Are we ready for the next one?

There’s no question; we’re all tired of dealing with the Covid-19 pandemic. However, no matter how much we want it to be over, it’s not. At least, not yet anyway. As a result, most of us aren’t thinking about something that we should be…the next pandemic. It’s not a question of if but when. It’ll happen at some point, and we need to be prepared. How can we be ready?

Every few years, a new pathogen emerges and threatens the global society: SARS in 2003, swine flu in 2009, Ebola in 2014, Zika in 2016, and Covid-19 in 2019. Over the past three decades, infectious disease outbreaks have occurred with alarming regularity. The World Health Organization (WHO) lists an influenza pandemic and other high-threat viral diseases, like Ebola and dengue, among the top 10 biggest threats to public health. The agency refers to these threats as “Disease X.” The goal is to encourage policymakers to think broadly about the next pandemic because it could be anything.

The Centers for Disease Control and Prevention (CDC) estimate that 75% of new infectious diseases in humans come from animals. Current estimates indicate the existence of 500,000 animal viruses that have the potential to spill over to humans. Only a tiny fraction (around 250) has already made the jump. These zoonotic infections have overwhelming effects on human life. One of the biggest concerns is the fatality rate. For severe acute respiratory syndrome (SARS), it’s 10%, the Nipah virus is somewhere between 40% and 75%, and it’s as high as 88% for Ebola. The rate for Covid-19 is likely less than 1%, but the overall burden of death has been substantially higher since it has affected so many people.

Analysis based on historical data on epidemic frequency and geographic distribution reveals that the incidence and severity of spillover infectious disease are steadily escalating. The data shows the annual probability of a pandemic on the scale of Covid-19 in any given year to be between 2.5 – 3.3%. So, there’s a 47 – 57% chance of another global pandemic as deadly as Covid in the next 25 years. We know that outbreaks will occur – it’s just a matter of when and where.

Close to 20 years ago, Elizabeth Fee and Theodore Brown, historians of medicine, expressed that the U.S. had “failed to sustain progress in any coherent manner” in its capacity to handle infectious diseases. The story is the same with every new pathogen. Americans rediscover the weaknesses in our health system, attempt to deal with the problem, and then “let our interest lapse when the immediate crisis seems to be over.” This cycle is now entering its third century.

Our capacity to fight back against these deadly viruses has dramatically increased since scientists have pinpointed which types of viruses are the most likely to cause future pandemics. So, the global pharmaceutical industry, governments, non-governmental organizations, and healthcare systems should have been better prepared for Covid-19. The coronavirus that causes it, SARS-CoV-2, is closely related to other coronaviruses, particularly the one that caused the outbreak of SARS in 2003. Most coronavirus core proteins share about 95% of their nucleic acid or protein sequences. In addition, for some, their active sites (the spot where antiviral therapies bind) are 100% identical. When SARS was at its height in 2003, drug discovery attempts were initiated to see which antiviral medication might be effective. However, the efforts were abandoned once the epidemic seemed to be under control. There wasn’t anything to support ongoing research, and there wasn’t a market for anything if it was developed. Given what we know about coronaviruses, if the work had continued and produced possible treatment for the SARS virus, it might have been available to treat individuals with Covid-19.

The WHO ordered an independent review panel of the global response to the Covid-19 pandemic. In May 2021, the committee called the pandemic a preventable disaster due to “a myriad failures, gaps and delays in preparedness and response.” According to the members, it was the 21st century’s “Chernobyl moment.” Data from John Hopkins University shows that as of December 2021, the virus has killed 5.26 million people worldwide, wiped out trillions of dollars in economic output, and turned life upside down for billions of people.

The Nuclear Threat Initiative, Economist Impact, and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health put together the Global Health Security Index, a measure of preparedness and problems for various health emergencies. It looks at what hindered their ability to respond effectively to Covid-19 and reduces their preparedness for future epidemic and pandemic threats. The worst area is in preventing the emergence of new pathogens. The report discovered that 155 out of the 195 countries in the survey failed to invest in preparing for a pandemic or epidemic within the past three years, and 70% have failed to invest in clinics, hospitals, and community health centers. The U.S. was the prime example. Despite being ranked first in pandemic preparedness, the U.S. has had the highest number of deaths compared to other industrialized countries. In fact, more Americans have been killed by the new coronavirus than in the 1918 flu pandemic. As a country, we spend more on medical care than any comparable country, yet our hospitals have been overwhelmed. We helped develop Covid-19 vaccines at miraculous and record-breaking speed, but our vaccination rates plateaued quickly. The report stated, “The United States’ poor response to the COVID-19 pandemic shocked the world. How could a country with so much capacity at the start of the pandemic have gotten its response so wrong?”

