Opinion: Epidemic preparedness is the building block for pandemic response

After each major disease outbreak, from SARS and Ebola to COVID-19, governments, scientists, and funders have turned their focus to pandemic preparedness and the concept of “Disease X” — an unknown pathogen that can cause a pandemic. And yet, at any one time, there are on average dozens of disease outbreaks worldwide that could spread and trigger the next global pandemic. This year alone has seen outbreaks of the H5N1 bird flu across the U.S. in dairy cows, mpox across 16 African countries and beyond, and Marburg virus in Rwanda. These ongoing challenges demonstrate why we cannot wait for the next pandemic to strengthen our defenses. So how can our responses to past and ongoing epidemics enhance our ability to prepare and respond to pandemic threats? Effective epidemic responses are the building blocks for a successful pandemic response. Responding quickly and effectively often requires years of planning and prior research. The COVID-19 pandemic is an example of how ongoing research and the existing knowledge of similar threats, such as SARS and MERS, can be pivoted to tackle new, emerging diseases with pandemic potential. Recent research has found that Coalition for Epidemic Preparedness Innovations’ 100 Day Mission, which aims to provide a globally accessible vaccine within 100 days of an outbreak with pandemic potential, could have saved more than 8 million lives during the COVID-19 pandemic, particularly in low- and middle-income countries. The COVID-19 response was by no means perfect, but the speed of vaccine development and knowledge building showed us what's possible when preparation meets opportunity. Research during outbreaks can strengthen the immediate response as well as future preparedness. It provides insights into how diseases spread and evolve, and how populations respond to an outbreak and the control measures. This can inform the development and deployment of more accurate diagnostics, more effective preventive measures such as vaccines and infection prevention control, and better treatments. Lessons learned during outbreaks enable decision makers to take swifter action to deploy control measures such as vaccination campaigns, or mobilize resources such as health care workers, equipment, or funding to where they will have the most impact. For example, as filovirus outbreaks — viruses that can cause hemorrhagic fevers, such as Marburg — have become more common, organizations have built their understanding of these and how to control them. In response to the Marburg outbreak in Rwanda, local governments, researchers, funders, and industry have leveraged accumulated knowledge to respond rapidly. As a result, just nine days after the outbreak was declared, a vaccine trial had begun. This would not have been possible without earlier research and understanding of the ethical, regulatory, and operational requirements needed for CEPI, the trial coordinators, and the Rwandan government to act swiftly. Similarly, a trial coordinated by ISARIC to understand the effectiveness of Marburg therapeutics began recruiting patients within 20 days of the outbreak being declared. Early detection is another crucial part of preparedness. Disease surveillance can help follow trends in disease burden and track emerging threats to detect outbreaks early. This enables swift action to implement intervention measures to reduce the risk to local communities, informing local, national, and global health strategies to prepare for endemic, epidemic or pandemic responses. “Local, equitable response to endemic disease outbreaks is the key to a rapid, effective pandemic response.” --— Researchers in countries most affected should be the ones leading the way if we are to gain a clearer understanding of the nuances of disease characteristics, transmission, and community needs in specific settings. However, despite Africa carrying 20% of the global disease burden, the majority of research and trials are carried out by high-income countries. The best way to support these researchers in countries most affected is by building in-country capabilities. A more effective country-led response requires strengthening local research facilities and diagnostics for endemic diseases, enhancing surveillance of seasonal diseases, training for health care workers, and expanding in-country vaccine manufacturing capabilities. Investing in building in-country capabilities puts us on the right track to countries being able to control diseases before they get the chance to cross borders. Equity must be at the heart of preparedness and response. Any form of preparedness must be tailored to those at risk. Researchers and decision-makers must engage with affected communities to understand how they view and respond to cases and intervention measures, and build trust, keeping them engaged, informed, and empowered during outbreaks. In short, by learning from past epidemics, we can better prepare and tailor responses that both strengthen responses to outbreaks of endemic diseases to protect those most affected, reducing the risk and impact of pandemics. Now is the time to strengthen our defenses against future pandemics — we cannot wait for the next threat to emerge. Local, equitable response to endemic disease outbreaks is the key to a rapid, effective pandemic response. If we invest in preparedness today, we can save the lives of tomorrow.