An ounce of pandemic prevention is worth a pound of cure
Authors: None The Lancet Microbe
Journal: The Lancet Microbe (2022)

It is self-evident that the global community was insufficiently prepared for the COVID-19 pandemic because it was not prevented or at least limited to regional outbreaks. Efforts to impress upon authorities the need for adequate pandemic preparedness have a long history, but authorities did not start to give this advice fuller attention until 2020. However, despite the current interest in pandemic preparedness, prevention measures do not involve a quick fix and are therefore still met with resistance. A central premise of pandemic preparedness is that one must plan to tackle the next pandemic not the last one. For this reason, uncertainty must be accounted for; so, planning that is overly specific risks leaving us unprepared. In a recent review in Science Advances, Aaron Bernstein and colleagues argue that pandemic preparedness will be most impactful if it is built on a foundation of broad proactive, rather than narrow reactive, plans. They highlight that many plans to date involve detecting and containing emerging threats, which amounts to action after the pathogen has caused some level of human disease. Bernstein and colleagues disagree that this is the best approach and conclude that the greatest benefit for the cost is achieved by preventing the spillover of potential zoonoses through effective surveillance and management of the interface between people and animals, given the major source of pandemic risk is viral spillover from animals to humans. Bernstein and colleagues put it succinctly: “If the current pandemic has taught us anything, then it is that no amount of technology can save us from poor governance once an epidemic takes hold in the human population.” Yet, technological solutions are almost the only interventions enthusiastically promoted by authorities. To genuinely minimise the risk of pandemics, Bernstein and colleagues emphasise the need to put an understanding of viral diversity at the forefront of preparedness efforts. Then we must address key points at which humans and animals intersect: wildlife trade and hunting, intensive agriculture, and destruction of tropical forests. Put simply, preventing spillover of pathogens with pandemic potential requires a change in how we interact with the natural world. A familiar point, but one that cuts across many crucial issues, such as climate change. So the benefits are even greater when this broader context is accounted for. Maybe it is possible to navigate a course between the two extremes of broad and narrow planning? In a recent review in The Lancet Microbe, Daniel Becker and colleagues outline approaches to prioritise viral discovery in zoonotic reservoirs. This approach makes the almost insurmountable task of understanding viral diversity promoted by Bernstein and colleagues seem manageable. Becker and colleagues used statistical modelling to guide sampling target prioritisation, enhanced through the comparison and validation of predictive models. Systematic validation refined the predictions and optimised wildlife sampling. Becker and colleagues’ support for systematic validation stems from the need to overcome the various logistical constraints that limit researchers’ ability to sample wildlife for pathogens. The limitation of previous approaches is that the lack of validation or adequate documentation of model performance results in the use of models that offer little, if any, benefit over random sampling. The potential to extend this work in the future to “longitudinal tracking of viral shedding over space and time, the isolation of the live virus from wild animals, and the experimental confirmation of viral replication” will only further shift the balance of cost versus benefit in a favourable direction. So, approaches and tools that might make significant inroads into the prevention of future pandemics and their enormous tolls on health and society are available. However, they still require foresight and investment that are difficult to come by. What is becoming increasingly clear, although it was never really in doubt, is that the hardest lessons of the COVID-19 pandemic will probably be ignored by governments. And, therefore, they will repeat the mistake of using the last pandemic as a model for addressing the next one. Maybe, with the costs of the COVID-19 pandemic still fresh in their minds, authorities might be persuaded by an argument that the right approach can save them money. For more on the cost and benefits of prevention see https://www.science.org/doi/10.1126/sciadv.abl4183 For more on the cost and benefits of prevention see https://www.science.org/doi/10.1126/sciadv.abl4183