Infectious disease expert Dr. Mark Kortepeter warns that we cannot have short pandemic memories and must continue to invest in public health infrastructure, education and science so that the cycle doesn’t repeat.
We have seen a sustained decline in Covid infection reports across the United States, despite relaxed countermeasures and slow downs in individuals receiving vaccination. In the meantime, we watch with cautious interest the surges occurring in parts of Europe fueled by the new Omicron BA.2 variant, which is also rising rapidly in the United States. As I monitor the events elsewhere with guarded optimism, hoping we might avoid yet another wave in the U.S., we should remember that hope is not a plan. Here are some key lessons about pandemics that we learned the hard way during Covid that we should be mindful of for future pandemic deterrence.
1) We have short memories. Despite the surges ongoing elsewhere, Congress has not approved new funding for Covid tests and vaccines. Whether it is for Covid or the next threat, we need a sustained investment in our public health infrastructure during the inter-pandemic period. One key aspect is maintaining a “warm base” of infrastructure to conduct clinical testing of countermeasures that can be expanded when the “balloon goes up.”
2) If we think we are prepared, we need to think again. Prussian Field Marshal Helmuth von Moltke the Elder is credited with the quotation that “no plan survives first contact with the enemy.” We learned this over and over with Covid that we were not prepared. Our preparedness plans need to include the flexibility to adapt in real time during the actual event. This also includes educating the public to understand that what we know about the pandemic will change over time, which will then necessitate changes in strategy.
3) Viruses move faster than our ability to respond. Once the factors align favorably for an outbreak or pandemic, things happen very quickly and often unexpectedly. It takes too long to spin up the response after the fact.
4) The oceans don’t protect us. In the pre-flight era, oceans provided some buffer or delay in the transmission of contagious diseases, especially if combined with ship quarantine. This is no longer the case, as someone can be infected overseas and arrive at our shores completely asymptomatic in a matter of hours, and they can be spreading infection within days. We saw this with Covid. We saw this with Ebola. By the time we even contemplate closing borders, contagion is already spreading.
The poet John Donne wrote, “No man is an island.” We live in an increasingly interconnected world, must maintain awareness of what happens elsewhere, because it can certainly come here. How do we prepare? We need to partner with other countries to reinforce disease surveillance systems that are sensitive enough to discern unusual events, but not so sensitive as to overwhelm us with false alarms. Having such a “window” into disease activity affords us the opportunity to fine tune our planning with each event, regardless of whether it lands on our shores.
5) The population has to be part of the solution. Our public health measures will fail without buy-in of the population. Sadly, the Covid experience has primed a significant minority of the population to resist countermeasures and mistrust the government. No doubt, they will be more reluctant in the next round. How to handle this needs to be planned in advance by harnessing social media, investing in trusted communicators, while at the same time finding ways to discredit and hold those accountable who deliberately spread mis-information.
6) We must maintain a robust science base that makes broad investment in response capabilities. Our Covid countermeasures like mRNA vaccines and monoclonal antibody treatments were grounded in innovations that preceded the crisis by a decade or more. Even then, they are not perfect. Nonetheless, they were generated rapidly, distributed widely, and caused significant risk reduction for the population amid a crisis. The next round, we may be dealing with an agent that we have not seen before or for which we have even less ability to respond. Therefore, we need to invest widely in broad capabilities against a variety of diseases that have pandemic potential as well as those that might be used against us in a deliberate act of bioterrorism.
We have seen the vicious cycle repeat itself with Covid several times – where we reduce countermeasures only to experience another punishing wave of disease shortly thereafter. As George Santayana once noted, “Those who cannot remember the past are condemned to repeat it.” Perhaps we will dodge a bullet this round, perhaps not.
My friends in the film business are fond of saying that “No one knows anything.” A studio can spend millions producing a blockbuster movie only to have it flop. Similarly, they can spend peanuts on a low budget film that hits the jackpot. No one can predict the success of either outcome in advance. Similarly, with pandemic planning, we have no clue what is coming next. We need to acknowledge and be humble about that in order to plan effectively for the unexpected, which is certain to come again eventually.
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