Insight
Life after Covid-19: four ways to prepare for the next pandemic
Covid-19 has given humanity a harsh wakeup call about the lethal impact infectious diseases can have. Vaccines are now rolling out across the globe, slowly but surely signalling the beginning of the end of the pandemic – but how do we avoid the next one? Chloe Kent dives deep into the regulatory reworks that could help us avoid future disaster.
Dealing with epidemic disease is, to an extent, an unfortunate part of being human. The 21st century, with its urbanisation, overpopulation and international trade and travel, has created the ideal conditions for novel diseases to multiply and spread.
From H1N1 and the Ebola crisis to the particularly virulent 2017/18 flu season in the US, mankind has contended with numerous deadly outbreaks this side of the millennium. Covid-19 is by far the most serious, but modern medicine has already allowed industry and governments to make significant progress against the disease, with multiple highly effective vaccines rolling out worldwide.
But even post-Covid-19, there will be future epidemics to contend with.
Science and human ingenuity may have proven themselves worthy adversaries against SARS-CoV-2, but human mistakes are part of what allowed the disease to get out of control in the first place. In many countries, key decision-makers underestimated the virus at the start of the pandemic, meaning crucial opportunities to stop or minimise its spread were missed.
Public health specialist and Numan chief medical strategy officer Professor Sam Shah says: “I think in most governments around the world we probably suffer from a degree of optimism bias. Policymakers were probably too optimistic as to what was going to happen. We did not take the risk and the severity of that risk in the way that we should have done, from a policy point of view.”
The next pandemic could be similar to Covid-19, a zoonotic virus that has spread from animals to humans. It may stem from the threat of antimicrobial resistance (AMR), or a particularly virulent mosquito-borne virus, such as Zika or dengue fever. Either way, there are several key safeguards that may help ensure that the next pandemic can’t wreak the same level of devastation.
Better healthcare integration could help during times of crisis
The NHS in England is currently set to be reformed so that health and care services can work more closely with one another. The restructure will improve integration between NHS bodies, as well as seeing the NHS and councils making decisions about local health together.
According to UK Health Secretary Matt Hancock, this will mean a focus on the health of the population as a whole and not just individual patients. While the opposition has questioned the mid-pandemic timing of the restructure, Hancock has urged that there is “no better time than now”.
Of course, restructuring healthcare systems alone isn’t going to be what stops the next pandemic. But in the UK and worldwide, many healthcare ecosystems are siloed and segregated, making it difficult for clinicians to share information about individual patients or groups.
Many healthcare ecosystems are siloed and segregated, making it difficult for clinicians to share information.
Improving integration and interoperability between different healthcare providers could enable more personalised and efficient delivery of service across the entire network.
Janeiro Digital co-founder and chief technology officer Justin Bingham says: “During times of crisis this would support effective resource allocation across services.
“It would provide quicker development and access to new treatments, and it would improve effective tracking of disease progression on an individual and population level, by making it far easier to spot trends due to the access to more accurate real-time data.”
AMR is a huge threat, but we can stop it in its tracks
Antimicrobial resistance (AMR) is one of the most significant threats to global health, and antibiotic development simply cannot keep up with bacterial resistance. The last time an antibiotic class was successfully introduced as a treatment was in 1987.
The high cost and low returns associated with antibiotic R&D make it commercially unattractive, and the pharmaceutical industry has instead turned to therapies with broader and more profitable indications. Now, we’re looking at trouble.
The US Centers for Disease Control currently lists 18 different types of antibiotic-resistant bacteria and classifies five of them as urgent threats to human health. Antibiotics are over-prescribed to patients and overused in animal agriculture, facilitating antibiotic-resistant mutations of previously treatable diseases.
Some clinicians now even consider AMR itself to be a pandemic.
It’s not just an antibiotic-resistant superbug that could be humanity’s next big healthcare threat – some clinicians now even consider AMR itself to be a pandemic, consisting not of one looming infection but many, all chronic and untreatable.
The UK Government is currently trialling a new subscription-style financial model, which pays drug companies upfront for access to novel antibiotics, to incentivise drug development. Instead of relying on volume sold to generate profit, companies simply need to develop a new drug. Of particular interest are antibiotics that can provide alternative treatment options for serious infections, such as bloodstream infections, sepsis and hospital-acquired pneumonia.
