Opinion: We need to prepare for ‘disease X’

Opinion:

Late last year, I participated in an exercise that aimed to explore what might happen if the world were presented with a rapidly spreading new disease without warning.

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Several simulated emergency meetings of the World Health Organisation’s advisory board, convened in response to a very serious new pandemic – a threat the WHO refers to as “Disease X”.

The exercise participants included highly experienced current and former health ministers and senior public health officials from nine countries. Urgent events required him to make tough policy decisions quickly with little information. Each decision had huge consequences for society and during the pandemic. It was like this in the initial days of Covid. The same will happen in other epidemics.

Some of the smartest and most experienced international public health leaders had differing, sometimes opposing views, on many fundamental questions about the response. Should he stop traveling in the early days? Should they close schools in affected countries first? If a future pandemic has a much higher death rate than Covid or if it severely affects children, should countries take different, stronger, faster measures to contain it? Top experts don’t agree yet.

These will be very difficult decisions for the leaders. And that is why it is essential to anticipate and prepare for them in advance, to reach broad consensus where it is achievable.

During the peak of the Omicron wave in January 2022, US congressional leaders across the political spectrum were frustrated by the need to change the country’s pandemic response. “We can never let this happen again,” was the repeated refrain.

But a year later, and three years after Covid was declared a pandemic, that collective resolve has waned. The promise of pandemic preparedness in radically new, far more ambitious ways has faded rapidly.

As terrible as Covid has been – it is one of the leading causes of death in the United States – this is not the worst. There are viruses like H5N1 Influenza (bird flu), Nipah and Ebola which have a mortality rate of twice, 10 times or more than that of Covid. Fortunately, those viruses have not developed the ability for efficient human-to-human respiratory spread. One concern is whether a new viral strain with a high mortality rate will also develop the ability to spread rapidly among people. There is growing global concern over the spread of H5N1 in animals – a development that governments must track and prepare for, and which should spur new pandemic preparedness efforts all the more widely.

The world needs to prepare for the next disease X, which is capable of posing a global catastrophic risk. Here’s what it takes to gather what we’ve learned from Covid and transform our preparedness.

We need to get vaccines in arms very fast

Many countries call this commitment the 100-day mission – referring to the number of days it takes to develop a safe, effective vaccine after sequencing a novel pandemic virus. This will require serious investment from governments and close partnerships with private sector vaccine manufacturing companies to set up very fast processes in research and development, clinical trials, regulatory review and more. This will require greater investment in technologies such as mRNA which can be used to screen for a range of Disease X threats. Right now, the bulk of government funding to help develop vaccines and drugs for pandemics is for existing, known pathogens, as opposed to preparing for future unknowns.

We need to make it very easy to develop and distribute tests

Until diagnostic tests are widely available, leaders and the public will continue to fly in the dark in future pandemics. We know now that we need the contracts that exist between the federal government and the diagnostic industry to be implemented quickly, because we don’t have time to start complex negotiations in a crisis.

The Food and Drug Administration needs a clear and established path to rapidly review new tests during a crisis. The Centers for Disease Control and Prevention should be ready to provide immediate clinical diagnostic guidance, and health insurers and the Centers for Medicare and Medicaid Services should be ready to provide rapid and complete coverage for testing is required. Pharmacies, doctors’ offices and community centers should be deployed to conduct rapid tests.

Imagine if everyone could easily get a free test at one of thousands of locations in the first weeks of Covid. This should be the expectation for the future.

We need a strong stockpile of high quality protective gear

Our national supply of personal protective equipment, or PPE, was very low in the first months of Covid, especially when it comes to masks. We need a far stronger and more flexible approach. The US supply chain is still quite vulnerable to disruption because we rely on so many single-use products that contain components from around the world, which many countries may be demanding at the same time in a pandemic.

We need to be in a position where health care workers and all essential workers can quickly get very high quality masks. That means shifting at least a sizable portion of our national high-filtration-mask supply away from disposable single-use ones to reusable respirators that can be worn repeatedly and safely.

We seriously need to change our attitude towards indoor air quality

Just as we expect clean water from our spigots, we expect clean air to flow into our buildings. Better filters, more outdoor air intake and new technologies to reduce pathogen burden should be part of the plan – these things are key to reducing the toll of the virus in future pandemics and overall. The Biden administration provided substantial funding for schools to increase ventilation, but many schools did not make this investment. The administration also launched an effort to improve indoor air in buildings across the country, but much of that plan’s implementation depends on local decision makers, building owners and operators, and better building codes.

We need strong research oversight and laboratory security

It is still unclear what caused the COVID pandemic, and new information and data will be needed to resolve that uncertainty. But without knowing what was the proximate cause of Covid, we must resolve to operate laboratories containing the deadly and infectious virus in the safest possible ways – nationally and internationally.

We need stronger government oversight for that kind of work, along with a framework that balances the proposed benefits with the major risks. The White House and the National Institutes of Health are reviewing these policies, and there are several important changes that, if adopted, would make US policy and practice on these issues safer and more effective.

These efforts are part of a larger set of actions and programs needed to prevent accidental or intentional occurrences of major epidemics and pandemics. That work should include requirements for monitoring or preventing laboratory synthesis of lethal or extinct viruses; a strong national capacity to attribute a novel pathogen to its origin; a commitment to support the Biological Weapons Convention, the international treaty that bans biological and toxin weapons; and vigorous investigation and monitoring of the practice of extracting from remote ecosystems viruses that may have pandemic potential and have never been introduced to people or studied in a laboratory.

CDC needs reset

CDC has essential national pandemic preparedness and response responsibilities as the nation’s top national public health agency. But the pandemic revealed its many challenges, including early testing accidents, complicated public guidance and an inability to collect some of the key data that national leaders and the public needed. The agency needs new officers to quickly collect data, new ability to contract, retain and recruit talent, and new ability to deploy people and funds to state and local public health organizations around the country. will be needed, who will need that help.

CDC needs to act fast to address the crisis in the United States and internationally. Currently, its budget is divided among about 160 programs that are not allowed to change during the pandemic – that has to change. There are some changes in the control of the CDC; Others will require legislative solutions (such as giving it more authority and funding).

TeaThese efforts are not the only ones needed – we also need stronger local public health capacity, stronger support for community organizations doing on-the-ground response work, and more – but they are an important start. And there are upcoming opportunities to act on them.

The Biden administration’s budget request seeks funds to prepare for the pandemic, and Congress must accept it. Congress also has the opportunity to re-authorize the Pandemic and All Threat Preparedness Act this year, and it will strengthen strategic preparedness and Can strengthen administration to respond.

Covid brought to the fore incredible resolve, scientific brilliance, individual and community tenacity and innovation. But even with that, millions have died, hundreds of millions have been sickened, and societies in the United States and around the world have been badly hit back. We are likely to face similar or worse pandemic threats in the future. We need to utilize the time that we have to make major changes in preparedness to save us from challenges that may arise again without warning.

This article was originally published in the new York Times.

Written by: Tom Inglesby

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