Episode 7: Global Health Security Requires Pandemic Prevention

Preventing Pandemics is a Security Issue

This fall, as the ongoing pandemic tragedy continues to reveal the shortcomings of a disjointed response to infectious disease threats, a series of convenings of the global community offer crucial opportunities to correct the course of the global COVID-19 response and better prepare for future pandemics. In their speeches at the COVID-19 Summit, hosted by US President Joseph Biden on the margins of the 76th United Nations General Assembly (UNGA), leaders of nations and international public health organizations described how the pandemic—true to longstanding expert predictions—has profoundly destabilized communities, nations, global regions, and the myriad social and economic connections among them.  All agreed that only a global effort can end COVID-19 and protect the world’s citizens, wherever they live, from the consequences of the next one.

In his address to the summit, UN Secretary-General António Guterres urged adoption of a global vaccination plan aimed at accelerating COVID-19 vaccine production and expanding access to vaccines in low- and middle-income countries, which to date have received a meager share of the global supply. Righting this inequity, he insisted, is not a matter of philanthropy, but of self-interest. As the rise of the delta variant demonstrates, if a pandemic pathogen circulates anywhere, it can spread everywhere.

As global leaders again come together for the World Health Summit and upcoming G20 meetings, the urgent need for action persists. It cannot be understated, like climate disruption and nuclear war, pandemics jeopardize human civilization.  All levels of government are responsible for and must be compelled to secure citizens against such profound threats.  With this paradigm in mind, the Influenzer Initiative’s documentary series has released its latest episode, Global Health Security Requires Pandemic Prevention. 

As MIT health economist Andrew Lo observed, every country willingly invests heavily in national defense. “But protection takes many different forms,” he added. “It’s not just about building missiles. I think that building vaccines is equally important, if not more so, because the probability of getting hit with a pandemic seems to be higher than getting hit with nuclear missiles.”  Former CDC director Julie Gerberding, now chief patient officer and executive vice president at Merck, emphasized that the goal of defense spending is to prevent wars, which in addition to saving lives protects against economic and social destruction resulting from warfare. The same rationale favors ongoing, consistent support to prevent future pandemics as damaging—or worse—than COVID-19.

Patrick Tippoo, executive director of the African Vaccine Manufacturing Initiative, likened investing in pandemic preparedness to purchasing homeowner’s insurance. “It pains me every month to be paying this premium and I think, ‘what’s the value in it,’ until something happens and I need to be paid out,” he explained.  “And then I realize that wow, if it weren’t for this, not having it would be very, very, expensive. And probably very difficult to absorb.”  Clearly the world was underinsured against the disaster that COVID-19 has become, based on comparisons between the cost of the coronavirus pandemic—of which recent estimates range from tens to hundreds of trillions of US dollars—and the funding of proposed global initiatives aimed at preparing for and preventing future pandemics in the tens of billions.  Now is the time to pursue such preparations because novel pathogens continue to emerge and, as Tippoo said, the consequences of another pandemic, given the global response to this one, are “too ghastly to contemplate.”

A critical focus of global efforts to prevent and prepare for future pandemics must be to transform the global R&D ecosystem to efficiently—and at regional and national levels in the Global South—propel vaccines and other pandemic countermeasures to complete the long path that commences with pre-clinical research and proceeds through clinical trials, regulatory approval, manufacturing, distribution, all the way to the all-important “last mile” delivery and administration in at-risk populations.  A recent report from a consortium including the Pandemic Action Network and the Africa Centres for Disease Control and Prevention notes that in the wake of COVID-19, many health security experts and world leaders “are rightly calling for a new, coordinated, and permanent system or structure to accelerate end-to-end R&D for emerging pandemic threats.”  The report points out that “longstanding and persistent market and systems failures in global health R&D, especially for vaccines against novel pathogens, have left the world at grave risk of deadly and costly pandemics.”

“We should be prepared for the fact that the influenza pandemic could be much worse”
-Michael Osterholm

This is especially true of vaccines for influenza, a certain pandemic threat as well as a persistent scourge that each year costs 300,000 to 600,000 lives and millions of dollars in lost productivity.  Eighteen months into the COVID-19 pandemic, its US death toll surpassed that of the previously most deadly infectious outbreak in the nation’s history: the influenza pandemic of 1918-19, which killed an estimated 50 million people in a far less connected and more sparsely populated world. Less lethal influenza pandemics in 1957,1968, 1977, and 2009 took between 2 and 4.5 million lives, combined. A virus as deadly as the 1918 strain, which killed about 3 percent of the world’s population, would today cause more than 230 million deaths—more than 40 times as many as COVID-19 to date.

“We should be prepared for the fact that the influenza pandemic could be much worse,” warned Michael Osterholm of the Center for Infectious Disease Research and Policy (CIDRAP).  To protect against such a disaster, researchers are striving to develop universal influenza vaccines (UIVs): vaccines that provide lifelong or multi-year protection against a broad spectrum of influenza strains.  But existing influenza vaccines, while life-saving, are not nearly as effective as COVID-19 vaccines, as molecular engineer Jeffrey Hubbell, of the University of Chicago, observed. “Universal influenza vaccines have not got the attention they needed,” said immunologist Teresa Lambe, of Oxford University.  “If we invested what we learned from the SARS-CoV-2 pandemic in these types of vaccines, we would be legions ahead of where we are at the moment.”

“I think we have, in our hands today, the power to protect all future generations from pandemics” – Rajeev Venkayya

Reflecting on global health security in light of COVID-19, US Secretary of State Antony Blinken and Secretary of Health and Human Services Xavier Becerra wrote, “Since the influenza pandemic more than a century ago, the world has made major leaps forward in science and medicine, as well as diplomacy, global governance, and the creation of a system of international law and organizations to foster cooperation across borders.”  Further cause for optimism in the face of pandemic threats stems from the promise of diverse and novel vaccine technologies proven against COVID-19, according to Rajeev Venkayya, president of global vaccines at Takeda Pharmaceutical Company. “I think we have, in our hands today, the power to protect all future generations from pandemics,” he told us. “This is the biggest accomplishment of the century.”

The question now is, in the words of computational biologist Martha Nelson, of the National Institute of Allergy and Infectious Diseases (NIAID), “what are we going to build in the ashes of COVID-19 that is going to take advantage of this opportunity?”  Or, as President Biden asked in his address to UNGA, will the world work together both to “defeat COVID-19 everywhere and take the necessary steps to prepare ourselves for the next pandemic? For there will be another one.”