If the U.S. had learned from its mishandling of the original SARS-CoV-2 virus, we would have been better prepared for subsequent variants. Instead, the CDC ended indoor masking for vaccinated people. As cases fell, laboratories discarded inventory, canceled contracts, and laid-off workers. States cut down on reporting Covid-19 data. Then Delta arrived and ripped through the half-vaccinated populace and pushed hospitals and healthcare workers to the brink again. Within months of Delta subsiding, Omicron appeared. However, there was encouraging news—it produced less severe illness than earlier waves. While Covid hospitalizations are surging, fewer patients end up in intensive care units or require mechanical ventilation. This has led the government to focus more on expanding vaccination than limiting the spread.

As new variants emerge, America’s response highlights how much progress we have made and how much work remains. When the highly mutated Omicron variant arrived, it set off a familiar chain of events. Health experts held news conferences that resulted in more questions than answers. Travel bans were imposed but very likely came too late. Virus tracking maps rapidly filled as the variant was reported in country after country. The same sequence unfolded when the initial outbreak occurred. Omicron is a dress rehearsal for the next pandemic. The work we must do now is the same work required to stop future pathogens. When Omicron arrived, we already had developed vaccines and treatments and were on high alert for new variants. Some experts aren’t convinced that we passed the preparedness test because we were days behind many other countries in detecting the variant. So, whatever progress we’ve made, it’s not enough.

Generally, experts agree that America learned from the past year, so the next public-health crisis shouldn’t be quite as disorienting. However, our pandemic preparedness still has major gaps, and many are too big for any single administration to fix. We can’t prevent the next viral outbreak, but we can prevent the next pandemic with better preparation.

Testing

Without accurate, timely testing, it’s impossible to slow the spread of a pathogen. From the beginning, America botched testing. The main problem was there wasn’t a coordinated national testing plan. Supply shortages and regulatory delays on test kits created an epic mismatch between supply and demand. Also, the CDC distributed faulty test kits. So, the wait at testing sites could take hours, and it could take a week or more for results. All these blunders permitted the virus to spread, unseen and unchecked.

The Food and Drug Administration’s (FDA) authorization process for new types of lab tests (emergency use authorization, or EUA) was initially too slow. The FDA changed its authorization process so that labs could spin up tests more quickly, allowing an increasing number of tests to get emergency authorization, including rapid, at-home tests. The CDC relaxed its stringent requirements on who could be tested for the virus. Also, labs diversified their supply chains, purchased new equipment, and hired more staff.

However, the U.S. was still doing less daily testing per capita and had a higher share of tests come back as positive than many other high-income countries, per the Johns Hopkins Coronavirus Resource Center. The Department of Health and Human Services (HHS) needs to better coordinate testing among public health labs, academic labs, and commercial labs. At the pandemic’s beginning, they were working on different kinds of tests.

Another thing that the U.S. got off to a very slow start on was genomic sequencing, which helps experts know how a pathogen is mutating and new variants are spreading. The main reason was that many public health labs were overwhelmed by the initial testing volume and competing obligations. Some research laboratories established their own independent sequencing programs despite lacking funding or coordination. The CDC created a grouping of academic, commercial, and public health labs in spring 2020 to start a more focused national effort. Unfortunately, the progress was slowed by a lack of resources and a fragmented healthcare system that didn’t have a way of getting patient samples from testing sites to sequencing labs. Also, the national effort is uneven. Some states have sequenced more than 20% of their Covid cases and others less than 3%. Experts point out that individuals with breakthrough infections and those with compromised immune systems should be priorities for sequencing since they have more trouble fighting off the virus, giving it more chances to mutate. Also, officials should make a more concerted effort to test travelers from abroad for the virus and sequence positive samples rather than restricting travel completely. Another challenge that labs faced this time was getting a sample of the coronavirus out of China, where it originated, and where controls on viral-sample shipping are strict. During the next crisis, the FDA should allow labs to use the virus’s genetic sequence, which is easier to obtain, as the initial way of proving that their test works.

