By Matthew Bauer
How should scientists, policy makers, and governments balance efforts to address the current pandemic with initiatives to prevent the next one?
We have seen this play out before during the 2003 SARS crisis. A burst of research funding and resources were thrown at tackling the health emergency that spread to 29 different countries. Ultimately, enormous efforts across the globe were able to halt the crisis, but as scientific research continued post-outbreak, it became difficult to sustain funding.
A chart published in Nature highlights the sporadic nature of coronavirus funding, with commitments since 2000 typically standing at less than 50 million per year, notwithstanding the exceptional years of 2004, 2005, 2015, and 2020
Dr. Peter Hotez of Texas Children’s Hospital has experienced the frustrations of this system play out within his own research on vaccines. After the 2003 SARS outbreak his research team helped developed vaccines against SARS. Nearly 10 years later, he was struggling to find the financial support needed to bring vaccine candidate to human trials.
This pattern was observed again when MERS outbreak occurred between late 2013 – 2015, and a spike in research funding followed but with no federal and global investment being put forward for vaccine research in anticipation for future pandemics.
Learning from history
We should learn from this history as we confront the ongoing COVID-19 pandemic. While many scientists and policy makers currently are focused on vaccine rollouts and booster shots in the face of the current threat, we must also devote resources towards surveillance and early warning systems for pandemics.
The 1918 flu may prove an instructive example. Following the tragic global public health crisis, sustained research funding led to the development of an effective vaccine in the 1940s. Because the flu virus mutates as it circulates, a viral surveillance program was implemented to inform the next year’s vaccine design. These global surveillance systems are only possible with sustained research funding for viral prevention.
This proactive surveillance network for seasonal flu is one of the only existing platforms for pandemic preparedness through vaccination. Currently, more than 144 national influenza centers exist, conducting regular surveillance of the circulating flu strains. This is atypical compared to vaccines that offer durable protection against viral infection, such as the polio vaccine. The difference lies in part that vaccines for the seasonal flu are not perfect at preventing illness, and in part that the virus rapidly evolves each year, while vaccines like polio have a significantly better efficacy against infection.
The WHO has released guidance for flu surveillance with three main goals: reducing the seasonal flu infections, reducing zoonotic flu, and mitigating the impact of a pandemic flu. To accomplish these tasks, scientists, policymakers, and global stakeholders require a substantial research budget. In 2019, Congress included a spending package for nearly $200M for development of universal flu vaccines to aid this effort.
Scientists will need to implement similar viral surveillance systems for SARS-CoV-2 as for flu. While the COVID-19 vaccines currently available are significantly better at protection compared to those for the seasonal flu, we will still need to make effective vaccines against new strains of SARS-CoV-2.
Toward pandemic preparedness
We must also devote resources to detecting other novel pathogens. Dr. Pardis Sabeti at the Broad Institute of MIT and Harvard, views the current pandemic as devastating in its own right but also a training run for the next inevitable pandemic, which could be even more deadly than SARS-CoV-2.
Before COVID-19 was declared a pandemic, Dr. Sabeti and Dr. Christian Happi had already founded Sentinel – an early warning system for pandemic preparedness. Sentinel uses a unique three-pronged approach to first detect viral threats in real time, then respond early to stop them from spreading, while simultaneously placing these tools within the hands of local communities to build capacity across the globe to quell the viral threat.
By using next-generation diagnostic tests that are field deployable, combined with software systems to share data in real time, Dr. Sabeti and Dr. Happi hope to empower communities to take an active step to prevent viral spread. They are among many groups, now in growing number, who aim to enhance genomic surveillance efforts around the world.
The scientific community has created critical therapeutics and vaccines against COVID-19, with significant resources invested from the government. We should sustain this funding beyond the acute phase of the pandemic to allow scientists to establish pandemic preparedness systems for future health crises.