The Middletown Press (Middletown, CT)
Health experts begin planning for future pandemics
As we head into the fall season booster vaccine uptake is low, children’s hospitals are straining at the seams and the Biden Administration is transitioning back to “business as usual” with respect to how COVID-19 is being handled. It’s a strange combination of familiar pandemic beats juxtaposed with the official winding down of crisis mode.
But as U.S. officials signal that they think the pandemic is over, a new analysis asks people to think about how future outbreaks might be prevented and contain. The article, published in the Proceedings of the National Academy of Sciences, calls for changes in how experts surveil and respond to emerging diseases.
“The real thing about this report is not what went wrong,” said Peter Daszak of the EcoHealth Alliance and one of the study authors. “It’s what we can do now going forwards. How do we stop it in the future? How do we prevent the next one? How can we sight it quickly and stop it from spreading?
Daszak said that globally it is important to identify potential hotspots where viruses may jump from animals to humans, surveil these hotspots regularly and regularly test emerging pathogens for their potential to cause human illness.
“One of our big proposals we call smart surveillance,” said Daszak. “There are a few million of these viruses that have not yet emerged. We’re not going to be able to find everyone but what we can do is go to places where they tend to come from.”
These hotspots would likely be in biodiverse areas where traditionally nondomestic animals regularly meet humans. Daszak said that this would likely be in the growing “wildlife farm” industry that supplies animals for the pet trade and in places where extraction industries like mining and timber are moving into new areas.
The authors further recommend that medical technology like mRNA vaccines be used to rapidly deploy preventative measures once a dangerous pathogen is identified.
This approach, where the connection between wild animal health and human health is taken as a given is called “One Health.” The idea is that there is no dissociation between environmental, animal and human health. In order to help humans, the environment and the animals that live there, must also be healthy.
“One Health has a lot to do with zoonotic diseases,” said Paulo Verardi professor of virology at UConn and member of the university’s One Health team. “We have to consider strategies that take into consideration the animals around us and the environment or the ecosystem in general.”
One Health has its origins in one of the founding fathers of public health, the German physician and social reformer Rudolph Virchow. He argued that there were, nor should there be any dividing lines between human and animal medicine after studying roundworm infections. Virchow, appropriately coined the term “zoonosis.”
Until the 1960s the concept lacked formal organization until veterinarian, epidemiologist and zoonotic disease researcher Calvin Schwabe coined the term “One Medicine” as a way of interrogating the connectedness between human and animal diseases. One Health is an expansion of One Medicine to incorporate the impact of wildlife and ecosystem health on human and domestic animal health.
Verardi said that UConn was pioneering a course about One Health this spring with plans to expand it into a minor the following year. The idea is spread the idea of health connectivity and build a program that promotes this kind of crossdisciplinary health research.
The policies proposed by the EcoHealth Alliance would center these concepts on a global scale, expanding disease surveillance and vaccine development to areas where humans, livestock and wildlife come in contact. The purpose of these policies is to build health, disease surveillance and science infrastructure as insurance against a new pandemic.
Are regimes of surveillance, biosecurity and preparedness enough?
In 2019, the United States was at the top of the charts for pandemic preparedness according to the Global Health Security Index. And after getting the most deaths and infections of any country worldwide and botching the pandemic response in innumerable ways the US still sits at number one. Clearly there is something amiss here.
“The basic model of pandemic preparedness is whack-a-mole as they learn about new diseases,” said Alex DeWaal an anthropologist at Tufts who has studies the politics of disease. De Waal said that One Health was pushing back on this by trying to address the ecological causes of diseases but risked falling into the same patterns if they failed to account for political and social dimensions of pandemics. “One Health could encompass all those things, in fact it should.”
Medical historians, anthropologists and socially minded epidemiologists say that the devastation of the pandemic is not simply a failure of preparedness.
They argue that outbreaks, epidemics and pandemics are not simply biological agents that function in realms of pure science. Social dimensions, political choices, and vested interests create systemic opportunities for disease to spread.
“Pathogens spread much the way water flows through cracks in the ice,” wrote epidemiologist Rob Wallace in a 2021 interview. “The infrastructure of power collectively arrives at decisions about how many and where the cracks in the societal ice emerge. And not just during a plague year or across an electoral cycle but going back decades.”
For Wallace, it doesn’t matter how prepared you are on paper. Without an accounting for these cracks in the ice, like lack of healthcare, food, protections for renters, sick leave and social services, experts argue that increased surveillance will never be sufficient. Without a political culture that values life pandemic planners will always run into entrenched interests.
Jeremy Greene, a medical doctor historian of medicine at John’s Hopkins echoed the sentiment. Without an accounting for politics or social conditions, disease surveillance is less likely to succeed. Greene does not see the failures of the pandemic as failures of disease detection and surveillance, he pointed out that COVID-19 was rapidly reported internationally. The failures were in pandemic policy, not awareness..
“If a surveillance system is merely designed to produce a signal without concern for all the various ways that signal will get diluted and contested or simply not heard then we are falling to learn some of the most profound lessons that we stand to learn from the public health failings of COVID-19’s pandemic management,” said Jeremy Greene.
When CT Insider asked Daszak of the EcoHealth Alliance about this he acknowledged the need for a strong government and claimed that the United States did not have to shift our politics in a major way. He pivoted instead to talking about misinformation.
“There was deliberate misinformation from people who are making political gain by saying things like ‘the masks are an attack on our freedoms as Americans,’ said Daszak. “We need mechanisms to understand that misinformation and disinformation are being actively pushed out as part of a political strategy, often other countries trying to do us harm.”
Greene called this obsession with information, misinformation and surveillance were the Achilles’ heel of public health. He said that without a reckoning with the way people live it is impossible for ordinary, wellintentioned people to translate public health messages into meaningful change.
“Without social supports for the most vulnerable,” said Green. “Everyday people, however well-intentioned cannot and will not comply with public health directives to refrain from social economic activity.”