5 years since COVID was declared a pandemic, we’re still poorly prepared for the next one
- Written by Sharon Lewin, Melbourne Laureate Professor, University of Melbourne; Director, The Peter Doherty Institute for Infection and Immunity
On March 11, 2020, as COVID continued to spread rapidly around the globe, the World Health Organization[1] (WHO) officially declared a pandemic.
More than 7 million people[2] have since died from COVID. The virus, and the public health measures enacted to control it, have had far-reaching effects on societies around the world.
Five years on, the virus continues to circulate. But, thanks to vaccines and immunity acquired from infections[3], hospitalisations and deaths due to COVID are vastly less frequent than in previous years[4].
Meanwhile, long COVID[5] continues to have a major impact on people’s lives. Estimates suggest more than 400 million people[6] around the world have had or are currently living with long COVID.
At this point, Australia and the world must take the lessons of COVID – in areas from surveillance, to outbreak response, to vaccines and therapeutics – to be better prepared for the next pandemic.
Some areas we went right – and wrong
Our diagnostic laboratories across Australia were well prepared. Laboratories at the Doherty Institute diagnosed the first case of COVID in Australia and were the first to isolate and share the virus[7] globally in early 2020.
At the same time, a national public health response was quickly put in place. This involved measures such as[8] closing borders, setting up testing centres, and limiting gatherings.
But there are several areas where we could have mobilised more effectively.
During the early stages of the pandemic, there were, at times, challenges with sharing data as well as biological samples and the ingredients for COVID tests between the different states and territories.
For example, there are currently restrictions in place that limit sharing of virus strains between states and territories. But when a new strain emerges, many laboratories need access to it to evaluate their testing capabilities.
One recommendation from an independent 2024 review[9] of the federal government’s COVID response was an Australian Centre for Disease Control. An interim version was launched in early 2024 and the Australian government is investing A$251.7 million[10] in this important initiative.
The goal for the new centre for disease control will be to provide independent technical advice on infectious diseases to government. It will also facilitate rapid integration of data from all states and territories leading to a more unified response.
At the start of a pandemic, we need to understand everything about the new virus and at great speed. This needs systems in place in “peace time”, ready to be mobilised in “war time”.
Back in 2020, we had protocols ready for hospitalised patients[12] and intensive care units[13] to collect specimens and also start new clinical trials. But we were not prepared on many other fronts, for example to collect samples or study how COVID was transmitted in the community or in different key groups.
Every day counts at the start of a pandemic.
Harnessing medical technologies
Relatively recent technological advances in both diagnostics (RAT tests) and vaccine development (the use of messenger RNA[14], which gives our body genetic instructions to fight COVID) have put us in a strong position to be at the cutting edge in any pandemic response.
Moderna, one of the two companies that pioneered the mRNA vaccines, has established its Asia-Pacific headquarters in Melbourne[15]. CSL, which made the AstraZeneca COVID vaccines in Australia and manufactures several other vaccines, has now incorporated mRNA in its repertoire[16].
This capability means Australians could have immediate access to mRNA vaccines in the event of another pandemic. We could also potentially manufacture these vaccines for low- and middle-income countries in our region.
But what if we can’t make an effective vaccine to fight a future pandemic? This is a situation we must be prepared for, as we’ve seen with infections such as HIV, where after 40 years of trying and billions of dollars spent, we still don’t have a vaccine[17].
In such a situation, we will need to rely on antiviral drugs. The way we currently make antiviral drugs takes significantly longer to develop than vaccines. And although we have some broad spectrum antiviral drugs[18], the most potent antivirals are very specific – meaning one drug treats only one type of virus[19].
To be better prepared for future pandemics, many groups around the world are working on developing a library of drugs that work against whole families of viruses[20] that could cause the next pandemic.
Another approach is to develop totally new technologies that are fully tested for one virus, but can be easily adapted to a new virus. This approach could allow more rapid deployment, as the details of safety and dosing would already be understood.
This is one of the major goals of the recently launched Cumming Global Centre for Pandemic Therapeutics[21] based at the Doherty Institute.
These ambitious efforts will require global collaboration, sharing resources and engagement of the private sector.
Once we have a vaccine or drug that works, we need agreed systems in place to ensure widespread equitable access. We fell seriously short of this goal with COVID. Some low- and middle-income[23] countries received vaccines months or years later than high income countries. For treatments, antivirals such as Paxlovid[24] were never available in many countries.
This is one goal of an agreement led by the WHO, called the “pandemic accord[25]”, to have member states agree on pandemic prevention, preparedness and response. But after years of discussion, there remains no binding agreement.
Preparing for the next pandemic
As COVID was (partly due to advances in technology) the most intensively studied pandemic in human history, we have a unique resource in the record of what happened to inform our response to any future pandemic.
And this is likely a matter of when, not if. New infectious disease outbreaks have continued to emerge over the past five years, including mpox, which was declared a public health emergency of international concern in July 2022 and again in August 2024[26].
Right now, there’s an outbreak of a new viral disease in the Congo[27], the origins of which have still not been identified[28].
We know bats, thought to be the source[29] of the coronavirus behind the COVID pandemic, carry an enormous spectrum of viruses that potentially threaten us. But new pandemics can also arise through mosquitoes and close contact with other animals.
Pandemics are global, not national, problems. We are at a pivotal time where countries including Australia must step up their commitments to this global effort. This will need politicians to rely on the evidence and lessons learned from COVID as well as private and public investment.
Unfortunately, five years down the track, we still have a long way to go to be prepared for the next pandemic.
References
- ^ World Health Organization (www.who.int)
- ^ 7 million people (data.who.int)
- ^ immunity acquired from infections (pmc.ncbi.nlm.nih.gov)
- ^ than in previous years (www.abs.gov.au)
- ^ long COVID (www.aihw.gov.au)
- ^ 400 million people (www.nature.com)
- ^ isolate and share the virus (www.mja.com.au)
- ^ measures such as (academic.oup.com)
- ^ independent 2024 review (www.pmc.gov.au)
- ^ A$251.7 million (www.health.gov.au)
- ^ FiledIMAGE/Shutterstock (www.shutterstock.com)
- ^ hospitalised patients (www.nature.com)
- ^ intensive care units (www.remapcap.org)
- ^ messenger RNA (www.genome.gov)
- ^ Asia-Pacific headquarters in Melbourne (www.health.gov.au)
- ^ mRNA in its repertoire (www.aumanufacturing.com.au)
- ^ we still don’t have a vaccine (www.sciencenews.org)
- ^ broad spectrum antiviral drugs (pmc.ncbi.nlm.nih.gov)
- ^ only one type of virus (retrovirology.biomedcentral.com)
- ^ families of viruses (theconversation.com)
- ^ Cumming Global Centre for Pandemic Therapeutics (www.doherty.edu.au)
- ^ hedgehog94/Shutterstock (www.shutterstock.com)
- ^ low- and middle-income (pmc.ncbi.nlm.nih.gov)
- ^ antivirals such as Paxlovid (www.citizen.org)
- ^ pandemic accord (www.who.int)
- ^ August 2024 (www.health.gov.au)
- ^ the Congo (www.aljazeera.com)
- ^ not been identified (www.science.org)
- ^ the source (www.nature.com)
