

• Increased globalisation.

• Environmental degradation and destabilisation of ecosystems.

• Creation of new urban or agricultural ecosystems.

• Economies of scale and monocultures in agriculture and dysfunctional agrifood systems.

• Loss of land and ocean biodiversity.

• Water scarcity.

• Human-induced climate change.

• Societal inequities.

• Irrational mass denialism of hard-won facts of science (vaccinations, antimicrobial overuse).

Some of these factors could be correlated with the United Nations' Sustainable Development Goals.

A blueprint for strategic pandemic prediction and prevention

“Pandemic prediction and prevention” is the organisation and management of appropriate measures (scientific, technical, economic, and political) as distinct from “pandemic preparedness or containment or mitigation”, which largely seek to reduce the severity and negative impacts of pending or established pandemics. Pandemic prediction and prevention seeks to:

• Reduce causes of new infectious diseases.

• Prevent outbreaks and epidemics from becoming pandemics.

• Prepare for potential future pandemics that could not be prevented.

• Ensure that the causing virus does not re-emerge thereafter (e.g., by sustaining itself in domestic animals).

The proposed strategic pandemic prediction and prevention is a multi-level inter-communicating structure comprising:

Under the UN umbrella, creating a new “World Environment Organization” (WEO) to respond to the nascent extreme climate change. WEO would have the power to censure countries for failing to keep with their commitments and pledges regarding the environment. Regretfully, its work may be hampered in several ways including: relying on countries to timely report outbreaks, assuming these countries will heed its advice and recommendations, and countries may not legally commit themselves to take appropriate remedial action when it comes to ill-defined pandemics.

Under the auspices of the World Health Organisation (WHO), establishing a legally-binding “International Pandemic Treaty” (IPT) to better prepare the world for the next pandemic. The IPT would prevent countries who are doing vaccine research from maintaining intellectual property on important technologies. Sadly, despite the hoped-for existence of an IPT and a commitment to the principle of equitable allocations, member countries will regretfully not learn from past history and return to their past behaviour (competing with each other for supplies) when the next pandemic strikes.

Shifting the current health paradigm to the new “One-World/One-ecoHealth” paradigm that will be grounded by the IPT and other international laws while at the same time developing the needed infrastructures and the national/ regional/ international organisations to pursue this global health agenda.

Involving international, intergovernmental, regional, and national health organisations.

Incorporating the Global Human Virome Project (GHVP) to help identify the bulk of the viruses that threaten us (more than 1.5 million mammalian and waterfowl viruses) of which 631,000 - 827,000 unknown viruses might be zoonotic with the potential to infect humans after spillover from host animal populations. GHVP offers a pathway to improve our capacity to detect, diagnose, and discover viruses that potentially pose threats to human populations, could provide an early warning of future threats, data to improve prevention and reduction of these threats, and inputs for advance preparation of responses for unexpected outbreaks of unknown diseases.

Actively developing pandemic models (epidemiological, climate-type) with the enabling technologies, and databases.

Folding-in the development of vaccines & therapeutics by designing a globally-coordinated vaccine surveillance system for monitoring vaccine changes predicated on new SARS-CoV2 virus variants, and inform and advise national authorities and vaccine companies.

Accelerating pandemic research for a better understanding of how pathogens spread and cause disease, and to generate safety and efficacy data to support regulatory decisions on clearance, approval, licensure, and emergency use. (Figure: 1)

Summary and conclusions

COVID-19 has evidenced the current poor state of global health. Ten intertwined cardinal socio-ecological factors have been identified as the root causes of pandemics. A pathway and a blueprint have been presented for pandemic prediction and prevention that could be gauged by four identified measures. Within that blueprint, a stage could be reached wherein future pandemics could be predicted and prevented. The creation of a new World Environmental Organization, a new International Pandemic Treaty, and a shift to a One World-One ecoHealth paradigm have been advocated. It must be emphasized the the cost of failing to control outbreaks, ruining and losing lives, destabilising the social fabric, and decimating economies is considerably greater than the cost of prediction and prevention.

References are available at www.asianhhm.com

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