It’s far from the only government stepping into the ring. Alongside the UK Government, the German and US Governments have been involved in the funding of CARB-X, an organisation that aims to invest in the development of new antibiotics to fight dangerous drug-resistant bacteria. Since CARB-X was established in July 2016, it has invested $284.8m in 78 projects around the world.
Tacking zoonotic diseases with the Global Virome Project
The Global Virome Project is an international research organisation aiming to catalogue all the as-yet-unknown animal viruses that could pose a threat to human health.
The organisation’s chair, Dr Dennis Carrol, estimates that there are around 1.6 million unknown mammal viruses currently circulating that could easily mutate to infect humans.
Carrol and his colleagues project that it would cost $1.6bn for 75% of these pathogens to be catalogued by sampling wild animal populations around the world.
Between 1,000 and 2,000 individual animals would be swabbed from each mammal and waterbird species thought to be capable of carrying viruses that may be capable of spreading to humans. This would allow researchers to build a database of animal diseases that pose the greatest risk to humans.
There are around 1.6 million unknown mammal viruses currently circulating that could easily mutate to infect humans.
At-risk communities in potential zoonotic disease hotspots could be more easily identified, and doctors in these areas put on high alert for early warning signs of novel disease spread.
Pre-emptive vaccine research could then begin into the most threatening candidates, giving medics a better chance of stopping any human illnesses in their tracks before they can cause substantial harm.
The Global Virome Project is now working on fundraising from governments, philanthropic foundations and tech companies.
Pharma needs to build trust with the general public
The pharmaceutical industry isn’t exactly known for its stellar reputation – in fact, it’s one of the least popular sectors in the world. Research carried out by DrugsDisclosed.com found that 81% of patients do not feel listened to by pharmaceutical companies and 93% do not trust advice from pharmaceutical companies about their medication.
When people don’t trust the organisations making the vital vaccines that can stop pandemics, there’s a significant risk that uptake won’t be wide enough to end a crisis.
Vaccine hesitancy often stems from an initial lack of trust in modern medicine, particularly when it comes to members of minority groups who have been historically mistreated by doctors. It’s up to the industry to set this right, not only through changes in business practice but through community outreach as well.
Vaccine hesitancy often stems from an initial lack of trust in modern medicine.
This could mirror the work of TruGenomix co-founder and chief scientific officer Dr Tshaka Cunningham, who acts as an ‘honest broker’ on behalf of the medical industry. As a member of the Faith-Based Genetic Research Institute, Cunningham goes into communities of colour – predominantly African American churches – to advocate on behalf of genetics and genomics research and encourage people of colour to get involved.
The way the industry operates on a day-to-day basis also needs to change. The Covid-19 vaccine rollout has scarcely begun, and patent laws and secretive bilateral deals are already getting in the way of equitable distribution.
Incidences such as this further erode the public’s faith in pharma, and all the honest brokers in the world won’t be able to convince the public to trust an untrustworthy system. Public mistrust of pharma companies won’t be what causes the next pandemic, but it could make curbing future outbreaks far harder than it needs to be.
Preparing for the challenge ahead
To a large extent then, preparing for vaccine distribution will mean learning from what’s been achieved so far.
“I think some of it has to do with modelling – you can do a lot of simulation around production and distribution logistics,” says Boyle. “You can plan some ‘what if’ scenarios, at least identifying where the weaknesses are in the system and what kind of stressors would bring down parts of it. Then when you start to see the stressor, you already know it’ll cause a breakdown in the system and you already have a contingency plan.”
In practice, this might mean implementing a regional strategy with some redundancy in the supply chain, giving back-up if a certain country ends up in lockdown.
Delivering billions of doses of vaccine to the entire world efficiently will involve hugely complex logistical and programmatic obstacles.
“Everybody wants to operate at minimum inventory levels and maximum cost efficiency levels, but we’re asking now ‘where does lean become too lean?’” says Boyle. “The risk profile of that position has changed and people are going to be re-examining some of their goals. It’s about ensuring resilience of the supply chain and working out what level of risk you’re willing to take.”
With the first vaccines in sight, it is time for logistics providers, governments, airlines, and many more to begin their preparations in earnest. As the speakers emphasised at the IATA teleconference, this is an enormous undertaking that requires careful planning from every stakeholder.
“Delivering billions of doses of vaccine to the entire world efficiently will involve hugely complex logistical and programmatic obstacles all the way along the supply chain,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “We look forward to working together with government, vaccine manufacturers and logistical partners to ensure an efficient global roll-out of a safe and affordable Covid-19 vaccine.”
