Yap Seng Chong/Swaine Chen: Get ready for the next pandemic

SINGAPORE

Outbreaks of infections have long plagued humanity, and changed history. The Black Death ripped through Europe in the middle of the 14th Century, killing a third of the population. Smallpox brought by European explorers helped seal the fate of the Americas 400 years ago. And in a mere four months, COVID-19 has transformed much of life in the 21st Century.

The mortal impact of infections is undeniably important. But even more dramatic are the victories that humanity has won against them. These are less sensationalized, likely because they require sustained, steady effort.

The understanding of aseptic technique began a long battle against surgical bacterial infections; the modern fruits of our success in this battle range from life-saving organ transplantation to cosmetic day surgery. Vaccines have slashed rates of childhood mortality from bacterial and viral infections; this provides reproductive security, driving modern economic development by enabling couples to have fewer children while increasing their education and productivity.

Thus, infectious diseases continue to be enormously significant. Not only can they disrupt cultures and countries, but countering them is a necessary prerequisite to unleash society’s innovative and productive capacity. It behoves us, then, to learn diligently from all infectious diseases.

COVID-19 is the most powerful infectious disease we have seen in the past 100 years. We refer to “power” here not as the speed with which it kills, but its integrated impact on society and the economy. Whole continents have been locked down. The energy of entire industries is being redirected to combat the SARS-CoV-2 virus. This response has been inspiring and further testifies to COVID-19’s unique position in the compendium of infectious threats.

This sweeping mobilization is again supported by sustained past investments in research and technology. In the next pandemic, we will have even more tools at our disposal, some generated during this period. Our response will be even swifter and more definitive, hopefully, but only if we learn from the current crisis, for there will indeed be a next outbreak, a next pandemic, and then others after that. We need to continue steady investment in research and technology. We also need full alignment within society, including politics and economics.

Several large-scale trends have contributed to COVID-19, trends that will make future outbreaks and pandemics more frequent and, possibly, more severe. One such trend is larger urban populations, increasing both density and interactions. A second is increasing global connectivity – both digital and physical. Finally, urban development drives two further complementary trends -- encroachment on previously undeveloped areas, where indigenous animals, plants and microbes previously held sole dominion; and increased demand for and specialization of food production, driving increased agricultural density and efficiency, and the search for alternative foods. There are doubtless other biological and non-biological factors that contributed to COVID-19, but we focus on these as they highlight aspects of a formula that cannot be ignored: Density + Mobility + Ecological Disruption = Outbreak Risk

Looking forward, then, what lessons can we take from COVID-19?

Researchers and policy makers should look at pandemics as a negative externality in which we all suffer the consequences. Countries have used diverse strategies to tackle the COVID-19 pandemic. Even within countries, such as the United States, different regions have responded in dramatically different ways, ranging from vigorously active measures to rather passive ones.

In the short term, we will learn which policies were most effective. In the longer run, we need to incorporate the strategies that worked best into preparations for future pandemics. We observe that, among the many policy debates occurring across the globe, economic imperatives are often placed in opposition to the advice of medical and scientific professionals. We believe that the recognition of negative externalities provides a path towards alignment of the economic and medical perspectives, which could then better recruit political support.

To cement the global learning curve and drive these policy innovations, we further propose that the World Health Organization be deliberately bolstered to organize the global infrastructure for pandemic preparedness in the “peacetime” when COVID-19 subsides. Emerging infectious diseases are a global problem, and we must act collectively as a planet. The next pandemic is just around the corner. We must learn, quickly, from the past and the present to ensure our collective future. 

Yap Seng Chong is Lien Ying Chow Professor in Medicine and Dean of the National University of Singapore Yong Loo Lin School of Medicine.

Swaine Chen is an associate professor at the National University of Singapore Yong Loo Lin School of Medicine, and group leader for infectious diseases at the Agency for Science, Technology and Research’s Genome Institute.

Yong Loo Lin School of Medicine