In the carousel of debates taking place these days among government, business, and health leaders attempting to prepare for the next pandemic, a popular question focuses on the value of increasing incentives that support R&D resources to confront the unknown pathogens of the future.
But this question misses the mark. In pandemic simulations and doomsday movies during the past decade, the frequent premise is that humanity can count on science to save it; if only humans could allow ourselves to be saved. Covid-19 response in the U.S. played out along similar lines: we were able to leverage technologies that had been studied for years and then rapidly deploy them in real-world conditions, only to have our pandemic response sabotaged by poor communications, inept leadership, ill-prepared support systems, and political partisanship.
Trust in messaging became a casualty of our media-rich culture, which can spew out both accurate information and biased tropes.
It is reasonable to assume that we have sufficient incentives for scientific investment and that the progress we make in the coming years will rise to meet the pandemic threat. Companies have seen that leveraging mRNA and other technologies to deliver vaccines for mega-demand moments like a pandemic can be profitable. Such preparation provides a gateway to a bonanza that fuels investor wealth and vaccine pipelines for many other diseases.
And the interconnected nature of our world combined with the increased destabilization of our ecosystems will all but ensure that another dangerous pandemic will evade and outpace our early detection systems. As such, we can expect infectious disease research to be a priority for the foreseeable future.
What is needed to encourage industry transformation?
So the question is not what we need to do to encourage scientific innovation to meet the moment. The question is whether we have the incentives, policies, and promotional reach in place to address three other building blocks to responding to a pandemic threat.
First we need the ability to scale down the size of vaccine production systems while scaling up production capacity. Akin to microprocessor power, think of it this way: if an mRNA vaccine facility now takes 12–18 months to set up and is the size of an IKEA store, is it possible to achieve faster set up times of production modules around the world, with smaller footprints producing more vaccine output?
The short answer is quite possibly yes. And with the acceleration of vaccine discovery, other points in the drug delivery value chain such as clinical trials and distribution processes will need to evolve as well. Technology platforms and processes are coming together to deliver this kind of sea change, but incentives and policies will be needed to nurture these new approaches so we don’t slide back to safe, status quo pre-pandemic operating models.
Most important, we need to evolve the way these technologies can be available equitably and used in a range of settings, from wealthy countries to emerging markets.
Second, we must have more responsive systems to meet the far-reaching disruption caused by a pandemic. This goes beyond funding and incentives for stockpiling PPE. In the U.S. we need more triage and flex capacity to manage demand on health systems in different parts of the country so that our hospital systems can handle surges and our critical care workers can remain protected.
Better response could mean activating FEMA and National Guard units much earlier, but it could also mean pushing incentives to the general public to follow health guidelines sooner, go to field clinics instead of hospitals, or tune in to health news channels that are run by a consortium of outlets rather than relying on one source of information only.
Internationally, we must work to shore up disease surveillance in other countries to identify and contain regional outbreaks before they become global.
Are we prepared for the next pandemic?
Achieving a better response to the next pandemic response also means getting another major piece right: early and rapid testing and better contact tracing. This is where there’s a powerful opportunity to improve government supply procurement and purchasing power to generate demand and drive down costs so that consumers and health systems do not see rapid, reliable testing as a barrier, but a pathway to maintaining a normal life.
Here’s the most important point: no amount of scientific innovation or streamlined systems will help us if we don’t begin tackling the structural and societal issues that are fueling widespread, entrenched resistance to public health mandates. How we view governments, institutions, social norms and risk are the biggest drivers to how we respond individually and collectively to the next pandemic. Or for that matter, how we respond to the greatest public health threat we all face: climate change.
If we want to consider solutions that stick, perhaps we should look at the Space Race for lessons. The Moonshot fueled a national push for STEM education that may have helped deliver many of the big tech breakthroughs of the late 20th century. We need to train a “WE” generation to replace the “ME” generation that has placed such heavy reliance on individual decision-making. That luxury resulted in high rates of infection for many at the hands of a few.
Covid-19 is a catalyst for change
Using Covid-19 as a catalyst, now is the time we should be creating incentives to build public health education and appreciation at the earliest ages, first with the generation of kids who have missed so much from the past two years. Now is the time to figure out how we create better communications processes — assessing and rewarding the channels that are most beneficial versus those that are detrimental.
And right now is when we should invest in more creative partnerships that foster collaboration between schools of public health, journalism, and government. Town halls sponsored by a mix of trusted local and national groups can encourage greater dialog about the role of science, public health, and policy in the 21st century.
These are the building blocks for confronting the next pandemic. We have the incentives and potential to meet the scientific challenges, scale our response, and improve our systems. But if we can’t change human nature, we don’t stand a chance.