Three years on from the UK first being put into lockdown, most people are trying to put the Covid pandemic behind them. But are we ready for the next one?
“No,” says David Heymann, a world leading epidemiologist. “Nobody anywhere is prepared for the next one.”
Heymann spent 22 years at the World Health Organisation (WHO) and led its response to the 2003 Sars epidemic.
From 2012 to March 2017 he was chair of Public Health England, and has also held crucial roles at the US Centers for Disease Control and Prevention.
Now a professor at the London School of Hygiene and Tropical Medicine (LSHTM), Heymann says a “lot of lessons” have been learned from Covid. But that does not mean they are being implemented.
In public health circles the codename for an unknown pathogen that could cause a pandemic is Disease X. Covid was a Disease X until it got its own name. There could be another one coming down the line.
But what is also on the minds of many in the field is something we already know about. “The ‘unknowns’ are important,” says. Heymann. “But the ‘knowns’ are also important. We know about avian influenza.”
Bird flu (H5N1) has already been jumping species, including spilling over into mammals.
Thousands of dead sea lions which had been infected with the disease have washed up on the beaches of Peru. It has been found in grizzly bears in the United States, and otters and foxes in the UK.
In all, there have been 283 cases of H5N1 in England since the latest outbreak started in October 2021.
The UK Health Security Agency (UKHSA) says the risk to the general public’s health is “very low”. Similarly, WHO director Tedros Adhanom Ghebreyesus said in February the risk to humans was minimal.
But he added: “We cannot assume that will remain the case and we must prepare for any change in the status quo.”
Worryingly, it has spread to humans before, with the first known human cases were reported in China and Hong Kong in 1997.
Transmission from animals to humans led to 18 people being infected, six of whom died. Since then, 19 countries have reported more than 860 H5N1 human infections, of which 53% have resulted in death.
Heymann says it is important is to watch people who work with poultry, the so-called “animal-human interface”.
″If they are infected with a human influenza virus and the poultry are infected with H5N1 and those two viruses get into the same human cell to reproduce - they can in fact cause a new virus which transmits very easily from human-to-human,” he told HuffPost UK. “And it can cause a pandemic.”
Emma Ross, also a former senior WHO official and now a Senior Research Fellow at Chatham House’s Global Health Programme, has a similar worry.
She says: “It starts with managing the interactions of animals and humans. That is a neglected area. If you can’t even detect when something is popping up to stamp it out before it gets out of control.” she says.
Asked if we are prepared for that eventuality, her response is: “No.”
Countries of the WHO have begun negotiations on a new global accord on pandemic prevention, preparedness and response. But Ross is unconvinced by its prospects for success.
“Global co-operation will come down to how much are countries going to be willing to give up of their national interest for the sake of the greater good,” she says. “Fighting a pandemic, even though it’s a global phenomenon, a lot of it is done at the national level because government’s primary responsibility is to their own people.”
Lord Bethall was a British health minister from March 2020 until September 2021. While incredibly proud of how his team responded to Covid, he is now deeply pessimistic about the UK’s ability to respond at that national level, should it happen again.
Once again, the Conservative peer does not think we are prepared. ”We have failed to learn the basic lessons of the last pandemic,” he says. “If you speak to anyone, they’ll say we have gone backwards rather than forwards.”
His main concern is data. Britain did not have the basic infrastructure to respond to Covid, Bethall says. It had to be built from scratch.
“At the beginning of the pandemic we didn’t even have a list of all the care homes,” he says. “Really basic. Can we send an email to all care home staff? No. We have no idea who they are. Can we send an email to all care homes? No. We don’t have a list of all the care homes.
Bethall says: “And now we’ve gone and undone a lot of that work.
”Test and trace has been disbanded. The data system has been largely unwound. The big laboratories have either been sold off or closed down.”
He shares a worry with Ross and Heymann. “The surveillance of new diseases around the world is underfunded and under prioritised,” he says. “I have little confidence that if a dangerous new virus popped up in Caracas or Macau we would know about it very quickly.
“The 21st century is going to be a century of shocks. We are less tolerant of shocks. If we lived in the 18th century then we accepted chaotic lives. It’s fine. It’s the 18th century - of course half the family dies in one day. Nowadays we have higher expectations.”
Why have things been allowed to slide so quickly? There is an “understandable human emotion” to move on from Covid, Bethall says.
But he adds: “It’s unforgivable from a policy point of view.”
Emma Ross concludes: ″You could expect with the crisis we faced and how devastating it was even economically - which tends to be a bit of a wake up call - If this doesn’t do it. What will it take to do it?
“The history of pandemics is: panic and then complacency. Once it has faded we tend to forget how bad it was.”