Lessons from Covid

David Dodwell says governments and non-profit groups are backing a global plan to contain future pandemics, but it will only succeed with China on board

It is depressingly ironic that, as protesters across major cities in China press top leaders to bring to an end the ineffectual cycle of testing and lockdowns that keeps the world’s secondlargest economy in thrall to the Covid-19 pandemic, a coalition halfway across the world is laying plans to protect us from the next one.

Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations (Cepi), last week launched the organisation’s “moon shot mission” – to put global surveillance in place that can provide the earliest possible warning of “Disease X”, and to develop international cooperation that enables us to administer safe and effective vaccines within 100 days of first detection.

The Cepi initiative seems worlds away from the forlorn whack-a-mole tactics of China’s antipandemic forces, which have traumatised the economy and ruined the livelihoods of millions.

And herein lies a profound problem: Cepi’s mission – ambitious and essential as it may be – is likely to be stillborn until China joins it. While Beijing retains its battle for “dynamic zero-Covid”, it is unlikely to join efforts to tackle future pandemics.

As the original epicentre of Covid-19, and potential home to many of the “Disease X” threats of the future, it must be self-evident that the intensive global cooperation needed to protect us from future epidemics will be missing until China joins.

The starting premise of the Cepi team, funded to the tune of US$3.5 billion so far by the Bill and Melinda Gates Foundation, the Wellcome Trust, and 30 governments worldwide plus the European Union, is that the price paid for the Covid-19 pandemic was so catastrophic that a repeat must be avoided. It calculates that Covid-19 will have cost us at least US$28 trillion worldwide by 2025, with at least 6.2 million dead and 400 million jobs lost.

While it acknowledges that future pandemics are inevitable, it believes that lessons learned over the past three years have the potential to avert much of the damage, and enable a much speedier recovery.

First, we will need to develop “distributed early warning systems”. Second, we will need to ensure pervasive information sharing. And third, we must fast track vaccine development to get jabs into arms worldwide as speedily as possible. Cepi says this is “doable”, but will require international cooperation.

The first task is what Cepi calls “sentinel surveillance”: a comprehensive global network for early detection and alerting, perhaps built on health “weather maps”. Promisingly, the US Centres for Disease Control has opened a new centre for epidemic forecasting.

Hatchett notes that the World Health Organization has identified 260 viruses that present known epidemic threats and need to be tracked, with these grouped into 25 viral “families”. He says Cepi would aim to develop “prototype vaccines” in all of these virus families to ensure speedy vaccine development if a threat emerges. This would allow us “to know the unknown enemy”.

This approach was partially adopted following the outbreak of Covid-19, which enabled vaccine makers to have a jab ready for use within a record

326 days (the previous vaccine development record, tackling a mumps outbreak in 1963, took 1,800 days – almost five years).

Based on lessons learned during the battle against Covid-19, Hatchett insists that the time from discovery to vaccination can be 100 days. He recalls that by day 100, after the recognition of Covid-19, there were just 2.3 million cases worldwide, but by day 326 this had risen to 68.7 million.

To compress the time taken in clinical trials and testing, Cepi says we will need a “calculated shift on clinical trials and regulation”. It proposes a global network of clinical trial sites and laboratories that agree to the same protocols, and pre-enrol “readyto-go” groups of people in different regions, countries, age groups and ethnicities.

“We have the tools. We know what needs to be done,” says Cepi. All we now need is comprehensive multilateral cooperation – which over the past three years has been dangerously lacking.

It is noteworthy that, for 10 years up to 2019, the US had in place a programme called “Predict” which was taking virus samples from animals around the world in the pre-emptive search for new viruses.

But in the final months of 2019, just as the first case of Covid-19 was being discovered, the programme was shut down by then-president Donald Trump. While our scientists have the tools, and know what is to be done, our politicians are even now capable of frustrating our best efforts.

We have paid an appalling price for the wilful politicisation of Covid-19, sometimes with more political focus on blame-games and recrimination than on the urgent international cooperation needed to control the virus. Cepi may have an intelligent 100-day plan. But it is the politicians that will enable us to follow it.