How do we prepare for the next pandemic?

Should the next pandemic come to pass sooner rather than later then governments and the World Health Organization, the UN agency responsible for keeping us well, will once more be thrust into the spotlight. Chris Smith been speaking to Maria Van Kerkhove, who leads the World Health Organisation’s work on emerging diseases, beginning by asking her whether another pandemic was inevitable...

Maria - It isn't a matter of if, it's a matter of when, which is why pandemic preparedness is so important for governments and organisations like mine, like the World Health Organization. It is important that we are ready. We are agile, we can act rapidly so that we could prevent these from happening if possible. But if we do see events like outbreaks and epidemics, we have the possibility to mitigate them, to limit their impact on a global scale.

Chris - Now, people like yourself have been saying that for a very long time, but we still got caught out by COVID. Why?

Maria - Well, there's a number of reasons why we were caught out. I mean, I think the world was preparing for an influenza pandemic, and influenza is something that we expect to circulate and to change and to have pandemics from. But we've never had a pandemic from a coronavirus before. And people like me here at the World Health Organization and in institutions around the world are preparing for things like this. But governments are dealing with so many different challenges for their populations. Infectious diseases are one of them, but infectious diseases emerge in the context of many other challenges. Like war, earthquakes, fires, economic crises. So it's not something that everybody is at the ready for at any moment of any day.

Chris - But surely the learning points in the last three years argue we're not doing enough, and we should be.

Maria - Absolutely. I mean, I'm not saying that that's right, that we're not ready for this. And I think we have globally learned so much from the COVID 19 pandemic. We've learned the ability to act fast and to rapidly mobilise what you have in your country. Whether it's about surveillance, to be able to identify cases. To make sure that they're cared for properly, to have clinical care, to have testing available to ensure that patients who need to be treated have access to therapeutics. To make sure that we have systems in place to not only develop safe and effective vaccines, but to actually use them. So we do need governments at the ready. And I think the trauma that we've all lived through in the last three and a half years, it's still fresh in our minds. It's something we have to use to propel us to keep up the momentum. The world's capacities to deal with pandemics have greatly improved in the last three and a half years. The challenge right now is the political will and the financing to keep up that momentum and to sustain the gains that have been made during COVID 19.

Chris - What changes has the World Health Organization made off the back of COVID?

Maria - We are a member state organisation, which means we work for governments around the world. We work for everyone everywhere. And what we try to do is to support governments in building capacities and sustaining capacities. We are working with all countries around the world to see how their response to COVID, where they were operating in a crisis mode, how the work can be calibrated to meet the needs of COVID right now because COVID isn't gone. But also the next threat is that, some of which we know some of these pathogens that are circulating, but there may be a new pathogen that's out there. We've worked to increase capacities from a scientific level. For example, say the development of safe and effective vaccines to make sure we have better production capacities around the world, not just in high income countries or in one particular part of the globe, but to make sure that there are more companies that can actually produce these safe and effective vaccines. And we're working not just on the scientific side, but also on the political side, to have statements from political leaders to ensure that we are much better prepared for the next one. And so these high level political statements, which may not sound important to everyone, are really historic because these are commitments shown by world leaders that we have to do better the next time. It's not just about a handshake saying we could do better. We have to do better the next time because these devastating impacts that COVID 19 demonstrated showed that we have to be much more collaborative. We have to be cohesive and equitable in our approach to not only responding to pandemics, but also to preventing and preparing for them.

Chris - Are all governments coming to the table and cooperating, or have we got any weak links in the chain? Are there any areas where we need to bolster our response and our presence as an international community, a medical community? Because obviously those are the places, if they're a weak link, where they're ripe for something like this to either take, hold or start in the first place.

Maria - That's a very complicated and important question with many different components. Countries are coming to the table to have this discussion. We've all gone through this collectively, and there is a willingness to ensure that we leave the legacy of COVID better than we started. There are a lot of weak links, not necessarily by countries, but by topic. You know, if we look at surveillance, do we have good surveillance around the world to detect the known pathogens that are circulating or could be circulating? And the next one, the next 'disease X', as we call it, which represents an unknown pathogen, and COVID 19 was disease X. So the next X we say is out there. We've worked really hard to ensure we have better supply chain management, better scientific achievements in terms of collaborations and addressing some of the unknowns about these pathogens, how they circulate, where they circulate, who they impact. A very big gap we have right now is around equity and access. And that is something that we need to continue to work on. So it's not only important that we have medical countermeasures, that we have diagnostics, therapeutics, vaccines, we have personal protective equipment. We need to make sure that the use of these life-saving interventions are available to those who need them most. We need equitable access to these materials around the world, and we have a long way to go to achieve that.

Chris - One thing that you haven't put on your list, there is the issue of information sharing and transparency. And the last time you and I spoke to each other, you were making international headlines because you'd penned a fairly forceful piece in a major scientific publication calling out what you saw as bad practice on the part of information sharing from China, who had not revealed quite a lot of information about what they clearly knew about the early days of the pandemic. What's happened in the aftermath, if anything, of you saying that?

Maria - Information sharing is a critical one. We think about surveillance or we think about data gathering on patients and clinical management. All of that information that exists in a country, in a hospital, in a market, you can pick the location. It's only as good as it is shared, meaning that if it's kept amongst those individuals that collect that information, it is not shared for discussion with other disciplines, with other institutions, with other countries, we can't learn from it. We work on the foundation of strong science collaboration, because none of us work alone. No matter what institution you work for or what discipline you come from, you work with others, you collaborate with others. But we need to have trust amongst individuals, between countries, between institutions, between individuals. And we need transparency. I think on a global scale, there are a lot of efforts to increase robust data collection. So better data collection, not just more, but to be able to share that in a way that leads to action. So yeah, I did pen a pretty strong piece, but I've been speaking like that for quite some time. We, as the World Health Organization, can only act on the information that we have. And for the most part, we have a lot of collaboration, a lot of information that is shared. If we think about the next pandemic, we need strong surveillance in animal populations at the animal human interface in people. Because many of these diseases that we're talking about are zoonotic, what we call zoonotic, meaning they transmit between people and animals. And if we don't have strong surveillance, then we don't have the ability to detect something fast. But if we don't have that information shared, we won't have any visibility on what is actually happening, which means we will not be able to limit the impact of these spillover events. And what I mean, spillover, I mean the transmission of these pathogens from animals to humans. This happens all the time and it doesn't cause an outbreak or an epidemic, but sometimes it does. And when it does, we have to be ready.