It's a terribly depressing phrase: "the next pandemic."
But as vaccines point the way out of COVID-19, here's a small preview of the great debate to come: When the next pandemic hits — and it will — what should be at the top of the list for handling it better?
Among a half-dozen Boston-area public health thinkers, the most widely shared opinion is that for the next pandemic, what's most imperative is that we learn from our mistakes on this one.
So what does the country need most?
1. Have A Plan For That
"A plan," was the simple but heartfelt answer from Dr. Michael Mina of the Harvard Chan School of Public Health. "We should have a strategy and a plan for any kind of pandemic that can come about, so that, should we ever find ourselves in a position again with a president like the one we currently have, we don’t have to rely on the current administration to come up with a whole new plan."
Of course, the country did have some pandemic planning in place, but no one would argue that it was adequate. Mina envisions something like a binder with fully developed instructions that can be plunked down on the president’s desk.
"I think that that is the number one thing we should be doing today to prepare for future pandemics," he says.
2. Germ Surveillance
Mina and others also talk about various types of infrastructure that should be put in place in advance, including better ways to detect a coming threat and sound the alarm.
He calls for a kind of global observatory of germs, something like the way meteorologists use monitoring tools around the world to forecast the weather.
And overall, we need more of the new science of genomic surveillance, says Dr. Bronwyn MacInnis, director of Global Pathogen Surveillance at the Broad Institute.
"Genomic surveillance involves sequencing the genetic code of viruses from infected people," she explains, "and using that information to track how viruses mutate as they spread across time and space."
A recent example: the identification of a new, apparently more contagious variant of the coronavirus in the United Kingdom.
"Many initiatives have been spun up to do genomic surveillance of COVID-19," MacInnis says, "but the US and, for the most part, the world, really still lacks the systems to do it quickly enough and comprehensively enough for the data to be useful in real time."
We should just have bunkers of laboratories.Dr. Michael Mina, Harvard Chan School of Public Health
3. Testing, Testing, Testing
Dr. Nahid Bhadelia, the medical director of the special pathogens unit at Boston Medical Center, emphasizes the need to invest in testing capacity, because we so "missed the boat" on detecting how quickly the novel coronavirus was spreading in American communities.
"Any time there’s a threat like this," she says, "it needs to be an instant reaction to building that capacity and getting it out to as many metropolitan areas and travel hubs as possible, to really pick the needle out of the haystack."
And Harvard's Michael Mina argues that the country should have testing capacity already in place, so it doesn't have to suddenly build it up again.
"We should just have bunkers of laboratories," he says. "We should have factories that can make [tests] in the millions, and flip those switches within weeks. We should be treating this like a department of defense project. "
"We have bunkers of missiles and bombs and planes," he says, so why not bunkers of testing equipment?
4. Manufacture More
Also needed: More manufacturing capacity for all the pandemic-related goods that have been needed, from ventilators to personal protective equipment.
"One of the things that failed us complete were our supply chains — and they still fail us," says Dr. Bhadelia from Boston Medical Center.
When there's a fire in just one place it's fine to depend on other countries for supplies, she says. "But if the whole world is on fire, it’s really hard to get the supplies where they need to be. And what you might see in the future in the U.S. is probably a repatriation of the supply chains, which I think is probably good for us."
Though she does have concerns about other countries that don’t have the same level of manufacturing heft and could get left out in the cold, she says.
5. Learn The Lessons Of COVID-19
Among the more societal fixes that experts call for: addressing the racial and class inequalities that led to disparities in the toll the pandemic has taken, and bolstering a public health system that has been under-funded for decades.
Most important of all, Harvard epidemiologist Bill Hanage says, is to learn from this pandemic's mistakes, "because we have made mistakes. We have made a lot of mistakes. We have failed to put in place a bunch of no-regrets, forward planning in which we say ‘If these things happen, then we do this.'"
Instead, he says, the pandemic response has involved arguing and reversals; it has been, in effect, "a rudderless pandemic response, internationally. That’s a global issue, and I think that a global state of preparedness for the next pandemic is something we should work toward. And the first thing to do there is to acknowledge the mistakes that we’ve made in this one."
Even more incentive to do better: In a new white paper, MIT Sloan School of Management senior lecturer Steve Spear and biotech investor Jason Paragas argue that the country has to do better, because the next pandemic could be even worse: the virus could be even deadlier or more contagious.
They recall that after 9/11, federal analysis concluded that the intelligence community had failed to integrate information on al Qaeda that was scattered among agencies. The response: a directorship of national intelligence, they write.
Now, they're calling for a system that would be better at amplifying pandemic lessons learned locally, to be sure the best known methods are shared and scaled up. They also call for a greater role for the private sector, much as private contractors support NASA.
Despite all the current challenges, they see preparation for the next pandemic as urgent, because the next one could be worse, and is likely already on its way.
"By the time the next one arrives," Spear says, "the system has to be in place."