Since the virus is shed in feces, analyzing wastewater can provide a snapshot of whether the virus, or a particular variant, is present in a community and how prevalent it is without relying on people to get tested. Some research teams began doing precisely that. Also, it led the CDC to partner with other federal agencies to create the National Wastewater Surveillance System. This collaboration could eventually be used to monitor antibiotic-resistant bacteria, foodborne pathogens, and other microbes.

One concern about testing is that the FDA is answerable to whichever administration is in charge. So, a president might be incentivized to slow testing so that the overall infection rates look better. While the Trump administration created Operation Warp Speed to turbocharge vaccine development, experts say that the country needed a similar effort for diagnostic tests. For certain, diagnostic testing in any future pandemic should be a priority from the start.

Inequality & Public Health Impacts

In 1849, Dr. Rudolf Virchow investigated a devastating typhus outbreak in what is now Poland. Afterward, he wrote, “The answer to the question as to how to prevent outbreaks … is quite simple: education, together with its daughters, freedom and welfare.” He understood epidemics are tied to poverty, overcrowding, squalor, and hazardous working conditions. American physicians and politicians who tackled the problem of urban cholera by fixing poor sanitation and dilapidated housing realized this as well.

The issue with the discovery that microscopic organisms cause infectious diseases was the idea that a pathogen is an entity that could be defeated if we have the right weapons. This meant we didn’t have to worry about the details of the social aspects of society. Unfortunately, this view accelerated a growing rift between the fields of medicine and public health. In the 19th century, these disciplines were overlapping and complementary. In the 20th, they split into distinct professions. Medicine became concentrated in hospitals, meaning physicians became separate from their surrounding communities and further disconnected them from the social causes of disease. In addition, it linked them to a profit-driven system that saw the preventive work of public health as a financial threat.

In the 1920s, the medical establishment used its growing power by lobbying Congress and the White House to erode public health services, like school-based nursing, outpatient dispensaries, and centers that provided pre- and postnatal care to mothers and infants. These services were examples of “socialized medicine,” unnecessary to those convinced that diseases could best be addressed by individual doctors treating individual patients.

By the early 1930s, the U.S. was spending just 3.3 cents of every medical dollar on public health and most of the rest on hospitals, medicines, and private health care. The number is currently 2.5 cents. Many public health department buildings were erected in the 1940s and ’50s. They’re now falling apart. They’re relying on fax machines and decades-old data systems. Small budgets also mean smaller staff. Since the 2008 recession, local departments have lost 55,000 jobs. Despite that, workers have to cope with not just infectious diseases but air and water pollution, food safety, maternal and child health, the opioid crisis, and tobacco control. When Covid-19 arrived, many had to pause their usual duties, and even then, they didn’t have staff to do the most basic version of contact tracing. Once vaccines were authorized, testing had to be scaled back so that staff could focus on getting shots into arms. We see fit to give responsibility to the local public health department, but no power, money, or infrastructure to make change happen. Public health’s bind: When a doctor saves a patient, that person is grateful. When an epidemiologist prevents someone from catching a virus, that person never knows. If successful, public health is invisible.

In 2008, experts argued that the country’s flu-pandemic plans overlooked the unequal toll that such a disaster would take on low-income and minority groups. This results from these individuals being more exposed to airborne viruses since they’re more likely to live in crowded housing, use public transportation, and hold low-wage jobs that don’t allow them to work from home or take time off when sick. Also, they’d be more susceptible to disease because their baseline health is poorer, and they’re less likely to be vaccinated. All these factors combined mean they’d die in greater numbers. These predictions came to pass during the 2009 H1N1 swine-flu pandemic and in 2019 when Covid-19 emerged.

The problem is that we, as a society, see social vulnerability as a personal failure rather than the consequence of centuries of racist and classist policy. So, we view the problem as something each person must solve on their own rather than a societal responsibility. Inequity reduction is essential not for moral reasons but basic epidemiological ones. Our inequality makes everyone vulnerable.

To be ready for the next pandemic, we need to focus on the living and working conditions that allow pathogens to flourish. This means addressing specific issues, such as paid sick leave, safe public housing, eviction moratoriums, food assistance, and universal healthcare. Also, when implementing mandates for social distancing, they need to be accompanied by financial aid for those who might lose work or free accommodation where exposed people can quarantine from their families.

