Scientific Foresight (STOA) By / May 17, 2022

The future of pandemics: Preparing for health shocks in the 21st century

Antimicrobial resistance is set to become one of the major health threats of the 21st century. Tackling it requires a multidisciplinary, ‘One Health’ approach involving scientists, industry, politicians and citizens. Further investment in public health, including in vaccine and medicine development and distribution, is an immediate priority. These were the main conclusions of a roundtable co-organised by the EPRS and the COST Association on the future of pandemics on 11 May 2022. The event is linked to a recent EPRS publication.

Written by Luisa Antunes.

The recent coronavirus pandemic will not be the last public health emergency. To discuss future pandemic preparedness and response, the European Parliamentary Research Service (EPRS) and the European Cooperation in Science and Technology (COST) Association co-organised a roundtable on 11 May 2022. Etienne Bassot, Director of the EPRS Members’ Research Service, reminded participants of the link to the first edition of an annual EPRS publication on Future Shocks 2022, in particular the sections on ‘Another major pandemic’ and ‘Responding better to future pandemics’, written by Luisa Antunes and Clément Evroux.

Ronald de Bruin, Director of COST, introduced the association, its mission and actions. Funded by Horizon Europe, its network of researchers from 40 countries focuses on interdisciplinary, out-of-the-box thinking that transcends science and engages with policy-makers for long-term impact.

Kathleen van Brempt, Member of the European Parliament (S&D, Belgium) and Chair of the Special Committee on the COVID-19 pandemic (COVI), raised the importance of a coordinated, interdisciplinary approach to solving public health crises. COVI will base its work on four main pillars: health; socioeconomic impact; democracy and fundamental rights, and international cooperation. Preparedness for future pandemics involves rethinking vaccine production, worldwide supply, inequalities and hesitancy, finding a balance between health investment and containment strategies, and refocusing scientific advice at EU level.

Ilaria Capua, Director of the One Health Center of Excellence at the University of Florida, introduced the concept of ‘Circular Health’. This expands on the 1960s ‘One Health’ concept, which drew on the interconnectedness of animal, human and environmental health, by including macroscopic factors such as social sciences, policy, legislation and governance, food practices, conflicts, mobility and transport, population growth, refugees, international trade and gender equality, amongst others. While antimicrobial resistance (AMR) is a major threat, a possible roadmap solution could build from the United Nation’s Sustainable Development Goals (SDGs), not forgetting the importance of digitalisation and data sharing.

Jeremy Webb, Professor of Microbiology, University of Southampton, expanded on AMR as one of the major public health threats of the century. A silent pandemic, it leads to extended hospital stays, prolonged bacterial infections and 1.3 million annual deaths worldwide (equivalent to total joint HIV and malaria mortality). It is expected to kill 10 million people annually by 2050, exceeding cancer as second largest cause of death worldwide. Its causes are the misuse, overuse and spread of antibiotics in humans, agriculture and the environment. The dearth of investment in public health, including lack of rapid diagnostics and research and development (R&D) into new antimicrobials further aggravates the issue, in a context where, unlike cancer, antimicrobial R&D is not lucrative for the private sector. New models and reimbursement mechanisms are needed. The United Kingdom’s National Health Service (NHS) has developed a subscription model strategy as an incentive for the private sector to develop new antimicrobials. Multidisciplinary cooperation between academia, the industry and politicians is essential, as is education and changing the public perception.

Andrea Ammon, Director of the European Centre for Disease Prevention and Control (ECDC) introduced the importance of multisectoral and multidisciplinary crisis preparedness, acknowledging the ‘One Health’ approach and risks such as globalisation and climate change, and investing in public health and digitalisation. The amended ECDC mandate will extend the role of the agency in Member State-joint preparedness and strengthen its ties with the European Medicines Agency (EMA). Community engagement and citizens’ trust are essential and depend on good risk communication and collaboration between scientists and policy-makers.

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Nicolas Collin, CEO of the Vaccine Formulation Institute (VFI), presented the VFI as an EU-funded non-governmental organisation (NGO) that develops open-source adjuvants for the benefit of the entire world. Adjuvants decrease costs, improve vaccine efficacy, prolong the immune response and augment the number of available doses in one vial. Fast vaccine development requires, ahead and in advance of a new pandemic, the existence of an established network of researchers, strong expertise and logistics, and human-validated technology. Funding is essential to maintain expertise, to ensure regular testing in clinical trials and to have many options ready prepared when a pandemic hits.

Sylvie Briand, Director at the World Health Organisation (WHO) introduced WHO’s International Health Regulations (IHR). First applied in response to the 2009 swine flu pandemic, they aim to accelerate the detection of new outbreaks and ensure global response coordination whilst minimising unnecessary economic and travel impact. The WHO is working on a new treaty for international collaboration that has so far received 131 panel recommendations, grouped in four areas: leadership and governance; systems and tools; finance, and equity. A white paper is open to consultation. Preparedness plans are, nevertheless, inadequate if not implemented; an impairment with the Covid-19 crisis was that a few countries had not consulted or updated their pandemic preparedness plans following the 2009 flu pandemic. Citizens’ trust also poses issues, especially when linked to privacy and data sharing, which require working together.

Clément Evroux, Policy Analyst at EPRS, presented the EU response to the Covid‑19 crisis, including health and economy instruments, such as the EU Health Union package and the SURE instrument to mitigate unemployment losses. EMA and ECDC mandates were updated, as well as the regulation on serious cross-border health threats. The European Health Emergency Preparedness and Response Authority (HERA) was created to carry out preparedness and decision-making on vaccines and medicines. Ways forward will involve joint efforts in public health, transport, the internal market, research, education and trade. A ‘One Health’ approach is essential to bring socio-economical stakeholders together and engage citizens, as well as to ensure a green transition and EU’s strategic autonomy in digital technologies applied to therapeutic countermeasures.

Alain Beretz, President of COST, summarised the event, identifying three transversal issues: time, multidisciplinarity and geopolitical context. A global approach to a future pandemic will have to include networking and data sharing. Scientific advice to politicians is key and strong emphasis should be placed on basic research, focusing on long-term sustainable goals and values, and addressing the technological and non-academic issues of science, including citizens’ trust.

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