Five years after the pandemic, the world is poorly prepared for another one

Anthony Staines for The Conversation

Dublin: In Europe ten people died from measles in 2024, and the US has had several major outbreaks. Bird flu has affected dairy herds in 17 US states from North Carolina to California and has just been reported in cats.

So far, it is reluctant to spread among people, although people can both get it and give it to animals.

Between 500 and 1,000 people globally are now dying every week from COVID.

This winter, healthcare in much of the developed world has been hit by a combination of flu, respiratory syncytial virus (RSV) and COVID, leading to rising hospital admissions and deaths. We don’t have real control of any of these diseases.

In the last 60 years there have been four pandemics – a million dead from flu in 1968-69; 774 people dead from Sars-1 in 2002; 7 million dead from COVID since 2021; 280 dead from mpox since 2022.

I’m not sure we are more ready for the next pandemic.

We are not controlling the diseases we can control. There have been cases of polio in children in Gaza and in young adults in New York. This is a disease that was nearly eliminated from the world.

Children are hospitalised with measles every day in wealthy countries. Many are very ill, some are left with brain damage and some die. Measles also came close to extinction but came back as vaccination rates fell.

Cotton Mather (a Puritan cleric) and Lady Mary Wortley Montagu introduced smallpox variolation (an early, crude form of vaccination) to the west in 1721.

The practice attracted controversy because of its danger and the immorality of deliberately infecting people.

Anti-vaccination arguments have continued to run ahead of the evidence of benefit ever since. Partly as a result, we have not yet controlled measles or polio.

There are vaccine side-effects, but these are much rarer and much less serious than those from the diseases. Vaccine safety is closely monitored and for good reasons – vaccines are given to people who are not ill.

Other simple measures were described by US Supreme Court justice Samuel Alito in 2020 as “previously unimaginable restrictions on individual liberty”.

There were cases during the peak of the COVID pandemic, where people who wore masks in public were harassed.

Lockdowns and other restrictions on mobility were much more intrusive, but there is clear evidence that both worked and people and economies benefited as a result.

Public health measures did control Sars-1, mainly because governments, public health teams and doctors got on top of it very quickly. They used the same approaches that have been used to control other severe outbreaks, including strong restrictions on movement.

Neither mpox nor COVID was controlled. In both cases, global responses were late, underfunded and slow and became the target of political attacks. In the case of mpox, it was initially thought, wrongly, only to affect gay men, and hence of limited significance to others. As a result, not enough was done to halt its spread early in the outbreak.

Many unscrupulous people took advantage of the COVID pandemic, selling useless remedies for the condition, such as bleach, hydroxychloroquine and ivermectin.

There were also campaigns promoting conspiracy theories about the origin of the virus, such as suggesting a deliberate release of an engineered virus, the purposes of the public health measures and the effects of the vaccine.

This made it very hard to deliver serious public health messages and interventions, especially to marginalised groups such as immigrants, poorer people or people with literacy challenges.

Experts are planning for pandemic bird flu, which may happen, but I fear that the next big one will be a virus we have yet to meet. It is critical that we have flexible plans to deal with something besides flu. Unfortunately, a combination of war and toxic politics is reducing our ability to develop and deliver these plans.

To deliver anything effectively, we need to strengthen global public health, including the World Health Organization and the US Centres for Disease Control and Prevention, which are both under severe threat to their future funding, as the US shrinks and rearranges its own agencies, and with Argentina’s plans to leave WHO.

Grounds for hope There are grounds for hope. One remarkable outcome of the COVID pandemic was the vaccines.

Most people in public health and vaccine studies thought it would be three years, at best, before a vaccine became available. It will be crucial to maintain the research base and the tools for fairer mass production of new vaccines for whatever happens next.

Two innovative UK studies – Recover and React – also showed a way forward for future pandemics. Recover provided a frame for doing quick drug trials on sick people, including finding that a cheap, safe medicine called dexamethasone worked to treat severe COVID, and provides a model for future clinical care for new infections.

React monitored the spread of the disease and its effects on UK communities. We need to maintain this capacity for smart, focused and timely innovation so we can quickly respond to whatever nature throws at us.

Most of all, we need politicians who will lead by example, giving clear messages about vaccines and other public health measures. We need a global understanding that if I have an infectious disease, that puts you and your family or country at risk. The virus does not care where you were born, what you believe in, or your political views.

In brief, we have the tools, the skills and the people to respond effectively to another pandemic. The outcomes of COVID and mpox were poor. Unless we improve delivery and leadership, we will fail to control the next pandemic too.

If we look at ourselves as a virus sees us, nothing more than tools for making more viruses, perhaps we can learn a bit of humility and get ready, together, for the next one.

Anthony Staines is a Professor, Health Systems, Dublin City University