Anticipating The Next Pandemic

There is no guarantee that the next pandemic will involve a respiratory virus. The recent proliferation of rodents in Australia suggests that a virus or bacterium carried by such animals might be the next threat we face

By Anil Madan

The journal Foreign Affairs recently republished a 2005 article by Michael T. Osterholm titled Preparing ForThe Next Pandemic. A version of his article also appeared that same year in the New England Journal of Medicine (NEJM). Osterholm is a professor at the University of Minnesota School of Public Health and Director of its Center for Infectious Disease Research and Policy. He is well known to Americans as a frequent commentator on the Covid-19 pandemic since 2020. Osterholm had a dire warning: “Can disaster be avoided? The answer is a qualified yes. Although a coming pandemic cannot be avoided, its impact can be considerably lessened.”

We should not lose sight of the fact that Osterholm was predicting that a strain of the H5N1 influenza virus would cause the next pandemic although he did allow that it could be caused by a novel strain. He reasoned that the increasing incidence of H5N1 infections in both humans and animals, near misses with respect to sustained human-to-human transmission and increases in the pathogenicity of the H5N1 Z genotype due to ongoing genetic changes, and a sort of perfect storm mix of people, pigs, and poultry in Asia was akin to having a laboratory capable of generating the next virulent strain.

Osterholm pointed out that in 1968, when the most recent influenza pandemic occurred, China’s population was just over half of its 2005 population of 1.3 billion. Its pig population had increased from 5.2 million to 508 million and its poultry population from 12.3 million to 13 billion. Undoubtedly, the numbers of pigs and poultry have increased exponentially since although population has been somewhat stabilized at 1.4 million. The rest of Asia was seeing similar changes, Osterholm postulated and he added that the exponential growth in foreign travel meant that we must accept that a pandemic is coming.

And so, it did.

Attentive readers will note that my column is titled ‘Anticipating The Next Pandemic’ rather than referring to preparing for the next pandemic. This is intentional.

The Association of American Medical Colleges (AAMC) has released many recommendations aimed at combating the current pandemic and preparing for future health crises. These are well intentioned but of dubious value. In a September 2021 press release, David J. Skorton, MD, AAMC president and CEO is quoted as saying: “It is not a matter of if there will be another pandemic, it is a question of when and how well-prepared the nation will be to protect communities against the next national public health emergency.”

This is, of course, reminiscent of Osterholm in 2005.

In response to the Covid-19 pandemic, the World Health Assembly requested the Director-General of WHO to initiate an impartial, independent, and comprehensive review of the international health response to Covid-19 and of experiences gained and lessons learned from that, and to make recommendations to improve capacities for the future. Out of this was created the Independent Panel for Pandemic Preparedness and Response. In May 2020, that panel presented its initial report and then followed up six months later, in November 2021 with another report. This was mostly a lament about vaccine inequity. But then the so-called Independent Panel was comprised mostly of aging politicians.

What are we to make of the reports of distinguished healthcare professionals who tell us that the next pandemic is inevitable? Not very much, I submit. Vaccine inequity is a well-recognized problem, but it is notan issue that comes into play until after a pandemic is already in place.

In other words, it says nothing about preventing a pandemic.

Likewise, the AAMC’s recommendations include such blandishments as: “The White House must lead the national pandemic response and ensure coordination among departments and agencies,” and “The federal government must engage industry and research universities at the outset of the next public health emergency and commit to purchasing diagnostics, therapeutics, and vaccines in advance.” As one can see, these have nothing to do with prevention of the next pandemic.

Nor did Osterholm suggest that one might consider reducing the population of pigs or poultry in China. Obviously, I say this somewhat tongue-in-cheek but to point out that given the economics of the poultry and pork industries, there is no solution here.

What is even more frustrating is that the experts really don’t know what they are maybe dealing with in the future. There is no guarantee that the next pandemic will involve a respiratory virus. The recent proliferation of rodents in Australia suggests that a virus or bacterium carried by such animals might be the next threat we face.

We remain woefully unprepared.

Cheerz…
Bwana


Mauritius Times ePaper Friday 13 May 2022

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