How should we be preparing for the next pandemic? Is it too early?
The COVID-19 pandemic is mostly in the rearview mirror. It has been over four years since the novel SARS-CoV-2 virus emerged. With it came over 700 million documented cases and over 7 million deaths around the world, though both these numbers are likely significant undercounts.
Discussions abound about being prepared for the next pandemic. Given the economic impact that COVID-19 had, any means to reduce a pandemic’s impact on lives and livelihoods should be met with open arms. Yet pandemics of the magnitude like COVID-19 do not occur every year.
The last pandemic that had such a significant societal impact was the influenza epidemic of 1918, which took around 50 million lives, dwarfing the 20 million lives lost in World War I. Yet the world was much smaller, and travel was more limited. There was no widespread commercial air travel across the continent and between continents like we have today. This means that the transmission of any microbe was both slower and more limited. On the other hand, surveillance technology and capabilities were less sophisticated, making it more challenging to track the spread of the virus.
Given that we are still raw from COVID-19, it is easy to think about preparation in the most extreme manner. This includes investments in surveillance, prevention and treatment. Yet no pandemic is the same. What was learned from the 1918 influenza was important but not sufficient for responding to the 2020 coronavirus.
Shelter-in-place orders seemed reasonable but were often implemented too late to be effective. Hospital capacity was overwhelmed, with weekly deaths surging to a peak of nearly 26,000 people at the height of the pandemic in early January 2021.
So with 20-20 hindsight, what preparations could have dampened the negative impact of the COVID-19 pandemic, perhaps saving lives and protecting the economy?
Directing attention to strategy rather than tactics is imperative. This means that investments in the weeds are likely to be wasteful. What is needed is a strong and resilient public health infrastructure.
Achieving this would require sustained investments in and empowerment over many years in the Centers for Disease Control and Prevention (CDC) as well as state and county public health departments, including robust, open bidirectional communication channels. This would ensure that reliable public health guidance would be readily available and timely, and entities would be well-positioned to respond quickly and effectively as necessary.
This does not mean waiting for the crisis to emerge, and finding emergency funds to address it, but rather ongoing and consistent investment to ensure that as risks surface, the public health infrastructure can act as needed to provide effective policy and implement necessary tactical guidance.
The challenge with investing in public health is that it is typically expensive, given that it is human capital intensive, with a payback that may take years, if not decades, to recoup. In the current economic environment, with numerous urgent competing interests, it is easy to downplay public health investments. Indeed, public health investments may be difficult for lawmakers to support because they prevent problems that, when successful, become invisible, like the eradication of polio and the availability of clean water. This is like how a well-functioning fire department never has to put out a fire if it provides robust education to prevent such events.
The next pandemic will arise as unexpectedly and swiftly as the last two. Indeed, it is not the risks that can be envisioned but the risks that are unknown and emerge unexpectedly that are most challenging and dangerous. This means that an agile and well-prepared public health infrastructure is critical to ensure that whatever actions are needed, we are well-positioned to meet the challenge.
That is why the nation invests in the Department of Defense. By investing in a capable and well-trained armed force, the nation is positioned to address emerging conflicts as necessary. That is also why investments in new weapon systems are necessary, to ensure that near peers remain one or more steps behind U.S. military capabilities.
Everyone wants to be prepared for the next pandemic. Yet until such a pandemic emerges, there is no clear path forward to respond. That is why a strong public health infrastructure is a sound investment both today and in the future. Without such investments, history will repeat itself, and what the nation experienced in 2020 is likely to be repeated — with an abundance of finger-pointing across the aisle in Washington that ultimately costs lives and livelihoods.
The risks of not taking appropriate actions today are too great to ignore.
Sheldon H. Jacobson, Ph.D., is a professor of computer science at the University of Illinois Urbana-Champaign. A data scientist, he applies his expertise in data-driven risk-based decision-making to evaluate and inform public policy and public health.
Janet A. Jokela, MD, MPH, is the senior associate dean of engagement in the Carle Illinois College of Medicine at the University of Illinois Urbana-Champaign. She is an infectious disease and public health physician.