Pandemics may become the new normal.
But that doesn’t have to be. Pandemics are preventable, and the world can do three things to prevent them.
First, we can create a global early warning system. Much like systems for tsunamis and earthquakes, an early warning system could allow for early detection of and rapid response to an outbreak before it spreads. It would gather intelligence through a combination of zoonotic reconnaissance, artificial intelligence (AI) surveillance and outbreak investigation.
Pandemics usually begin when a virus or other pathogen jumps from animals to people in what is called a zoonotic spillover. The coronaviruses that caused severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and now covid-19 pandemics all jumped from bats to humans through an intermediary animal host — civets in SARS, camels in MERS and a still unknown intermediary in covid-19. Routine reconnaissance for spillover between these sentinel animals and the people in close contact with them could provide early warning of an impending outbreak.
Sleuthing for spillovers across the globe is futile unless you know where to look. AI can help. Using machine learning algorithms to sift through molecular, epidemiologic, ecological and climate data, scientists have mapped out global geographic hotspots most vulnerable to zoonotic spillovers.
AI can also help with early warning once an outbreak has occurred. The Global Public Health Intelligence Network, an AI-based surveillance system started by Health Canada and the World Health Organization, analyzes more than 20,000 online news reports in nine languages daily. It was credited with sending the first alerts for SARS and MERS.
More recently, a private company, using AI-driven algorithms to scour news reports and airline ticketing data, issued an alert about the coronavirus outbreak in Wuhan, China, a week before the Centers for Disease Control and Prevention or WHO did.
Big data alone would cause too many false alarms if not backed up by outbreak investigations on the ground. A global early warning system would require a cadre of well-trained epidemiologists who could be rapidly deployed to investigate and contain an outbreak. Programs conducting zoonotic reconnaissance, AI surveillance and outbreak investigations already exist, but they need to be massively scaled up and integrated into a comprehensive global early warning system.
Second, we can prevent future pandemics by strengthening public health. Early warnings would be useless if local, national and global public health systems cannot mount an effective response to an outbreak. Places in the world that have crushed the epidemic curve so far — such as Taiwan, Singapore and South Korea — all have robust public health systems that took early actions, set up a unified command, executed a coordinated and science-based strategy, deployed massive technological and human resources, ramped up testing and contact tracing, and provided trustworthy and transparent information to the public.
In contrast, testing remains inadequate throughout the United States, and chronic underfunding has left most state and local public health departments without a sufficient workforce to conduct mass contact tracing. Tragically, despite plenty of early warnings, the federal government was unprepared, misguided and disorganized in its response, leaving the states to fend for themselves. Covid-19 exposes the vulnerabilities of public health systems throughout the United States and worldwide, which need to be fixed before the next pandemic.
Third, we can prevent future pandemics at their source by minimizing the risk of spillovers. Protecting natural habitats from relentless human encroachment and creating buffer zones around protected areas are important long-term goals. More immediately, we can stop wildlife trade, not only by regulating, monitoring or shutting down live animal markets like the ones in Wuhan, but also by enforcing international law to combat illegal and unsustainable wildlife trade. The United States and China are responsible for 60 percent of global imports and exports of all wildlife, respectively; it’s time for our two nations to step up.
Preventing future pandemics will require an unprecedented level of global cooperation. The question is whether we can get our act together before the next pandemic strikes.
Michael C. Lu, MD, MPH, is dean of the School of Public Health at the University of California at Berkeley.