Are we prepared to combat the pandemic and other emerging infections?

The Covid-19 pandemic has forced decisions to be made in a multitude of areas while mobilizing a huge number of resources to search for effective vaccines and treatments against the clock. The rapid development of diagnostic tests and highly effective vaccines has proved to be among the greatest achievements. However, the scientific community has also encountered major limitations, as no treatment has proven to be effective against the new virus. And, in general, the lack of an approach that considers the interdependence of human, animal and environmental health (One Health) has become apparent, as well as a scenario of profound inequity in access to vaccines.

In order to assess what we have learned from this pandemic, what current tools and technologies are available and how we can act to be better prepared for new infections in the future, some of the best international experts have gathered virtually at the CaixaResearch Conference "Pandemics: Overcoming Covid-19 and Preparing for the Future" on 16-17 November 2021 online. This initiative, co-organized by the "la Caixa" Foundation and Biocat, was supported by a scientific committee from the Barcelona Institute of Global Health (ISGlobal) and the AIDS Research Institute (IrsiCaixa).

Here is a summary:

The way out of the pandemic must be collaborative, global and green

The pandemic raises many questions such as, for example, when we can consider it to be over or how long the third dose will last in vulnerable people and whether they will have to be revaccinated. What is clear is that "we must turn this crisis into an opportunity. Alliances have been forged like never before to be able to fight this virus and if we don't take advantage of it we will never forgive it," said Robert Fabregat, Biocat CEO. Dr. Antoni Plasencia, CEO of ISGlobal, added, "we are increasingly interconnected and health must be addressed on a global scale. We must promote equity in health and break the vicious cycle of poverty and disease.” 

Dr. Maria Neira, director of the World Health Organization's Department of Public Health and Environment, points out that more effort must also be put into providing the best tools for prevention and health promotion. "Ultimately, we must reduce our vulnerability across the board to new pandemics or health threats.”

In this regard, Dr. Neira presented the 10 priorities agreed at the Climate Summit (COP26) with more than 300 health-related organizations, so that national governments put into practice real actions to combat the climate crisis and to make health and social justice the focus of all their actions.

The Race to Develop Diagnostic Tests and Therapies

Researchers around the world have been working against the clock since the beginning of the pandemic to develop therapies and treatments for Covid-19. This session has shown that the results achieved in terms of possible therapies have not been as expected, beyond the use of corticosteroids to reduce inflammation. Jens Lundgren, professor of infectious diseases at the University of Copenhagen, spoke of the efficacy of monoclonal antibody therapy in less advanced cases, but stressed that it is not as useful if the patient is already hospitalized, apart from the fact that it is expensive and its administration is complex.

The same goes for antiviral therapies, which are not effective in advanced cases either. "Diagnosis must be early, and we need better risk predictors," Lundgren adds.

Related to the goal of identifying and acting on cases when they are still mild, Dr. Nathalie Strub-Wourgaft, director of the Neglected Tropical Diseases initiative, presented anticov.org. This adaptive clinical trial platform, active in 13 countries, seeks to reposition drugs to be useful in early stage Covid-19. This is critical in developing countries, where there is limited hospital capacity. They must therefore be easy to administer, safe and affordable.

On the other hand, diagnosing the disease massively and rapidly has been crucial from the very beginning. Dr. Sergio Carmona, Medical Director of FIND (a global alliance for diagnosis), is very positive about the rapid development and distribution of rapid tests. He also adds that "saliva tests must be developed, and it is important to improve sequencing tools to follow the evolution of the virus".

Goal: to make vaccines available worldwide

In parallel to the development of therapies, treatments and rapid diagnostic tests, the great hope lies in vaccines. Professor Mariano Esteban, head of the Poxvirus and Vaccines Group at CSIC, explained that "we had the sequence of the virus very early, which allowed us to quickly start vaccine development projects.” He adds that "the approved vaccines are effective.” The project he leads, which is already working in animals, is based on a vaccine that can produce neutralizing antibodies and activate cellular immunity.” 

Highly effective vaccines have been created, "but what is indispensable when you have them is to distribute them. Vaccines save lives but only if they are administered," adds Clarissa Simas, a researcher at the London School of Hygiene and Tropical Medicine, in her presentation on barriers to vaccine uptake. Simas remarks that "hesitancy and reluctance to vaccinate are not a new phenomenon.” And that is why it is so important for the population to be properly informed. The most reliable source of information for patients is health professionals. However, in many countries they do not provide information about vaccines systematically, and this is an area where there is much room for improvement," she says. In addition, an important driver for vaccination is "confidence in their importance. More so than data on safety or efficacy.”

