Future Pandemics: Are We Ready?

The COVID-19 pandemic has laid bare numerous vulnerabilities that could be exploited by future pandemics, and experts suggest that another outbreak may not be far off.

According to researchers at Duke University, the likelihood of encountering another pandemic akin to COVID-19 is approximately 2% each year. For individuals born in 2000, this translates to a 38% chance of facing such a crisis by now, a figure that is expected to rise. William Pan, Ph.D., a global environmental health associate professor at Duke and a co-author of the study, emphasizes that significant pandemics like COVID-19 and the Spanish flu are relatively likely. This understanding should prioritize efforts to prevent and manage future outbreaks.

As human populations encroach upon the natural habitats of various animal species, the risk of emerging viruses, bacteria, or fungi increases. This pattern has led to several public health emergencies in recent years, but our collective memory tends to fade quickly.

In 2001, following the September 11 attacks, weaponized anthrax was mailed throughout the U.S. A new coronavirus surfaced in 2002, triggering a global response that ultimately prevented a pandemic. Despite debates about whether the SARS outbreak constituted a pandemic due to its geographic spread, it remains a notable example. The H1N1 influenza pandemic in 2009 caused widespread disruption, while the Middle East Respiratory Syndrome emerged in 2012, affecting many countries. The Ebola epidemic in West Africa in 2014 and the Zika virus outbreak in 2015 further exemplify the ongoing public health challenges we've faced.

But what if a more severe threat arises? What if we urgently need citizens to stay home? Would police, fire, and EMS personnel take a vaccine against a truly deadly pathogen? And what about healthcare workers, who have already endured so much during this pandemic—would enough of them be willing to face another wave of disease and death?

The Hendra virus, which emerged in 1994 in Australia, serves as a stark reminder of the dangers posed by unknown pathogens. This virus, which caused severe illness and fatalities among both horses and humans, illustrates how new threats can arise unexpectedly. Similarly, the hantavirus outbreak in the Four Corners region of the U.S. in 1993 marked the first hantavirus epidemic in the Western Hemisphere. More recently, the Nipah virus epidemic in Southeast Asia in 1999 highlighted the potential for zoonotic diseases to spread rapidly among both animals and humans.

Amid these biological threats, a different challenge to public health has recently emerged. Several U.S. state legislatures have passed laws that diminish the authority of local health officials and shift power to elected representatives. These changes often limit the duration of declared public health emergencies and prohibit local entities from requiring masks or vaccinations. Encouragingly, the voices of a small but vocal anti-vaccine and anti-science faction have gained traction, influencing public opinion and legislative decisions.

As we contemplate the future, the question remains: What if something worse occurs? The historical precedents of influenza and coronavirus have been managed through a combination of luck and scientific advancements. For example, the swift development of mRNA vaccine technology has enabled rapid responses to emerging variants of COVID-19.

Nevertheless, glaring health disparities persist, preventing many individuals from accessing essential healthcare services. In Texas, for example, life expectancy varies significantly based on wealth, race, and education. Overlaying maps of life expectancy with historical redlining practices reveals stark correlations between socioeconomic status and health outcomes.

Furthermore, ongoing attacks on scientific integrity from various sectors, including those with medical qualifications, have led to misinformation about disease prevention and treatment. Some healthcare professionals are spreading anti-vaccine narratives, undermining public trust in proven medical practices.

Potential worst-case scenarios loom large: conflicts that engulf global superpowers, urban encroachment on wildlife habitats leading to the emergence of new pathogens, and inadequate public health infrastructure could all contribute to the spread of a novel disease. As infected individuals travel from outbreak zones to larger population centers, health inequities may exacerbate the situation. Misinformation on social media could further hinder effective responses, resulting in widespread transmission of the disease.

The fatigue stemming from the COVID-19 pandemic may lead some to resist necessary public health measures. If loud minority voices sway decision-makers, we risk allowing a new, more contagious pathogen to evolve, crippling essential services and creating chaos.

In the face of these challenges, we must consider the potential consequences of neglecting public health measures. The fear surrounding vaccinations, fueled by misinformation, could result in a resurgence of preventable diseases among children.

While it's possible that global climate change or a lack of armed conflict may spare us from a new pandemic, we must also strive for a robust global disease surveillance system that can detect early signs of outbreaks. Moreover, we need to cultivate a culture of skepticism toward harmful misinformation.

Ultimately, I hope to be proven wrong about these dire predictions. However, the events of the past two years offer little optimism. The erosion of public health frameworks, coupled with threats against health experts, indicates a troubling trend. As social media proliferates with pseudoscientific claims, we must remain vigilant and prioritize evidence-based approaches to public health.

René F. Najera, MPH, DrPH, is a public health expert and epidemiologist. He works in a local health department in Virginia and is dedicated to improving community health outcomes. The opinions expressed in this article are solely those of Dr. Najera and do not reflect the views of his employers or associates.

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