We also need to address the health of America’s population as a whole. We have high rates of obesity, poverty, uninsured, and a lack of trust in the healthcare system. The Covid-19 pandemic has underscored the central importance of primary care and preventative medicine. Unless people can afford to go to the doctor as soon as they feel ill, clinicians are trained to diagnose and report unusual conditions, and health centers provide accessible treatments and vaccinations rapidly, new infectious diseases will be able to spread quickly.

Policy Changes

If a person tested positive for or was exposed to Covid-19, they were supposed to stay home for two weeks. However, it became clear that people weren’t quarantining. The main reason: They didn’t have paid time off from work. During the pandemic, the federal government passed several laws that allowed Americans to stay home from work if they were sick or had to take care of children who were home from school. Yet, many didn’t realize they could take it, and now those provisions have expired. This means America remains the only industrialized country without mandatory, national paid leave. We’ll find ourselves in the same situation if it isn’t established before the next pandemic.

The $1.9 trillion American Rescue Plan wasn’t only an economic-stimulus bill; it was also a pandemic-preparedness bill. Beyond funding public health, it also includes unemployment insurance, food-stamp benefits, child tax credits, and other policies that are projected to cut the poverty rate for 2021 by a third. The number is even higher for Black and Hispanic people. Some of the measures are temporary, so they need further legislation to make them permanent.

In September 2021, the Office of Science and Technology Policy and the National Security Council drafted a new strategy to prepare for future pandemics. It would cost $65 billion over the next 7 – 10 years. The plan resembles those that were written before Covid-19 and never fully enacted. The country would get new vaccines, medicines, and diagnostic tests; new ways of spotting and tracking threatening pathogens; better protective equipment and replenished stockpiles; sturdier supply chains; and a centralized mission control that would coordinate all the above across agencies.

Some health experts weren’t impressed, saying the $65 billion should be a down payment, not the entire program. The pandemic plan compares itself to the Apollo program. Yet, when adjusted for inflation, the government spent four times as much ($260 billion) putting astronauts on the Moon. Others worry about the way the money is being distributed. Close to $24 billion has been allocated for technologies that can create vaccines against a new virus within 100 days. Another $12 billion will go toward new antiviral drugs and $5 billion for diagnostic tests. While reasonable goals, devoting two-thirds of the funds toward them suggests we haven’t learned from the current pandemic.

Funding

The massive human suffering and economic impact underscore why we need to dedicate funding to the public and private sectors. We spend tons of money on healthcare, but it has little to do with stopping the spread of infectious diseases. To deal with an epidemic, we need public health workers. One primary reason we struggled with things, such as contact tracing, was budget cuts following the 2008 recession that gutted the nation’s public health departments. According to an analysis from Kaiser Health News and the Associated Press, since 2010, spending on state and local public-health departments declined by 16% and 18%, respectively. So, public health departments’ data systems are outdated, meaning workers had trouble tracking people’s vaccine status, counting Covid-19 deaths, or sharing data across state lines. While the American Rescue Plan dedicates $7.7 billion to hiring and training more public health workers, experts say what’s really needed is a larger annual public health budget. Like businesses, they need yearly revenue to make payroll, which has to come from Congress (who isn’t known for acting swiftly and boldly). Experts agree that in the same way the U.S. invests in and prepares for national defense, we need to prepare for another pandemic by investing in our public health system.

Some of the recent changes could leave us better positioned for the next pandemic. For instance, public health laboratories have new equipment and expertise. However, many health officials have already left their jobs, and legislators have passed more than 100 laws limiting the public health powers of state and local authorities. Republican legislators in 26 states have passed laws that curtail the possibility of quarantines and mask mandates. By allowing states to block local officials or schools from making decisions to protect their communities, they’re removing emergency actions without the preventive care that would enable people to protect their own health.

The CDC has learned the best emergency responses use everyday systems that are strong enough to scale up in an emergency, not only at home but also abroad. Yet efforts to bolster such systems are often unfocused. A study from the Institute for Health Metrics and Evaluation, a global health research group at the University of Washington School of Medicine, found that the annual funding for global health in 2019 was an estimated $41 billion (less than 20% came from the U.S.). Of that total, it’s estimated that less than 1% ($374 million) was for pandemic preparedness. According to credible estimates, investments starting at $5 to 10 billion a year for the next two or three years and continuing for at least a decade are needed to boost preparedness in low- and middle-income countries. These funds would come in addition to funding for better research and primary healthcare.