Carolyn Reynolds, co-founder of Pandemic Action Network (PAN), has criticized the lack of targeted investment in emerging infections. "New infectious outbreaks are inevitable, but pandemics are not if we are prepared," she said. Rynolds also criticized the inequality between countries when it comes to distributing the vaccine: "7.5 billion doses have been distributed and only 5% of developing countries have received at least one.” She adds that "some companies have performed better than others during the pandemic, but in general, we cannot rely on the market when it comes to dealing with a crisis.”

Do we need more vaccines? Elia Torroella, director of R&D and regulatory affairs at HIPRA, is quick to say yes. "We are far from having Covid under control, there are still many people to vaccinate and, although the ones we have are good, we can obtain better vaccines," she explained. Dr. Adolfo Garcia Sastre, virologist and director of the Institute for Global Health and Emerging Pathogens at the Icahn School of Medicine at Mount Sinai in New York, adds that "the most urgent problem right now is to vaccinate, which makes it difficult to carry out clinical trials".

Another topic of debate has been the vaccination of children under 12 years of age. Daniel Prieto-Alhambra, Professor of Pharmacoepidemiology at the University of Oxford, states that "the direct benefit of vaccination in children is small, but perhaps we have failed to communicate the value it provides in terms of wellbeing: infections are minimized, non-drug measures are reduced, etc."

One Health: a comprehensive solution to prevent and combat pandemics

The health crisis caused by Covid-19 has shown that human health and animal health are interdependent and linked to the ecosystems in which they coexist. Hence, the One Health concept, which seeks to address pandemics holistically, collaborating from multiple disciplines and working locally, nationally and globally. It was clear from this session that we are living in a climate crisis that increases the risk of emerging infections (many mosquito-borne) and new pandemics. Therefore, the One Health approach is more necessary than ever. 

Dr. Rachel Lowe, professor at the London School of Hygiene and Tropical Medicine, has pointed out that "if we limit the temperature increase to 1°C by the year 2100, another 2.4 billion people will be at risk. If it rises by 3.7°C, another 4.7 billion people will be at risk. And it's not only to do with climate change, but other factors such as unplanned urbanization and inadequate infrastructure also come into play.”

It is estimated that 70% of infections affecting people come from animals and, in most cases, from domestic animals. Therefore, according to Dr. Richard Cock, professor at the Royal Veterinary College, University of London, "emerging infections are mostly due to human action.” Cock adds that "we approach the risk of pandemics wrongly, from an anthropocentric concept of health instead of working on prevention with a One Health approach. What we need to do is to change economic policy". 

On the other hand, socio-cultural characteristics and improved communication (cell phones, roads, air traffic, etc.) have led to an increase in the frequency and number of people affected by epidemics. Dr. César Muñoz-Fontela, team leader at the Bernhard Nocht Institute of Tropical Medicine in Hamburg (Germany), gives as an example the recent Ebola epidemic in West Africa, which fortunately did not turn into a pandemic partly because "communication and transport are more limited in East Africa than in West Africa".

COVID-19 and  public health transformation

The pandemic has developed differently in different contexts and has affected people unevenly. Dr. Edna Bosire, a researcher at Georgetown University's Center for Innovation in Global Health and the Malawi University of Health Sciences, introduced the term syndemic, "the existence of two or more epidemics along with social factors interacting simultaneously in a population," in this session. 

Dr. Bosire believes that recognizing the role of context in how diseases cluster and interact is important in designing effective public health responses. She also highlights Kenya as an example of an African country prepared at national, regional and local levels, which was able to react quickly to the first wave of the pandemic, unlike the United States and other Western countries. 

Dr. Carmen Cabezas, Catalan Public Health Secretary, has highlighted that "this pandemic is a syndemic that has affected the entire health system and society, especially people with lower socioeconomic status". She also added that "we have to look for planetary health and incorporate it in all policies". If we take into account that 80% of the determinants of health are outside the system itself, "we cannot think about health without considering wellbeing and sustainability," she adds.

On the other hand, new digital technologies have made it possible to have more detailed data when making decisions. The different applications based on artificial intelligence against Covid-19 have worked to detect outbreaks, automate imaging diagnoses, make more careful prognoses and plan hospital capacity, among many other uses such as in epidemiology. Dr. Miquel Luengo-Oroz, head of Big Data at the United Nations Global Pulse, gives an overview but also highlights that there are areas for improvement, such as "increasing collaboration and avoiding bias". He also considers it necessary to ensure "data privacy and ethical use". 

If anything has become clear during the two-day conference, it is that the pandemic is not over. The way we face it and work together in different areas will largely determine its future.