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We have a chance to prevent pandemics — will we?

We have a chance to prevent pandemics — will we?
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For all of its novelty, COVID-19 is yet another iteration of a century-old trend. Since 1918, seven pandemics have caused the deaths of over 70 million people. Each one started with a virus that spilled over from animals, mainly from wildlife, to people. By clearing rainforests, trading wildlife, and raising domestic animals in close proximity to wildlife, we have created opportunities for viruses with pandemic potential to spill over to humans.

Bottom line: Our broken relationship with nature is the spark that ignites pandemics.

The World Health Assembly will have the opportunity to break this cycle when it convenes on May 24. Delegates will meet amidst widespread calls for a new global health architecture, one that would minimize the chances of another COVID-19.

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We are deeply concerned, however, that the assembly’s provisional agenda does not explicitly contain plans for addressing why viruses are increasingly spilling over from wildlife into people. Instead, the provisional agenda appears to emphasize preparedness and response initiatives after a virus has already made the leap.

While no doubt critical, these are the same areas that the public health sector has traditionally focused on. Too many public health experts incorrectly assume that viruses will inevitably spread from wildlife to people. By locking ourselves into such a reactive posture, we ignore the science and put lives at risk.

Experience from Ebola to Zika shows us that putting all of our eggs in the “preparedness and response” basket is a recipe for failure because infectious diseases will surprise us again and again. We need to also invest in preventing pandemics at the source (that is, preventing spillover), because the preparedness and response tools we have today, even if upgraded in a post-COVID-19 world, may not work for a future “Disease X”.

Take COVID-19 as an example. Resource-rich countries that had invested in preparedness and response for years were caught off-guard and overwhelmed by COVID-19. We quickly shifted our hope to vaccines as we saw how non-pharmaceutical interventions failed to contain COVID-19.

Unfortunately, experts now agree that achieving global herd immunity is unlikely any time soon, in no small part because we can’t get shots in arms quickly enough. We won’t even achieve herd immunity in countries with unlimited vaccine supplies because of the rampant spread of disinformation that has fueled anti-vaccine movements. If we’re fortunate enough to reach global herd immunity, we still risk the threat of a new SARS-CoV-2 variant resistant to vaccines

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When they meet later this month, delegates at the World Health Assembly must embrace a strategy that connects public health to nature and commit to working with partner agencies to address the drivers of spillover. They should demand resources toward a comprehensive pandemic initiative that incorporates prevention in addition to preparedness and response and acknowledge that the World Health Organization alone is not responsible for leading the world on pandemic prevention. Rather, pandemic prevention requires an all-of-government and all-of-society approach. 

The global community has a unique opportunity to make COVID-19 the last pandemic, but the window will close soon, and we have to get this right on our first attempt. Otherwise, we will undoubtedly be in the midst of another pandemic within a decade. The drivers of spillover can be meaningfully addressed for $10 billion per year — a negligible cost compared to the millions of lives and trillions of dollars lost from COVID-19.

Implementing this new pandemic prevention scheme would yield a range of other benefits. When we protect nature, we benefit from cleaner water, less polluted air, and more productive agriculture—all factors that help people live longer and healthier. By focusing on hotspots for spillover, we could also improve health care in vulnerable communities. And since tropical forests naturally absorb carbon, protecting these places would slow climate change, a looming existential threat in itself. 

As physicians, we believe we have a moral obligation to prevent diseases in addition to just treating them. We have seen the limits of modern medicine when nature is pushed to its breaking point.
Countless lives depend on our ability to correct for the narrow pandemic approach of the past.

It’s time for a new paradigm, one that sees the forest for the trees and recognizes that they’re both essential to preventing the next pandemic.

Neil M. Vora, MD is a pandemic prevention fellow at Conservation International and a member of the Preventing Pandemics at the Source coalition. He previously served as an epidemiologist for the U.S. Centers for Disease Control and Prevention for nine years where he focused on outbreak response.

Céline Gounder, MD, ScM, FIDSA is an internist, infectious disease specialist, and epidemiologist. She's the host of the “Epidemic and “American Diagnosis podcasts, the CEO of Just Human Productions, and a CNN medical analyst. She served on the Biden-Harris Transition COVID-19 Advisory Board.