The Urgent Need for Proactive Surveillance of Infectious Disease at Mass Gatherings

As the world gradually recovers from the shockwaves of the COVID-19 pandemic, the spectre of another potential public health crisis looms ominously on the horizon

Having recently returned from a convention in Singapore, where over 14,000 people from 220 nations converged, I felt the subtle, omnipresent dance of potential contagions. Each handshake and shared breath carried the possibility of anything from a benign cold to the dreaded resurgence of COVID-19. My last shot of this seasonal influenza vaccine and COVID booster was back in September 2023, and I could sense that my protective shield has dimmed since then. Reflecting now, I realize I should have sought another booster, a renewed armour, before travelling through busy airports and the largest and diverse convention I’ve ever attended.

As the world gradually recovers from the shockwaves of the COVID-19 pandemic, the spectre of another potential public health crisis looms ominously on the horizon. A recent report in The Lancet on the risks of avian influenza H5N1 at mass gatherings is a critical reminder that our vigilance against infectious diseases must remain steadfast, especially as we approach a summer filled with major religious, cultural, and sporting events.

Mass gatherings have always been fertile ground for spreading infectious diseases, serving as hubs for international transmission. From the annual Hajj pilgrimage to the bustling celebrations of Kumbh Mela, these events draw millions of people from around the globe, creating perfect storm conditions for pathogen spread. The resurgence of avian influenza, particularly the H5N1 strain, poses a renewed threat that demands immediate and focused attention.

The Silent Spread of H5N1

H5N1, also known as Highly Pathogenic Avian Influenza, has been on the radar of global health authorities since its emergence in 2004. Despite not currently transmitting easily from person to person, recent reports of mild or asymptomatic human cases in the USA, China, Vietnam, and Europe are alarming. The first human case in the USA was reported in 2022 in Colorado, linked to direct poultry exposure. Similarly, England has documented 298 cases since October 2021. This underscores the virus’s persistence and the potential for rapid, widespread outbreaks if left unchecked.

Lessons from History: Preparedness Pays Off

Historical precedents demonstrate the critical importance of proactive public health measures. The past decade has seen mass gatherings successfully navigate Zika, Ebola, and COVID-19 threats through meticulous planning and surveillance. For instance, the 2015 Africa Cup of Nations in Equatorial Guinea proceeded safely amidst the Ebola outbreak, thanks to stringent health protocols and international cooperation.

The ongoing efforts to prevent outbreaks at events like the Tokyo 2020 Olympics and various religious gatherings highlight the effectiveness of preparedness. Yet, these successes should not breed complacency. The ever-evolving nature of viral pathogens necessitates continuous vigilance and adaptation of our health strategies.

The One Health Approach: A Unified Front Against Zoonotic Diseases

The interconnectedness of human, animal, and environmental health underscores the need for a comprehensive One Health approach. Mass gatherings often involve the consumption of animal products and, in some cases, live animal sacrifice. This creates multiple avenues for zoonotic transmission, particularly with avian influenza viruses.

Countries hosting mass gatherings must implement rigorous screening and testing protocols for poultry and other animals to mitigate these risks. This includes mandatory surveillance of imported animals and those used in religious rituals. Wastewater surveillance can also provide early detection of viral presence, allowing for swift intervention.

Bridging Knowledge Gaps: Research and Surveillance

Mass gatherings present unique opportunities for real-time research and data collection. Understanding the transmission dynamics of H5N1 and other zoonotic pathogens is crucial for developing targeted interventions. Enhanced surveillance, using advanced diagnostic platforms, can identify and monitor emerging threats, filling critical knowledge gaps.

The Path Forward: International Cooperation and Vaccine Development

Ultimately, the global community must unite in the face of these emerging threats. Developing and distributing effective vaccines for H5N1 and its variants will be pivotal in safeguarding public health. Collaborative efforts involving organisations like the WHO, FAO, and OIE are essential for a coordinated response.

A Two-Year Effort to produce a global pandemic treaty misses its deadline. On Friday, May 24, Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, announced that the negotiators from the group’s 194 member nations couldn’t reach a consensus in time for the World Health Assembly, which started this week.

The goal had been to draft a document that could be adopted at the meeting and then sent to countries for ratification. However, the sticking points—including the willingness of richer countries to share vaccines and treatments with less well-off countries in the Global South—could not be resolved in time.

What Next?

Scientists predict the next pandemic could occur soon, perhaps in two years or twenty. Still, the message is clear: proactive surveillance and preparedness are not optional. They are imperative. By learning from past experiences and embracing a unified approach, we can protect millions of lives and ensure that mass gatherings are celebrated safely worldwide.

Christopher Nial is a senior partner at FINN Partners. He specialises in global public health and the intersection between climate change and public health. With over 30 years of experience, he is passionate about leveraging public health strategies to save lives.


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Christopher Nial
Christopher Nial
Christopher Nial is closely monitoring climate change impact on global public health. He serves as a Senior Partner at FINN Partners, is part of the Global Public Health Group, and co-leads public health initiatives across Europe, the Middle East, and Africa.
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