Just over a century ago, in 1918, the misnamed Spanish Flu struck. It came in multiple waves, finally dying down in 1920 but never going away entirely.

In January 2020, SARS-CoV-2 emerged in China and soon started spreading around the globe, to become the world’s largest pandemic since the Spanish Flu. As of November 2021, it’s still very much with us.

Essentially 100 years separated these two massive pandemics. But, when pundits refer to the current pandemic as a “once-in-a-century” event it bears repeating that another pandemic of this magnitude or worse could very well occur in a shorter time frame.

Indeed, the Covid-19 pandemic should not have come as a total surprise, as dangerous new microbes can emerge at any time and have done so repeatedly in recent years. Since the beginning of the HIV epidemic in the early 1980s, for example, 36 million people infected with the HIV virus have died. And, since 2000, multiple infectious threats have emerged that have spread to parts of the globe, including SARS in 2002-2004, H1N1 flu in 2009-2010, MERS in the 2010s, Zika in 2015-2016, and periodic Ebola outbreaks from 2014 through 2021.

“Sooner or later, a new virus may emerge or re-emerge that could be more transmissible than the Covid-19 virus, more virulent or both,” World Health Organization (WHO) Director, Dr. Tedros, and former mayor of New York City, Michael Bloomberg, wrote in February of this year. And so it’s of paramount importance to prepare for the next pandemic.

In doing so, there are lessons to be learned from the global response to Covid-19. These include several positive take-aways. For instance, the speed with which research and clinical development of diagnostic tests, treatments, and vaccines occurred, has been astounding. In addition, the global scientific community generated and shared data in unprecedented ways, which is a welcome change from epidemics of years past.

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Nonetheless, it’s vital that a number of glaring errors not be repeated. For example, in most countries there was a playbook for how to deal with a pandemic like Covid-19, but too often it was either ignored or followed haphazardly. Last year, fault lines appeared between nations in terms of strategies to address Covid-19. Some countries, like Finland, South Korea, and New Zealand, adopted a rigorously designed plan and stuck to it. Others seemingly had no coherent set of protocols, or abandoned them.

In and of itself, establishing different approaches to tackle an infectious disease outbreak is inherent to the diversity of nations’ policymaking institutions, legal frameworks, and cultures. What became more problematic as time went on, however, was poor and inconsistent communication from political leaders, politicization of public health measures, and even disinformation at times.

The implementation of non-pharmaceutical intervention measures, the rollout of vaccination programs, and the pursuit of global vaccine equity have been hampered by ineffective leadership. In particular, the lack of a systematic set of coherent government policies aimed at curbing transmission, as well as a dearth of international cooperation between countries on the vaccine supply front, represent a “failure of governance.”

Preparing for the next pandemic implies that policymakers will have to understand and address the cited failures. Here, it’s imperative that policymakers develop a long-term pandemic preparedness strategy that is evidence-based, educates the population, and strives for what the former WHO Director-General Dr. Margaret Chan calls “health security.” Chan posits that “respiratory pathogens with pandemic potential pose an existential threat as serious as climate change, environmental degradation and nuclear war.” Underscoring Chan’s point, Dr. Maria Van Kerkhove, Technical Lead of the WHO’s Covid-19 Response, warned that “pandemic preparedness and readiness is a constant. It doesn’t begin, it doesn’t end. There is no peacetime.”

Echoing the warnings issued by Chan and Van Kerkhove, Dr. Scott Gottlieb writes in his book, Uncontrolled Spread, why we must view public health preparedness through the lens of national security. Here, the U.S. has an indispensable role to play, given the influence it exerts as the world’s largest economy, along with having several public health agencies the world has traditionally looked up to, including the Centers for Disease Control and Prevention.

But, public health preparedness in the U.S. faces enormous challenges. For one thing, it appears that already U.S. legislators are no longer prioritizing efforts to prepare for the next pandemic. Some might be shocked by this, in light of what has transpired over the last 20 months. But, the apathy displayed by many lawmakers is consistent with decades of neglect of public health, which has led to chronic underfunding, at the local, state, and federal levels.

Essential public health components are even an afterthought in the Biden Administration’s $65 billion pandemic preparedness initiative. Missing in this plan are, for example, comprehensive plans on how to equitably distribute and provide access to developed and procured medical technologies, as well as ways to improve outreach and information campaigns, and properly fund local public health authorities.

At a bare minimum, public health departments at the local, state, and federal levels ought to be revitalized. But, this will be a difficult undertaking in the face of entrenched opposition to public health interventions. Twenty-six states have curtailed public health powers amid the Covid-19 pandemic. In these states, legislators have rolled back the capacities which state and local officials use to protect the public against infectious diseases.

Governors and state officials have thwarted efforts to institute even a bare minimum in terms of non-pharmaceutical interventions, namely indoor mask mandates. More importantly, they have impeded vaccination uptake by not only opposing vaccine mandates, but also in some instances sowing doubts about vaccine safety and efficacy among constituents. In part, this anti-vaccine rhetoric has contributed to more than 150,000 preventable Covid-19 fatalities during the Delta variant wave; what Dr. Peter Hotez calls “death by anti-science.”

The anti-science crusade has politicized public health and created the impression that its suggested rules run counter to individual liberty. Therefore, combating the insidious anti-science attitude will be a daunting task. And, political leaders and policymakers can’t prevent pandemics in isolation from the now widespread anti-science movement, writes Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, in his book Preventing the Next Pandemic.

Preparing for the next pandemic will be difficult under any circumstances. But, it’s made harder by a persistent lack of resources and the rise of anti-science attitudes. Accordingly, making preparations for future infectious disease outbreaks will involve more than just resource deployment. Public health officials will also need to work on improving messaging, specifically to explain science-based decisions to the public in a nuanced way that allays fears of government overreach. Here, policymakers will have to walk a fine line when rebutting the narrative of disinformation campaigns, as run, for example, by the anti-vaccine community.

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