Implementing strategies and providing funds to strengthen early-warning systems, share data, improve rapid-response capacities, and strengthen health protection systems worldwide will save millions of lives and trillions of dollars. Both large and small countries will spend billions a year, but that pales in comparison to the International Monetary Fund’s estimate that Covid-19 has cost the world some $20 trillion. The U.S. government has called for a $10 billion global health fund to prepare for future pandemics and announced a $250 million contribution to jumpstart the effort. The price of disaster will dwarf the cost of preparedness. The focus should be on three distinct areas of financing: prevention, preparedness, and surveillance; response and countermeasures; and reconstruction.

New financial mechanisms offering accountability and boosting confidence for government investments are needed to make sure funds are readily available when and where needed. There will need to be specific benchmarks toward ownership and oversight in recipient countries involving ministries of finance, health, and agriculture. It will also need to include the private sector and civil society groups. The World Bank, the African Development Bank, the Asian Development Bank, and other entities can play essential roles. The Global Fund could both generate and disburse funds.

Coordination & Collaboration

The way one experienced the pandemic was primarily determined by the state one lived in. A major ongoing challenge of the U.S. Covid-19 response has been the undermining by politicians of the motives and messages of health officials, debating the seriousness of the virus, and the effectiveness and safety of vaccines. The result: people have been unwilling to comply with public health recommendations that would slow the spread of the virus.

Also, the Trump administration’s unwillingness to have the federal government take the lead made it much harder to manage. The Biden administration believes that the federal government is a necessary leader in pandemic response and will be better positioned to coordinate actions. But the ability of any government to handle a pandemic is limited where federalism and individualism are prized.

The response to Covid-19 suggests hope for the future. The extent of the crisis and the speed of drug development led the biopharmaceutical industry and government agencies to work together to streamline regulatory processes. These changes must continue once the pandemic ends. Also, in March 2020, two dozen researcher and development (R&D) leaders from the world’s leading biopharma companies came together to form the Covid R&D Alliance. This demonstrates that this type of industry collaboration can rapidly assemble and coordinate therapeutic responses to the pandemic.

Preparedness

We need to take the lessons we’ve learned battling Covid-19 and use them to prepare us for the next pathogen that emerges. We must develop a clear set of priorities for mitigating pandemic risk, including understanding the drivers of disease spillover and how they change over time. One key aspect is building strong incentives for early action to contain outbreaks before they spread. Every country should be able to identify any new suspected outbreak within seven days of emergence. Next, they should start to investigate the event within one day, report it, and mount an effective response set by clear, specific benchmarks for different pathogens within seven days. Using this process will help governments focus attention and resources.

One area that needs to be addressed is vaccination participation. While vaccines were produced far faster and were more effective than experts had estimated, this doesn’t matter if people can’t or won’t get vaccinated. Since mid-April, every adult in the U.S. has been eligible for vaccines. During that time, more Americans have died of Covid-19 per capita than people in Germany, Canada, Rwanda, Vietnam, or more than 130 other countries did in the pre-vaccine era.

Another element that must be fixed is the national stockpile. It’s supposed to hold in reserve items, such as N95 masks, so they’re readily available when there’s an emergency. The issue this time, the federal government distributed 85 million N95s during the 2009 Swine flu pandemic and never replenished the supply, leading to a shortage in 2020. Since then, the federal government has bought 325 million N95s. The bottom line is that when we use part of the supply, it needs to be replenished sooner rather than later. To further improve the stockpile, the government should have mask manufacturers rotate out the mask supply regularly so that it never expires. Typically, N95 masks expire after about five years. These measures should be followed for any items part of the national stockpile.

It’s vital to create a guide list of potential pathogens that might cause the next pandemic so the biopharmaceutical industry has what it needs to begin creating an arsenal of antiviral molecules. Most likely, the next outbreak might come from the coronavirus or influenza families. Other possible culprits include flaviviruses (ex. West Nile virus), filoviruses (ex. Ebola virus), and alphaviruses (ex. human encephalitis diseases). When developing these antivirals, it’s essential to focus on broadly active compounds where possible and use virus-specific compounds from the new strain to fill in gaps. One program started with this intent involves national and global experts who have joined forces to create a public-private partnership to integrate academic, industry, government, and community stakeholders in the AHEAD100 initiative (Advanced Human Epidemic Antibody Defenses 100). The goal is to develop a portfolio of human monoclonal antibodies for the 100 viruses most likely to cause future outbreaks. To get antibodies through Phase 1 clinical trials and manufacturing needed stockpiles will cost $25-30 million per virus. This equates to a total of $2.5-3 billion for the top 100 viruses. Experts point out that is only a fraction of the trillions Covid-19 has cost the global economy. Concentrating on known pathogens is a critical first step, but the industry must also be ready to start entirely new programs with minimal notice.

