A Covid-Inspired Plan to Prevent All Future Pandemics

What would happen if a pandemic much worse than Covid hit?

This is a question that has haunted me since the early days of 2020, when it was unclear exactly how deadly Covid-19 was. What is now known as SARS-CoV-1, after all, killed almost 10% of people with confirmed infections; MERS, another coronavirus, has had a death rate of over 30% in confirmed cases. But none of these viruses were highly transmissible; However, SARS-CoV-2, better known as Covid, was a highly contagious virus from the start, and had it been killed at a rate close to that of these earlier pathogens, the result would have been horrific. .

In general, there are trade-offs between how infectious a virus is and how lethal it is, but this is not a rule of thumb: smallpox was more contagious than Covid and as deadly as MERS. There is also the question of which age groups are affected; the 1918 flu disproportionately killed healthy young adults, unlike the seasonal flu, and many viruses are especially dangerous to babies. (I had a newborn at the start of Covid, and one of the things we were most grateful for was the random chance that this virus didn’t seem deadly to infants, as it easily could have been. )

I am not reciting this litany to be as depressing as possible. We should be realistic about how serious a pandemic really is, but we’re also not that far off from a world where the answer to “What if a pandemic much worse than Covid hit?” is “we just crush it”.

That’s the message of a new report from the Geneva Center for Security Policy by MIT biochemist and Future Perfect 50-selected Kevin Esvelt on what to do to prepare for the next pandemic. The take away key? We are not powerless, whether against nature or the malevolent actions of human beings. We need to invest to be truly prepared, but if we’re ready, we could even face the worst-case scenario: a deliberate release of a man-made virus designed to be both deadlier and more contagious.

Three stages of pandemic preparedness

Esvelt, who is deeply involved in biosecurity, calls the first stage of preparation to be delayed. If someone triggered a deadly artificial flu tomorrow, we’d be in trouble. Covid has made clear the extent of the holes in our pandemic response plan. We are still short of sufficient stocks of high-quality PPE to protect all essential workers in the event of another virus outbreak. We don’t have the ability to detect a virus early and react before it spreads widely. And we know from the rapid spread of the omicron variant that once a sufficiently contagious virus spreads, even countries willing to resort to extreme measures will find it very difficult to contain it.

As bad as Covid is, a virus designed to be deadly and contagious could be much worse, so it will be crucial to ensure that in the near future we prevent access to dangerous viruses that could be deliberately released and that no does not accidentally come free. Esvelt proposes that we achieve this by reworking programs that look for viruses that are said to be incredibly contagious and deadly so that they work on spillover prevention instead, by looking at research funding to ensure that research on the development of Most deadly viruses are unfunded and examining DNA synthesis machines to make it harder to print your own deadly virus at home.

These aren’t meant to be perfect solutions – even if they make it harder to release a dangerous virus, they wouldn’t entirely prevent a determined actor – but they could buy us time to develop the technology that will fully protect us. future pandemics.

The next step for Esvelt is detection: developing better tools to identify when a new virus is spreading. In the very early stages of an epidemic – for example, when Covid started to spread in China at the end of 2019 – a virus can be stopped with targeted measures. Once it’s all over the world, things get more difficult.

And even if it’s too late for early containment, early detection of a virus accelerates the development of effective countermeasures. Esvelt argues that a single strategy can detect any biological threat. “Any system capable of detecting exponentially growing patterns of nucleic acid fragments should be able to reliably detect all catastrophic biothreats,” he writes.

The key is to exploit our growing ability to sequence genetic material quickly and inexpensively. No matter what form a bio-threat takes, whether it uses DNA or RNA, if you notice exponential growth of a new type of nucleic acid, that’s a trick that Something grows exponentially. So you can monitor wastewater at key points – for example, airports and city centers – for anything new and fast growing. Then you can take a closer look to understand what it is and how worried we should be.

It won’t be cheap – except compared to the cost in lives and money of a pandemic, in which case it actually seems very cheap. “Building such an observatory seems to be extremely affordable compared to traditional defense budgets,” says Esvelt. “In the United States, a system performing untargeted metagenomic sequencing of wastewater from the 328 ports of entry could likely be operated for less than $1 billion per year at cost; systems in smaller countries would be cheaper.

What to do when you detect a virus

Let’s say we build this sewage filter system and detect a new, rapidly spreading virus. So what? Here, Esvelt argues, we need to go back to basics: mRNA vaccines are a life-saving technology, but they simply cannot be produced at scale any faster than a virus can spread. So you need PPE, ventilation, and good technology to sterilize the spaces people have to work in.

The problem with PPE, as we all know from the Covid pandemic, is that there isn’t enough of it, and what we have isn’t great. Getting good masks at the start of the pandemic was nearly impossible, but high-quality masks are also very uncomfortable to wear for long periods of time. Cloth masks are more comfortable but not really adequate for a highly contagious virus.

But even more than two years into the Covid pandemic, we haven’t really tried to develop good usable PPE. Imagine if we put a fraction of the effort into developing better powered air-purifying respirators – the safest option for defending against a virus – that we put into developing new phones.

We need PPE innovation, but it’s less about scientific innovation and more about consumer product innovation. This means making the best PPE options wearable, robust for normal use instead of demanding perfect use, and widely available. With this tool in hand, we could face something more contagious and deadlier than Covid with far more protection, even before the first vaccine rolls off the assembly line.

“The combination of a reliable early warning system with sufficiently protective and reliable P4E in the hands of essential workers can make nations virtually immune to pandemic-class agents,” Esvelt writes.

When we want we can

All of these plans, of course, will likely run into additional complications as they roll out. Esvelt has a good plan in place, but implementation is never easy for a massive project like this. But what his insights make clear is that pandemics are a choice – a choice we choose to make as a society when we don’t bother to invest in preparing for them.

For better or for worse, we haven’t always reacted so softly to a major disaster. After 9/11 killed nearly 3,000 Americans, we implemented costly and cumbersome screening procedures at all airports in the United States, as well as at all international airports that send flights to the United States , all to make sure no one could ever hijack a plane again. After Covid-19 killed over a million Americans, we did next to nothing to make sure it didn’t happen again with a new virus next week.

It’s a terrible mistake. But it’s a horrible mistake that we have the power to choose to stop making.

A version of this story originally appeared in the Future Perfect newsletter. Sign up here to subscribe!

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