The Next Pandemic Is Right around the Corner — Why Aren't We Prepared for It?

 by wayne persky

Founder and President of the Microscopic Colitis Foundation

The COVID-19 pandemic revealed that our health systems around the world are severely limited by many vulnerabilities. But it also offered valuable lessons that, if heeded, could better prepare us for future outbreaks. Unfortunately, as we emerge from the shadows of the Covid 19 pandemic, signs indicate that we may not be as ready for the next pandemic as we should be. ​

The next pandemic could be right around the corner, driven by factors such as global travel, urbanization, climate change, and zoonotic diseases. Despite the eye-opening lessons that we should have learned from our recent experience, the medical community and the world at large remain inadequately prepared for the next virus based crisis.

The popularity of global travel virtually guarantees that new viral threats can spread rapidly.

In our highly interconnected world, a pathogen can spread from one continent to another within hours. The rapid movement of people facilitates the swift transmission of diseases, making containment challenging. The extensive travel networks that connect major cities also connect pathogens, enabling a localized outbreak to become a global threat in a matter of days.

Populations are concentrated.

The world's population is increasingly concentrated in urban areas, often in densely packed and underserved communities. These settings can become breeding grounds for infectious diseases, where the close proximity of individuals accelerates transmission rates. Poor sanitation, inadequate healthcare infrastructure, and insufficient public health measures exacerbate the risk.

Even climate change is a factor.

Climate change is altering ecosystems and affecting the habitats of various species, including those that carry infectious diseases. As temperatures rise, vectors like mosquitoes and ticks expand their range, bringing diseases such as malaria, dengue fever, and Lyme disease to new areas. Extreme weather events and environmental degradation also displace populations, leading to increased human-animal interactions and the potential for zoonotic spillover.

Zoonotic diseases have become a major problem.

Zoonotic diseases are increasing (Esposito, Turku, Lehrfield, and Shoman, 2023).1 Approximately 60% of emerging infectious diseases are zoonotic, meaning they are transmitted from animals to humans. The destruction of natural habitats and the illegal wildlife trade increase human exposure to animal pathogens. But the migration patterns of many birds, and normal human interactions with both wild and domesticated animals play a huge role in the increasing risks associated with zoonotic diseases.​

So why aren't we responding to the handwriting on the wall?

Is there a problem with our short-term memory? Although the world's response to Covid 19 was robust in many ways, the tragic events that unfolded have not translated into sustained preparedness. As the immediate threat recedes, there is a tendency to return to pre-pandemic complacency. The political will to invest in long-term public health infrastructure and pandemic preparedness wanes as other priorities take center stage. And this complacency will almost surely come back to bite us in the butt.

Underfunded public health systems are a major problem.

Many public health systems remain underfunded and under-resourced. The pandemic exposed significant gaps in healthcare infrastructure, supply chains, and workforce capacity. Despite the fact that we learned these lessons the hard way, investment in public health remains insufficient. Without sustained funding, health systems cannot build the resilience needed to respond to future outbreaks.

Global inequities lead to serious problems.

The disparities in healthcare between wealthy and low-income countries are stark. While some nations have robust healthcare systems and rapid access to vaccines and treatments, others struggle with basic healthcare provision. These inequities mean that a disease outbreak in a low-resource setting can quickly become a global threat due to inadequate containment and treatment capabilities.

We can't seem to get organized.

Effective pandemic response requires coordinated efforts at local, national, and international levels. The COVID-19 pandemic highlighted the shortcomings in global health governance, with fragmented responses and inconsistent policies hampering efforts to control the spread. A unified, coordinated approach is essential for timely and effective response to future pandemics. But due to a lack of agreement, most countries continue to ignore the risks, and kick the can down the road.

The public's trust in government healthcare agencies has declined.

For example, the Centers for Disease Control and Prevention (CDC) in the U.S. made so many missteps during the Covid 19 pandemic that their level of trust by many members of the public has declined significantly, according to numerous survey results. The infodemic that accompanied the COVID-19 pandemic, characterized by widespread misinformation and conspiracy theories, undermined public trust in health authorities and compliance with public health measures. Combating misinformation and rebuilding trust will be critical if they hope to regain public respect so that public health messages will be heeded during future crises.

The last pandemic severely depleted clinical healthcare staffs.

