April 10, 2023
JAKARTA – In a previous opinion piece, I argued against complacency and for continued vigilance, as the COVID-19 pandemic is far from over. While there is much talk of the Sars-CoV-2 virus becoming “endemic” in most countries, there is still some confusion about the meaning of the term with some experts warning that “a disease can be endemic and both widespread and still deadly”.
But perhaps a more important and interesting question is when, and in what form, will the next pandemic take place?
The 21st century alone has seen at least seven pandemics at approximately two-to-three-year intervals beginning with the original SARS virus in 2003 (SARS-CoV-1), so the question of the next pandemic is centered on “when” and not “if”. On reflection, many lessons have been learned during the COVID-19 and other past pandemics, which could help us better prepare for, and respond to, the next pandemic. Four key lessons learned are particularly important in helping us forecast or predict the next pandemic.
First, what may cause the next pandemic? The next global pandemic will most likely be caused by a zoonotic virus referring to an infectious disease that is transmitted between species from animals to humans. Such a virus will likely originate in bats or other small mammalian species that have somehow “spilled over” to human populations.
The virus is likely to have RNA, rather than DNA, as its genetic material, as RNA is known to be rather unstable genetically, is often segmented and can undergo many mutations, which give rise to multiple “quasi-species” or variants as was seen with the SARS-CoV2 virus, as well as the potential for recombination between viral strains. Likely candidates for causing the next pandemic include coronaviruses, influenza and perhaps the Nipah virus. The recent upsurge in influenza cases globally is perhaps an early warning sign.
Second, where is it likely to occur? It is highly probable the next pandemic will originate or happen at tropical latitudes and middle altitudes in regions particularly affected by climate change and global warming. Within these regions, the pandemic will most likely emerge in an area of high human population density. It is a fact that most epidemics in the past 80 years or so have occurred or started in large urban centers.
In this regard, it is a source of concern that 60 percent of the global population is estimated to be going to live in urban areas by 2030. Another study found the rise of megacities was particularly seen in Northeast Asia, Southeast Asia and South Asia where 74 percent, 65 percent and 55 percent of the population respectively will live in cities by the year 2050.
Two salient facts are important. In a well-cited study analyzing infectious disease outbreaks from 1980-2004, it was shown that “hotspots” of such outbreaks occurred in lower latitude regions, such as tropical Africa, Latin America and Asia, which, coincidentally and worryingly, also have weaker surveillance and response capabilities compared to the developed countries of Western Europe and North America.
Third, how will it spread? The next pandemic will likely be spread through respiratory transmission with human-to-human transmission occurring through the airborne spread of the virus, perhaps the most efficient mode of spreading an infectious agent. With global travel rapidly regaining pre-pandemic levels, infection during the next pandemic will no doubt spread rapidly with human travel around the world.
Fourth, how would human populations be affected? As with the COVID-19 pandemic, hopefully, vaccines would become rapidly available and quickly deployed, but it is important to consider vaccination may lead only to transient immunity following infection, as has been observed during the COVID-19 pandemic.
Most importantly, and as was starkly illustrated during the COVID-19 pandemic, the next pandemic will once again disproportionately affect people living in developing countries. Populations all over the world will also, once again, be severely affected by disruptions in global trade and supply chains.
Finally, how can we better prepare in light of the above?
First, continued surveillance of potential pathogens, especially in cities and, crucially, at the animal-human interface, is particularly important as the foundation of an early warning system. Such an early warning system should be based on sophisticated technologies such as genome sequencing and artificial intelligence and big data analytics, but must also take into account local knowledge, which may be equally crucial in flagging potential outbreaks before they spread beyond national borders.
Second, health systems must be on continuous alert for rapid response to any crisis. This includes sufficient healthcare capacity and facilities; personal protection for frontline healthcare workers; surveillance and contact tracing of infected cases; the ability to quickly ramp up vaccination and provision of booster doses; and, importantly, effectively countering misinformation and fake news through timely and targeted communication strategies.
Third, global international cooperation and solidarity is another key requirement and should be based on trust, transparency and a commitment to collective action and backed by adequate resources as envisaged in the launch of the Pandemic Preparedness and Response Fund by Indonesian President Joko “Jokowi” Widodo during the Group of 20 Summit in Bali in November 2022.
Together with ongoing discussions on the development of a global pandemic treaty, such a fund could be an important step to bolster the world’s preparedness for future pandemics. A global, rather than a purely national, outlook is critical as “no one is safe until everyone is safe”.