Pandemics are here to stay. Here's how to prepare for the next one

Imagine if every time there was a new financial crisis, the President appointed a new Federal Reserve and granted it new fiscal powers. With no existing structure or network in place, chaos would result. Why, then, do we expect this approach to work in a public health crisis such as COVID-19?

With our long history of fighting diseases, two points have become increasingly clear. The first is that successfully managing viral pandemics requires a dedicated, mission-focused health organization whose leaders have experience in this field. The second critical lesson of public health – one that we are painfully relearning in this pandemic – is that an outbreak anywhere threatens all of us. Here’s how we can potentially get back to work faster and make sure we stay at work when the next pandemic strikes.

The spread of coronavirus was hardly a surprise, and certainly not an anomaly. Population growth and increased mobility has led to rapid transmission of pathogens globally. We are now seeing new, deadly viral outbreaks almost every year.

This is our new normal. We need to ask ourselves: what is a sustainable, humane model for dealing with this new normal in a manner that permits the economy to continue to function?

No developed country should have a passive strategy as its response to a viral pandemic. And yet everything that has been done in the US and Europe in response to Covid-19 has been passive. People have to self-isolate, self-identify as having symptoms, and even seek out a test themselves.

We have fought widespread infectious diseases before. The most successful eradication campaigns include smallpox, and our ongoing efforts against polio and Guinea worm which have resulted in near eradication. When we set out to control polio, we go out and actively find infected people. Guinea worm eradication efforts have been successful because here, too, we go out and actively find infected people. This is active suppression, and it’s the same successful strategy that has been deployed by authorities in Wuhan against COVID-19.

One active option that proved successful in Wuhan is central isolation. This means that all confirmed cases are brought away from their homes to a specialized medical facility. For such a strategy to work, people with symptoms and people who have been in contact with cases must be isolated while being tested and awaiting results. This avoids the situation where infected people awaiting results have become super spreaders by getting on airplanes or attending parties.

Another option is moving faster towards herd immunity, which is when enough people have developed antibodies that further transmission of the virus is prevented. In this option we isolate and protect only the medically vulnerable and people above 65, and everybody else goes back to work or to school. Not every virus allows us to take advantage of herd immunity; it wouldn’t work for seasonal flu as it is dangerous for children and pregnant women. This, too, requires widespread testing so that we know when enough of the population has sufficient antibodies and the elderly can come out from isolation.

The final option is one that has worked well in some Asian countries and is the most debated in the media: test-isolate-trace. Before COVID-19 we saw this strategy successfully applied during the last Ebola outbreak. When Ebola was first identified in Lagos in 2014, the threat of it becoming endemic in the largest and most-densely populated country in Africa was terrifying. Nigeria quickly commandeered the Polio Operations Center in Nigeria, and this became the springboard for rooting out the Ebola virus. The organization’s leaders and professionals quickly identified ‘patient zero,’ identified everyone he had been in contact with, and quarantined and treated anyone infected. As a result, Nigeria was declared Ebola-free within three months.

Which of these options to apply, and where to apply them, is for public health experts to decide. Each of these options, or a combination of them, will all let us out of self-isolation faster than a passive strategy would. It could also keep us working, keep children in school and in general require less adaptation for society when the second wave hits or when the next new deadly viral pandemic arrives.

Every option requires a dramatic increase in testing, and a vertical health organization to implement it. This kind of organization has a narrow mission and only one focus. It functions separately from most national healthcare systems, with a clearly established direction at the top carrying through to healthcare professionals and line workers on the ground.

We have excellent current and historic examples of what a vertical organization can achieve. Smallpox is eradicated, polio and Guinea worm have both been reduced by more than 99%, and malaria has been reduced by 62% since 2000.

There are examples of this approach in other spheres. The best-known is the US Federal Reserve – an expert-led, expert-managed, empowered body that is politically independent. It collects and analyzes relevant data and takes action for the good of the economy.

A permanent shift to a 'public health Fed' is what’s called for. They will provide both preparedness and rapid response. These vertical health organizations, acting quickly, thoroughly and vigorously will generate political support, public engagement and cooperation. And when there is no new outbreak, there are plenty of problems to practice on.

As an outbreak anywhere threatens all of us this is not purely a domestic issue, so whether preparing for a new viral pandemic every year, or for vector-borne diseases, let’s fight them where they are right now and not wait until they arrive on our shores. The critical lesson of everything we have learned in public health is that we need to be proactive in tackling these diseases.

The US provided $11 billion in global health funding in 2019, up from $5.4 billion in 2006. There is significant pressure to cut that funding — but we can’t afford to lose it and it’s an insignificant amount compared to the cost of any one of those diseases spreading. Well-resourced public health verticals at home and abroad can be the most useful security assets and foreign policy tools. Most importantly, we don’t have an economy if we don’t have public health. If this viral pandemic has shown us anything it is that good public health at home and abroad is an investment - not an expense.