More than a year after the COVID-19 outbreak was declared a pandemic, and after more than 172 million people have gotten sick and 3.7 million have died, it still isn’t clear exactly how the virus began to spread. While some scientists argue that it may have escaped from a research lab in China, many experts still think that—like SARS, Ebola, MERS, and HIV before—it made the jump from a wild animal to a human somewhere in the wild. And it’s likely to happen again, though the next time, it might be worse. If a virus happens to spread as easily as SARS-CoV-2 but is as deadly as something like the Nipah virus (a virus with a mortality rate as high as 75%) it could reshape civilization.
The next pandemic could emerge at any time. But it’s also possible to prevent it from happening, not just to try to contain it after it starts to spread. “The underlying assumption is that pandemics are inevitable,” says Maureen Miller, an infectious disease epidemiologist at Columbia University. “And my thesis is that they are not.”
A long list of things went wrong with the response to COVID, many of which were outlined in a recent report from recent report from a World Health Organization panel. After the first COVID-19 cases began to show up in China in late 2019, Chinese officials hid data about the severity of the problem. The World Health Organization was slow to declare the Chinese outbreak an emergency. Globally, testing was slow. Contact tracing didn’t happen at the necessary scale. The guidance on masks was confusing. Shutdowns happened haphazardly. COVID vaccines weren’t distributed equitably.
But the problem started even earlier, when the first person was infected. There’s little attention given to addressing the root cause of pandemics, and the fact that the human relationship with the natural world is making it more and more likely that disease can jump from animals to humans, says Aaron Bernstein, interim director of the Center for Climate, Health and the Global Environment at Harvard University, who is leading a new task force looking at how to prevent pandemics when they start and creating a report for global leaders.
“I think we have a long way to go here in addressing what I would call primary prevention of pandemics, which which involves acting before people get sick,” he says. “Right now, most of the conversation is what do we do once there’s a problem in people.”
As nature deteriorates, pandemic risk increases. If a forest is logged or cleared to make way for a farm, for example, it’s more likely that wildlife from that forest will move into more populated areas and come in contact with more humans, and there will be more chances of virus “spillover” from those animals to people. As wildlife habitat is degraded and animals are under more stress, it’s also more likely that they could be sick. “As humans move into [wild areas], they disrupt the ecology tremendously,” says Miller. “And they also do come in contact with things they’ve never seen before, and many that will cause harm to humans because there’ll be naive to that exposure.” Viruses can spread from wild animals eaten for meat, or sometimes through contact with fluids from an infected animal. Industrial animal farms are another source of virus spread.
It’s critical to deal with these problems and not only how to speed up vaccine production or strengthen health systems, Bernstein says. “It would be one thing if we were living on a planet where the planet was stable, and life on Earth was intact,” he says. “But that’s not the planet we’re living on. We’re living on a planet with a climate crisis, and a biodiversity crisis, each of which are unprecedented in our species history. So we can invest all the money we want on strengthening health systems and vaccines and drugs and tests. And if we do that without recognizing what’s going on in the world around us, we’re throwing good money after bad.”
Some of the same steps that can help slow down climate change can also help prevent the spread of viruses, including stopping deforestation and better managing industrial animal farming. In a previous study, Bernstein estimated that it would cost $30 billion a year, a tiny fraction of the economic cost of the COVID pandemic, to take steps to protect nature and farm animals and prevent the next pandemic. For example, if farmers working at the border of a rainforest get help to grow more food on their existing land, and have incentives not to expand into the forest, it will help protect habitat for wild animals, so there’s less likelihood of contact with humans. Stronger laws and enforcement can also cut back on the illegal wildlife trade.
When virus spillover does happen, we need a better system for detection, Miller says, with long-term surveillance in the hot spots where it’s most likely to happen, including genetic sequencing of viruses in cases when patients have a disease that can’t easily be diagnosed, and broader studies of antibodies in the general population. It’s possible to spot potential issues long before there’s a pandemic; in a study in China before COVID, for example, Miller and colleagues found a new coronavirus that had jumped from bats to humans but wasn’t yet making people sick. Discovering that early can help scientists know what to track before the virus potentially evolves to become more dangerous. (Of course, any research at a lab has to happen with careful protocols in place so a lab leak doesn’t happen.)
A network of surveillance networks is emerging, but still needs to happen in more places and have more funding, she says, just like work to stop deforestation needs more funding. It’s important to show proof that prevention systems are working—since by definition, if they are working, we won’t see anything happen because people aren’t getting sick. Governments could notify citizens not only when a virus of concern is detected in the population, but could also potentially use models to show what might have happened if they hadn’t taken action to intervene.
“Prevention is always really tough, because when it’s working, and especially if it’s working well, it looks like the status quo, Miller says. “There is always initial interest after a public health event, and funding, and research, and moving forward in understanding. And then when nothing happens, that interest starts to wane, and other uses for the funds become apparently more pressing. What we have to do is show the value of the prevention in real time, not unlike what was developed after 9/11: ‘We prevented X attacks in New York City.’ You have to make those statistics available to the public.”