Global Actions

Many countries, especially low- and middle-income countries, have long-standing weaknesses in preparedness domains, translating into regional weaknesses. Even countries with stronger preparedness levels were profoundly challenged, highlighting vulnerabilities associated with the breakdown of global supply chains and the role that a lack of trust, cohesion, and mechanisms for intra-government coordination have played. Robust preparedness means there needs to be sustained political will. There needs to be a set of globally agreed norms and standards on pandemic preparedness and regular monitoring and assessment of performance against those standards to create this.

The WHO remains the indispensable anchor of these efforts. It performs several crucial roles: providing evidence-based public-health guidance, facilitating international collaboration, openly tracking data, and helping countries to strengthen their public health efforts. However, the organization has limitations. It’s often been underfunded, underpowered, and reluctant to criticize governments. Therefore, it must be much better insulated from political and geographic considerations in the hiring and promotion of staff and its assessments of countries and recommendations to them.

New entities are helping to reshape the landscape of global health. The Global Fund to Fight AIDS, Tuberculosis, and Malaria and Gavi, the Vaccine Alliance, (the two largest new public health groups) have a combined budget that is about twice that of the WHO. The Global Fund focuses on programs to combat the three diseases in its title, while Gavi helps provide vaccines for lower-income countries. Both receive financial resources from country governments, which have steadily increased their investments because of their efficiency, accountability, and impressive results. However, both were created without solid technical components (in large part to avoid alienating the WHO). So, while they’ve brought more resources, energy, and accountability into global health, they haven’t substantially strengthened laboratory capacity, disease monitoring, primary care, and other capacities essential to beating pandemics. Some new philanthropies, notably the Bill & Melinda Gates Foundation and the Welcome Trust, are also prominent and influential.

The world must increase its manufacturing capacity for diagnostics, treatments, and vaccines. One way is to increase manufacturing in countries with relatively small populations, which would be able to vaccinate their own people without impacting the overall supply. Increasing manufacturing capacity is critical to ensuring equitable access to low-cost vaccines. While not every country needs its own vaccine manufacturing capacity, we need to guarantee sufficient production capacity in developing countries that can be quickly scaled up.

Another global issue that needs to be tackled is improving laboratory safety. There are insufficient international standards and no global oversight regarding labs, leaving the world vulnerable to the unintentional release of deadly pathogens. This is thought to have occurred with influenza from a laboratory in the former Soviet Union in the late 1970s. It did happen with smallpox in the U.K. in 1978 and with SARS in China in 2004. Experts emphasize that the release of a biological agent could be as deadly as a nuclear war. Therefore, we need similarly robust systems of standards and inspections to reduce the risk. One option is a global compact to limit the number of laboratories, personnel, and experiments to allow them to be more safely managed, thus substantially reducing the risk. The other type of transmission we must concentrate on is the risk of diseases spreading from animal populations to humanity. Usually, the most dangerous new pathogens emerge from crossing species. One suggestion to decrease the risk is ending the commercial sale of wild animals for food. In parts of the world where wild game is essential to nutrition, economic measures will need to be taken to make it easier to substitute other locally available protein sources.

A pandemic is an opportunity for a course correction to the trajectory of civilization. Historically, pandemics have challenged us to make fundamental changes to how society is organized. Cholera forced our cities to be rebuilt for sanitation. Covid-19 should make us rethink the way we ventilate our buildings. The arc of history doesn’t automatically bend toward preparedness—it must be bent. We can’t lose all the advances we’ve made and the knowledge we’ve gained. Although the timing and nature of the next pandemic is unknowable, it’s sure to happen. The next pandemic could be much sooner and more severe than we think. Despite incredible scientific and medical advances, future pandemics are more likely as the global population grows, climate changes, and humans push into spaces occupied by wild animals. Failure to act will worsen the spread of infectious diseases by leaving the world vulnerable to emerging threats.