COVID-19 isn’t the world’s first pandemic, or its last.

“This [SARS-CoV-2] is the big one of the last hundred years, but we’ve had others, and we’ll continue to have others, I’m sure,” says Dr. Bob Bollinger, professor of infectious diseases at Johns Hopkins University and founding member of emocha Health, a health care technology platform.

The devastation and heartache COVID has caused is hard to quantify or overstate. But it is important to acknowledge the global collaboration that brought COVID-19 testing and vaccines to market faster than many thought possible. It is also important to reflect on what went right — and wrong — with the world’s pandemic response so governments, private entities, scientists, health care workers, and the public can be better prepared for the next one.

Preventing zoonotic infections

Three out of every four emerging infectious diseases are zoonotic, meaning caused by germs that spread between animals and people, according to the U.S. Centers for Disease Control and Prevention (CDC). Although the evidence is not conclusive, studies suggest SARS-CoV-2 is a zoonotic infection that most likely started in bats.

Zoonoses occur all the time, but “they don’t all turn into pandemics that cause this much mortality, morbidity, and destruction,” Bollinger says. A perfect storm of factors made COVID so deadly, including that it is an easily transmittable respiratory illness.

Amit Kumar, PhD, a researcher, scientist, and CEO of Anixa Biosciences

“Prohibiting wildlife trade markets is a first step [in preventing pandemics] since pandemic diseases like COVID, Ebola, and HIV are zoonotic diseases that eventually burden humans,” says Amit Kumar, PhD, a researcher, scientist, and CEO of Anixa Biosciences, a biotechnology company focused on the treatment and prevention of cancer and infectious diseases.

Kumar adds that creating rules is one thing — they also have to be enforced. “China prohibited these markets years ago after SARS arose in 2003. Over the years, with black market activities and eventually open markets, SARS-CoV-2 arose due to poor enforcement.”

Wet markets — marketplaces that sell fresh meat, fish, produce, and other perishable goods — are important food sources in many countries; eliminating them entirely may not always be possible or advisable. Epidemiologists stress the importance of regulations. Experts say commercial chicken and hog farms should also be controlled, as they are ideal environments for transforming and transmitting potentially dangerous pathogens.

We also can mitigate the risk of the next zoonotic infection through global collaboration. In Boston, Tufts University School of Medicine is leading Strategies to Prevent Spillover (STOP Spillover), a global initiative to identify and stop the spread of emerging viruses. Working with the United States Agency for International Development (USAID) and partner institutions, scientists will target zoonotic viruses in 10 high-risk countries in Africa and Asia, and create plans for identifying how outbreaks occur, mitigating risk and preparing health systems for future outbreaks.

Platform technologies key to defense
A number of technology breakthroughs should help us weather the next outbreak, including diagnostic platforms that allow scientists to quickly adjust COVID-19 tests for other viruses, and vaccine platforms for rapid vaccine design, including messenger RNA, or mRNA vaccine platforms. We are also getting better at identifying potential pandemics before they start.

“Inexpensive sequencing technology and high-powered computing enabling sophisticated bioinformatics are perhaps the most relevant technological advances we have to identify potential pandemics,” Kumar says.

These tools help global organizations, including the World Health Organization (WHO), CDC, National Institutes of Health (NIH), and the MRC Centre for Global Infectious Disease Analysis run surveillance programs to detect new viruses in people, animals, food, and water, explains Bollinger. This is the strategy that helps us design the influenza vaccine before flu season starts.

Continuous improvements in big data analytics should also improve our pandemic response strategies, as we can use computer modeling to more effectively allocate resources and improve testing and contact-tracing strategies.

Bollinger adds that more investment in antiviral research is important, and Kumar cautions the next pandemic may be caused by antibiotic-resistant bacteria.

A global approach to pandemic preparedness

Pathogens often emerge in places where sequencing tools are unavailable, making global collaboration imperative. Kumar says COVID-19 taught private companies, government entities, and nonprofits “to move fast and collaborate.” This mindset will be key when we face another global health crisis.

Kumar’s dream is to create a worldwide monitoring network. “We could pick a few thousand hospitals throughout the globe and place sequencers in those hospitals. When an ill person came to the hospital, as a matter of course, the pathogen could be isolated and sequenced, with the sequence sent to a centralized worldwide facility to be examined, tracked, and monitored.”

When a new pathogen is detected, the geographic area where it emerged would be temporarily locked down. In theory, a system like this would have identified hotspots like Wuhan, China, and Milan before the virus spread to the United States. Kumar says this system is “only a dream” because it would take cooperation between nations, and “a willingness to shut down a particular region for the good of the planet.”

Investing in health, science, and the public’s trust

To understand and prevent human and zoonotic pathogenic threats, we need to increase public research funding for basic infectious disease research and invest in ongoing disease surveillance, notes Mary Premenko-Lanier, PhD, director of immunology and virology at SRI International and associate professor at Samuel Merritt University.

“Infectious disease surveillance is not a money-making business and the public health agencies must be given adequate funds to monitor for potential zoonotic jumps of pathogens into humans,” she says. “The support for infectious disease monitoring must be supported at all levels — local, state, country, worldwide — and sustained. It could be years to decades until the next pandemic. Countries must work together, use each other’s strengths and recognize they cannot go at it alone in this modern era.”

Premenko-Lanier says the United States should take several steps to fare better against a future virus, including: stockpiling essential medicine, personal protective equipment, ventilators, and other medical necessities, and investing in infrastructure to support contract tracing and emergency response efforts. Fostering the public’s trust in science and the public health system is equally important, he says. He believes this requires the scientific community and government to take accountability for missteps, as well as communicating what went right.

Bollinger notes the importance of instilling trust in science and curbing the dissemination of misinformation.

Perhaps the most important strategy in pandemic preparedness is ongoing collaboration. The successful deployment of COVID diagnostics and vaccines is “a great example of the kind of cooperation and communication we need to reduce the risk and impact of pandemics,” Bollinger says.

The hope is that to protect one another, we will all work together going forward.