True pandemic preparedness requires responding to small scale outbreaks as they happen, Professor Adam Kucharski argues in an opinion piece published in PLOS Biology.

Using the example of ongoing H5N1 bird flu outbreaks globally, the Co-Director of the Centre for Epidemic Preparedness and Response at the London School of Hygiene & Tropical Medicine (LSHTM) explains what this looks like in practice to prevent potential threats from developing into a major epidemic.

According to Professor Kucharski, the key is intervening when a virus spills from animals to humans, as happened when the bird flu strain H7N9 caused over 1,500 human infections in China in 2013–18. Chinese authorities tackled the outbreak using a “One Health” approach by treating a predominantly animal and environmental health problem before it became a major human one through closing markets and vaccinating animals.

He explains how early intervention is especially important if a virus quickly spreads to humans and adapts for efficient transmission. This could lead to significant numbers of infections and larger outbreaks that are challenging to control with public health measures.

Professor Kucharski warns that society is already falling into traps that will hamper future outbreak response, writing: “The problem is that we cannot base our response on a future we do not yet know. In that sense, the term ‘pandemic preparedness’ is something of a misnomer, because a pandemic never starts with a known outcome.

“It is only in hindsight that we can distinguish between isolated spillover events, localised outbreaks and full-blown pandemics. In the initial stages, all these events will look similar. For example, in early January 2020, epidemiological reports of a novel coronavirus were mostly consistent with a large zoonotic spillover event in Wuhan, rather than efficient human-to-human transmission.”

In the piece, Professor Kucharski points out that global focus is firmly on solutions rather than early prevention for future outbreaks: “Although the G7 ‘100 Days Mission’ aims to accelerate development of diagnostics, vaccines and treatments for epidemic threat, it does not address the problem of how to respond in the meantime […] countries would still have to face the threat without them for several months.”

Society must find out how best to target public health control measures, address existing social inequities and facilitate early decision-making, he argues. This will help ensure outbreaks do not spiral into global pandemics.

Professor Kucharski also reminds us not to forget the lessons of COVID-19, concluding that: “In hindsight, it may feel obvious what countries should have done in January 2020 in response to COVID-19. But we must overcome this hindsight and remember how the situation and signals looked at the time, because it is likely we will face similar signs with future infectious diseases, regardless of their name.”

Publication: Adam Kucharski, Planning for major pandemics means tackling minor outbreaks. PLOS Biology. DOI: https://doi.org/10.1371/journal.pbio.3002945 

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