Plague of forgetfulness - are we ready for the next Covid?

Zoe Crowther

@zoenora6

Earlier this year the World Health Organization (WHO) published its list of 30 so-called “priority pathogens” – essentially a rogues’ gallery of the viral and bacterial diseases that pose the greatest global risk.

Alongside old-timers like the plague and influenza were newcomers such as mpox, as well as one known simply as “disease X”. This is, in fact, a placeholder for a most unwelcome surprise guest at the pandemic party. We might not yet know what causes disease X, its symptoms, rate or means of transmission, but we do know that just like Covid-19 it will appear from nowhere and upend the world once again.

Disease X represents the uncertainty facing governments across the world: how to prepare for a world-halting pandemic that could originate from anywhere, spread everywhere, and occur at any time.

In the two decades prior to 2020, the word “pandemic” was mentioned only 555 times in Parliament. Throughout 2020, when Covid-19 spread across the world, the word was used 6,551 times. However, with each year that has passed since, the word “pandemic” has been used fewer times. Not a single major political party specifically mentioned preparing for a pandemic in its election manifesto.

While the NHS is frequently polled as the most important issue for voters, when it comes to pandemics there is a sense that Britain wants to forget and move on. But experts insist the danger of pandemics is ever-present and demands urgent action.

Professor Sir Andrew Pollard was knighted in 2021 for his role leading the development of the Oxford-AstraZeneca vaccine. “It’s very easy for pandemic threats to go out of people’s mind when we’re not in the middle of a crisis, but we can be absolutely sure that there will be future pandemics that bring the world to a halt again,” he tells The House. “It will happen, and it’s impossible to say exactly when or how frequently.”

One of the key government failures identified by the UK Covid-19 Inquiry has been that plans prior to 2020 assumed the next pandemic would be an influenza virus. British and global institutions have since tried to ensure they are not caught out by this mistake again.

Many of these efforts are in their infancy. At the start of November, the UK government announced plans to create the world’s first real-time surveillance system to monitor the threat of future pandemics, forming a new partnership between the government, NHS England, and UK life sciences company Oxford Nanopore Technologies. This will form part of the new government’s 10-Year Health Plan.

The UK Health Security Agency (UKHSA), set up in 2021, has published a new pathogen genomics strategy this year to identify and analyse the pathogens that pose the greatest threat to the United Kingdom. It also seeks to improve global genomics surveillance of emerging diseases, based on the assumption that “no country is safe until all countries are safe”.

Some believe formal international accords are needed to strengthen global surveillance and co-ordinate responses, however. Jon Ashworth was Labour’s shadow health secretary during the first year of the pandemic. Four years later, now head of Labour Together, he believes we still “live in an era of epidemics and pandemics”, with globalisation and climate change meaning viruses can “more easily vault from animal to human”.

“My worry is that the West and governments generally are slightly taking their foot off the gas and playing it by ear as to what they would do when the future pandemic hits,” Ashworth says.

The former shadow health secretary believes global accords on how to respond to pandemics are needed on surveillance and on how richer countries should share vaccines with poorer nations. The WHO is attempting to draw up such an agreement, but talks broke down earlier this year after false claims circulated – including that they would give the WHO the power to impose lockdowns or force countries to give away up to a fifth of their vaccines.

New Labour MP Zubir Ahmed, an NHS transplant and vascular surgeon who is parliamentary private secretary to Health Secretary Wes Streeting, agrees that pandemic planning must be “absolutely internationalist”. “You can’t plan pandemic resilience from an office in Whitehall – it absolutely has a political co-operative dimension to it, like possibly nothing else does.”

It will happen, and it’s impossible to say exactly when or how frequently.

Professor Michael Parker, director of the Ethox Centre at the University of Oxford and former member of the UK Scientific Advisory Group for Emergencies (Sage), says attention has “shifted away” from international aid. This, he argues, will have a direct impact on tackling infectious diseases, which often arise from “marginal land” near rainforests.

Parker insists the UK should be “doing more than we are” to oversee “very high levels” of surveillance, including genetic testing of humans, animals and wildlife, surveillance drones, satellites looking at farmland use, and social media to monitor symptoms emerging across the world.

If a new pandemic grips the UK in the next few years, testing and diagnosis will also be crucial to the early response. The UK was particularly weak in this area in response to Covid-19 and multiple experts see the UK’s testing capability as a “potential strategic risk” as this country lacks a large diagnostics industry.

Neither does the UK have a huge vaccines industry. Pollard says many parliamentarians “fundamentally misunderstand” the context of the fast development and rollout of Covid-19 vaccines in 2020, giving them a false sense of confidence for the future.

“Coronaviruses had 20 years of research on them, which meant all the research and development that tells you exactly how to make a coronavirus vaccine had already been done,” he says. “So, the only bit that was left to do was manufacturing and trials… and there weren’t all the delays in waiting for funds.” In the event of the next pandemic being neither influenza or a coronavirus, the vaccine development landscape would be very different.

In an attempt to overcome this problem, the Coalition for Epidemic Preparedness Innovations (CEPI) finances research projects across the world to develop vaccines against emerging diseases. In the UK, the Vaccine Network brings together industry, academia and funding bodies to advise the Department for Health and Social Care (DHSC) on investment into vaccine research.