Unfortunately, the quality of healthcare available at most of our healthcare institutions has been severely compromised by major staffing problems, many of which were provoked by the Covid 19 pandemic. Because of burnout, overwork, and various other reasons associated with the pressures caused by the pandemic, many experienced clinicians have either retired, or gone into other lines of work, and healthcare institutions are attempting to replace them with physician assistants (PAs), nurse practitioners (NPs), and recent graduates of medical school.​

But medical schools are not turning out graduates quickly enough to fill more than a fraction of the openings, ensuring that the shortage of primary care physicians (PCPs) will continue for years into the future. Most institutions are also suffering from a shortage of nurses, and this is seen as not just a short-term problem, but most likely a long-term shortage.

An article from Bloomberg Opinion highlights the vulnerabilities

of the U.S. primary-care system in the face of emerging public health threats (The Editors, Bloomberg Opinion, 2024, July 10).2 Despite the diminishing immediate threat of COVID-19, new challenges such as a bird flu strain in dairy cattle, a flesh-eating bacteria outbreak in Japan, and resurgences of diseases like measles and polio underscore the need for a robust healthcare system. However, the U.S. public-health system is ill-prepared for another pandemic due to funding lapses, a demoralized healthcare workforce, and insufficient investment in primary care. The system definitely could not be classified as "robust".

1. We are currently faced with several developing health threats.

• Bird flu is relatively widespread in U.S. dairy cattle.
• Flesh eating bacteria that can kill people within 48 hours are spreading in Japan.
• Diseases such as measles, polio, and dengue are researching worldwide.

​2. Primary care in the U.S. is currently under strain.

• ​Political obstinacy has resulted in a dysfunctional Congress that has allowed once reliable medical funding to relapse.
• The healthcare workforce is depleted and demoralized.
• Although pandemic preparedness legislation was passed in 2022, it lacked adequate appropriations.

3. Primary care is vitally important.

• ​It serves as the first point of contact and includes preventive measures and chronic disease management.
• Regular access to primary care improves overall health and saves money by reducing emergency room visits and other costly services.
• Primary-care workers were crucial during the COVID-19 pandemic for testing, vaccinations, and promoting preventive measures.

​4. The Covid 19 pandemic left us with the following problems.

• Many primary-care practices reduced services or closed during the pandemic.
• Delayed treatments and screenings may have led to avoidable deaths.
• Funding from Congress stabilized some practices, but overall investment remains low compared to other nations.

​5. Projections show the following workforce challenges.

• ​Recruitment challenges and lower reimbursement rates for primary-care physicians compared to specialists.
• Predicted shortage of up to 40,000 primary-care doctors by 2036.
• One-third of Americans currently lack a primary-care doctor.

Bird flu presents an imminent pandemic threat.

A recent study published in *Nature* highlights the complex nature of the bird flu outbreak, particularly the H5N1 virus, in dairy cows (Caserta, et al., 2024).3 The research underscores that while milk plays a significant role in spreading the virus, the situation is more multifaceted than initially believed.

The virus, detected in more than 20% of nasal swabs from cows, has also spread to other species, including cats, raccoons, and wild birds. Some farms reported a significant increase in cow deaths, suggesting the virus might be more severe than previously thought. Genomic sequencing revealed that the virus spreads efficiently among cows and potentially to other species, complicating containment efforts.

Infected cows showed symptoms like decreased feed intake, altered fecal consistency, respiratory distress, and decreased milk production. The virus displayed a specific affinity for the epithelial cells lining the alveoli of the mammary gland. Transmission occurred not only between cows but also between different species, indicating a high potential for cross-species infection.

We're clearly vulnerable.

Unless our legislators manage to break their stalemate, and provide adequate funding for healthcare, their failure to act will almost surely cause U.S. residents to face future health challenges that may well exceed the challenges of the Covid 19 pandemic. And even with adequate funding, it will take time for our healthcare system to resolve its current problems.

With an already very vulnerable healthcare system, the possibility of another pandemic occurring before the system has recovered from the previous pandemic, or worse yet, multiple major challenges at the same time, would almost surely overwhelm our currently compromised health system.

References

1. Esposito, M. M., Turku, S., Lehrfield, L., and Shoman, A. (2023). The Impact of Human Activities on Zoonotic Infection Transmissions. Animals (Basel), 1646. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215220/

2. The Editors, Bloomberg Opinion. (2024, July 10). The US primary-care system can't withstand the next pandemic, some believe. Medical Xpress, Retrieved from https://medicalxpress.com/news/2024-07-primary-pandemic.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter

3. Caserta, L. C., Frye, E. A., Butt, S. L., Laverack, M., Nooruzzaman, M., Covaleda, L. M., & Diel, D. G. (2024). Spillover of highly pathogenic avian influenza H5N1 virus to dairy cattle. Nature, Retrieved from https://www.nature.com/articles/s41586-024-07849-4