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Since February this year, WHO Director-General Tedros Adhanom Ghebreyesus and Director of China’s National Bureau for Disease Control and Prevention Wang Hesheng have said that “Disease X” caused by an unknown pathogen is difficult to avoid, and we should prepare for and respond to the pandemic caused by it

First, partnerships between the public, private and non-profit sectors are a central element of an effective pandemic response. Before that work begins, however, we must make real efforts to ensure timely and equitable global access to technologies, methods and products. Second, a range of new vaccine technologies, such as mRNA, DNA plasmids, viral vectors and nanoparticles, have been shown to be safe and effective. These technologies have been under research for up to 30 years, but were not licensed for human use until the Covid-19 outbreak. In addition, the speed with which these technologies are being utilized shows that it is feasible to build a true rapid-response vaccine platform and can respond to the new SARS-CoV-2 variant in a timely manner. The availability of this range of effective vaccine technologies also gives us a good foundation to produce vaccine candidates before the next pandemic. We must be proactive in developing potential vaccines for all viruses with pandemic potential.

Third, our pipeline of antiviral therapies is well prepared to respond to the viral threat. During the Covid-19 pandemic, effective antibody therapies and highly effective drugs were developed. To minimize loss of life in a future pandemic, we must also produce broad-spectrum antiviral therapies against viruses with pandemic potential. Ideally, these therapies should be in the form of pills to improve distribution capacity in high-demand, low-resource Settings. These therapies must also be easily accessible, unconstrained by the private sector or geopolitical forces.

Fourth, having vaccines in warehouses is not the same as making them widely available. The logistics of vaccination, including production and access, need to be improved. The Alliance for Innovative Pandemic Preparedness (CEPI) is a global partnership launched to prevent future pandemics, but more effort and international support are needed to maximize its impact. While preparing for these technologies, human behavior must also be studied to raise awareness of compliance and develop strategies to counter misinformation.

Finally, more applied and basic research is needed. With the emergence of a new variant of SARS-CoV-2 that is completely different in antigen, the performance of various vaccines and therapeutic drugs that were previously developed has also been affected. Various techniques have had varying degrees of success, but it is difficult to determine whether the next pandemic virus will be affected by these approaches, or even whether the next pandemic will be caused by a virus. Without being able to foresee the future, we need to invest in applied research on new technologies to facilitate the discovery and development of new drugs and vaccines. We must also invest extensively and heavily in basic research on epidemic-potential microorganisms, viral evolution and antigenic drift, the pathophysiology of infectious diseases, human immunology, and their interrelationships. The costs of these initiatives are huge, but small compared to the impact of Covid-19 on human health (both physical and mental) and the world economy, estimated at more than $2 trillion in 2020 alone.

The enormous health and socio-economic impact of the Covid-19 crisis strongly points to the critical need for a dedicated network dedicated to pandemic prevention. The network will be able to detect viruses that spread from wild animals to livestock and humans before developing into localized outbreaks, for example, to forestall epidemics and pandemics with serious consequences. While such a formal network has never been established, it is not necessarily an entirely new undertaking. Instead, it will build on existing multisectoral monitoring operations, drawing on systems and capacities already in operation. Harmonization through the adoption of standardized procedures and data sharing to provide information for global databases.

The network focuses on strategic sampling of wildlife, humans and livestock in pre-identified hotspots, eliminating the need for worldwide virus surveillance. In practice, the latest diagnostic techniques are needed to detect early spillage viruses in real time, as well as to detect many key endemic virus families in samples, as well as other new viruses originating in wildlife. At the same time, a global protocol and decision support tools are needed to ensure that new viruses are removed from infected humans and animals as soon as they are discovered. Technically, this approach is feasible due to the rapid development of multiple diagnostic methods and affordable next-generation DNA sequencing technologies that enable rapid identification of viruses without prior knowledge of the target pathogen and provide species-specific/strain specific results.

As new genetic data and associated metadata on zoonotic viruses in wildlife, provided by virus discovery projects such as the Global Virome Project, are deposited into global databases, the global virus surveillance network will become more effective at detecting early virus transmission to humans. The data will also help improve diagnostic reagents and their use through new, more widely available, cost-effective pathogen detection and sequencing equipment. These analytical methods, combined with bioinformatics tools, artificial intelligence (AI), and big data, will help to improve dynamic models and predictions of infection and spread by progressively strengthening the capacity of global surveillance systems to prevent pandemics.

Establishing such a longitudinal monitoring network faces considerable challenges. There are technical and logistical challenges in designing a sampling framework for virus surveillance, establishing a mechanism for sharing information on rare spillovers, training skilled staff, and ensuring that public and animal health sectors provide infrastructure support for biological sample collection, transportation, and laboratory testing. There is a need for regulatory and legislative frameworks to address the challenges of processing, standardizing, analyzing, and sharing large amounts of multidimensional data.

A formal surveillance network would also need to have its own governance mechanisms and members of public and private sector organisations, similar to the Global Alliance for Vaccines and Immunisation. It should also be fully aligned with existing UN agencies such as the World Food and Agriculture Organization/World Organization for Animal Health /wHO. To ensure the long-term sustainability of the network, innovative funding strategies are needed, such as combining donations, grants and contributions from funding institutions, member States and the private sector. These investments should also be linked to incentives, especially for the global South, including technology transfer, capacity development, and equitable sharing of information on new viruses detected through global surveillance programs.

While integrated surveillance systems are critical, a multi-pronged approach is ultimately needed to prevent the spread of zoonotic diseases. Efforts must focus on addressing the root causes of transmission, reducing dangerous practices, improving livestock production systems and enhancing biosecurity in the animal food chain. At the same time, the development of innovative diagnostics, vaccines and therapeutics must continue.

First, it is essential to prevent spillover effects by adopting a “One health” strategy that links animal, human and environmental health. It is estimated that about 60% of disease outbreaks never before seen in humans are caused by natural zoonotic diseases. By more tightly regulating trading markets and enforcing laws against wildlife trade, human and animal populations can be separated more effectively. Land management efforts such as stopping deforestation not only benefit the environment, but also create buffer zones between wildlife and humans. Widespread adoption of sustainable and humane farming practices would eliminate overuse in domesticated animals and reduce the use of prophylactic antimicrobials, leading to additional benefits in preventing antimicrobial resistance.

Second, laboratory safety must be strengthened to reduce the risk of unintentional release of dangerous pathogens. Regulatory requirements should include site-specific and activity-specific risk assessments to identify and mitigate risks; Core protocols for infection prevention and control; And training on the proper use and acquisition of personal protective equipment. Existing international standards for biological risk management should be widely adopted.

Third, GOF-of-function (GOF) studies aimed at elucidating transmissible or pathogenic characteristics of pathogens should be appropriately supervised to reduce risk, while ensuring that important research and vaccine development work continues. Such GOF studies may produce microorganisms with greater epidemic potential, which may be inadvertently or intentionally released. However, the international community has yet to agree on which research activities are problematic or how to mitigate the risks. Given that GOF research is being conducted in laboratories around the world, there is an urgent need to develop an international framework.