Gearing up to pre-empt, push back pandemics
Executive Director, Foundation for people-centric Health systems
The Covid-19 pandemic is weakening in many countries across the world. Though the caseload is still high, the outcome of those infections — moderate to severe disease and hospitalisation — is relatively mild. Life is returning to near normalcy in many, if not all, countries. People are making possible adjustments to learn to live with SARS-CoV-2. In the months ahead, Covid could transition into an endemic disease. However, the endemic stage would be achieved by different countries at different points of time, depending upon their level of past infections, vaccination coverage and population behaviour. Then, one day, in the coming months, the pandemic would be declared over.
In this backdrop, discussions have started on when the next pandemic will break out. Which pathogen (new or old) may be the cause of the next pandemic? In a recently released book, Bill Gates has argued that the next pandemic could occur in 20 years from now. However, many others argue that thinking it may take another 20 years before the world would face a new pandemic is very optimistic. The gap between the last pandemic before Covid-19 was just 11 years ago, caused by swine flu H1N1 (2009), which happened in 2009-10. Then, between the last and ongoing pandemic, there have been five disease conditions, which were declared as public health emergencies of international concern (PHEIC), by the World Health Organisation. Each of the PHEIC has the possibility of turning into a pandemic. Covid-19 was declared PHEIC on January 30, 2020, six weeks before being declared as a pandemic on March 11, 2020.
In different parts of the world, the outbreaks and epidemics keep happening regularly. Then, with every passing day, the possibility of emergence of new diseases and the next epidemic is greater than the previous day. The reasons are multiple: global warming and rising temperatures which result in microbes adapting and surviving to new conditions and places; deforestation and increasing human intervention in forests means new microbes coming into human contact; the rapid and unplanned urbanisation and the dense settlement in cities contribute to speedy spread of infections. Faster and better air travel connectivity ensures that a human being (and a pathogen) can travel from one part of the world to another in less than 24 hours.
Let’s understand how rising temperatures and climate change increase the likelihood of future pandemics. A study in the prestigious journal Nature has estimated that if the earth’s temperature rises by 2°C in the coming 50 years, the chances of epidemics will increase manifold. The study says that increasing the temperature by 2°C would mean that the wild animal species will be forced to settle in new areas closer to human settlements. If that happens, the disease-carrying germs will also get into contact of humans. In that scenario, by 2070, 10,000 to 15,000 new germs (bacteria and viruses) which were previously confined to animals and forests would come into contact with humans. Thus, since all these microbes will be new, humans will have no prior immunity, which will increase the likelihood of disease spread and epidemics.
The linkage between global temperatures and the spread of diseases is not a new revelation. It has been established for a long time that human, animal and environmental health are intertwined. According to a scientific estimate, every year, 13 million people around the world are dying from environmental factors that are avoidable. It has to be understood that when forests are cut for indiscriminate development, then these microbes easily come in contact with humans. The Covid-19 pandemic is another proof of this interconnection and one of the likely sources in the chain of origin of SARS-CoV2 is through forests, bats and animals in the meat market before reaching humans.
This knowledge and understanding should nudge us to act. There is renewed focus on the ‘One Health’ approach which proposes to take measures to protect the health of animals, environment and humans. This is one of the ways and working together at the national and global levels can delay and push the next pandemic forward. There is a great need today to commit to better health for the current and future generations without tampering with the environment. The governments have to ensure that there is no loss to nature in the name of development. By preventing global warming, we can avoid diseases and governments have to take steps together. The citizens and civil societies concerned, elected representatives and governments need to work together. The economic cost of epidemics and pandemics is heavy for any society. With a very small fraction of that cost as investment in epidemic preparedness and response, we can delay the future pandemics.
Epidemics can spread due to many other reasons, and we should be prepared for them too. Every country will have to keep making the necessary preparations to prepare and respond to any future outbreak and epidemics. The vaccine research and development needs to be better funded and prioritised. The capability of diseases and genomic surveillance has to be strengthened at several levels. Governments must scale up public health services, including primary health centres. One of the ways to do so is that preparedness for epidemics must be linked with preparedness to deal with other natural disasters. We cannot stop outbreaks and epidemics completely. However, with the help of modern science, we can prevent a few, delay a few others and reduce the impact of the rest.