“That’s good news, but we’re still at the beginning of that story,” Pollard says. “We’re not 20 years in like we were with coronavirus.” He adds that there is “no more money” coming from the government to fund vaccine research now than there was before Covid.
In a more positive development, the advent of mRNA vaccines has sped up the process in recent years, as genetic instructions can be slotted in to tailor vaccines to different diseases.

According to Pollard, this means new vaccines could potentially be rolled out within six weeks rather than six months. “There isn’t a huge global capacity yet, but it’s going to be there soon. That will allow us to make millions and then billions of doses of vaccines much more quickly.”

As well as fast vaccine development, the importance of stockpiling ready-to-use vaccines, antiviral medicines, and personal protective equipment (PPE) is another important lesson from Covid. H5 avian flu is listed as a potential pandemic risk, and while there are vaccines available, many of the stockpiles have been in storage for many years and might be out of date. They also might not be effective against new virus strains or be enough to cover healthcare workers as well as patients.

CEPI’s Dr Nicole Lurie told The Telegraph earlier this year: “We all hope that they will be fine, but we don’t necessarily know.” 

Although the widespread assumption is that the next pandemic would be caused by a virus, another global health emergency could be unfolding: growing antimicrobial-resistant bacterial infections which do not respond to antibiotics. The WHO draws up a list of  these bacterial pathogens each year in a bid to promote research and development of new antibiotics.

Danny Chambers, a new Lib Dem MP and veterinary surgeon, describes this as “one of the biggest global public health threats” that is already happening across the world: “It’s something we need to work really hard on to prevent.”

The MP, who holds an MSc degree in infectious disease control, is also concerned about the increasing risk of zoonotic diseases – infections that can spread from animals to humans. Climate change, habitat destruction, and intensive fur and meat farming have created the conditions for zoonotic pathogens to spread wider and faster than ever before. Up to 75 per cent of new and emerging infectious diseases that can cause pandemics are now from animal origin.

“Often veterinary services, animal health research and animal vaccine development have less resources put into them than humans, which I totally understand why,” Chambers says.

“But if the next disease is going to come from animal origin, that’s where you want to be targeting quite a lot of resources to make it either less likely to happen or make sure you pick it up really early so you can control it.”

In early 2022, the government confirmed £200m of investment into the UK’s world-class Animal Plant and Health Laboratory in Weybridge. However, later that year, the Public Accounts Committee  (PAC) found that the facility had been left to “deteriorate to an alarming extent” due to “inadequate management and under-investment”. An  MP and former PAC member says the slow progress in improving this facility in the years since remains a “big concern”.

Another unanswered question is how the public could respond to non-pharmaceutical measures such as lockdowns or social distancing in the future. There has been little research into how effective these measures were during Covid, and even less into whether the behavioural response of the public might be different next time.

Professor John Edmunds, an epidemiologist at the London School of Hygiene & Tropical Medicine and a previous member of Sage, says: “All of that [research] needs to be done, and we’re unfortunately, a long, long way from that.”

Pollard adds that a key part of pandemic preparedness is making sure that all communities within the country are prepared for interventions. “We’re in the middle of a measles outbreak at the moment because people are not vaccinating their children,” he explains.

 “That is telling us that we have a serious problem in confidence in vaccines. If there is a pandemic where the vaccine might be the only life-saving thing we have, if we haven’t got it right in peacetime, we can’t get it right in a pandemic.”

While bodies such as UKHSA are looking at some of these concerns, there has been no updated, centralised pandemic plan set out by the government. Edmunds says the frequent switching between prioritising the economy or health during Covid-19 was “unhelpful”, and that a coherent plan might help to avoid that in the future.

“One of the values of a proper plan would be to write down at the beginning what you are actually trying to achieve,” he says, adding that having a senior minister in charge of pandemic preparedness across government would ensure it is continually prioritised.
Ahmed, too, says he is worried some lessons from Covid are “starting to be lost”: “We managed to do a lot of things, like trials and regulation, very quickly, despite the bureaucratic machine of government and the health service.

“Are the relationships we developed, the networks, the new ways of working, things we should actually keep rather than just going back to type? There’s still that window of opportunity open to have those conversations and to use that knowledge. The biggest danger of this pandemic is putting all the learnings into a box and forgetting about them.”

He admits the government is “not explicitly saying we’re getting ready for the next pandemic” as “there’s just so much information overload”.

“You wouldn’t expect us to because of the number of priorities there are to sort out, but all of the stuff we’re doing does speak directly to future-proofing the country and planning better for another pandemic,” he says, pointing to the new government’s focus on prevention, public health, addressing health inequalities, and modernising NHS technologies.

Ashworth, however, says ministers need to be “better prepared” and a regular government report on pandemic preparedness would be helpful. While defence ministers carry out “wargaming” for a nuclear attack, Ashworth argues ministers across government should do “germ-gaming” for future pandemics and hopes this is something the DHSC and Cabinet Office are “now thinking about carefully”.

“I used to warn my shadow cabinet colleagues that the lesson of history is that there won’t be a 1945 moment when we come out of the other side of [Covid-19],” Ashworth says.

“There was a lot of chatter that things will never be the same again, a new society will have to be built. But the lesson of history is once populations come out of pandemics, they want to move on and forget about it… The lessons from pandemics can very easily and quickly be forgotten.” 

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