Increasingly our attention is being directed to the possibility of another pandemic, how to anticipate it as well as how to construct ways of detecting its spread and control its impact. There is no doubt that major pandemics cause substantial morbidity and mortality, economic loss and disruption, beside producing extraordinary scenes of human anxiety, hysteria and fear. As The Guardian noted in 2105, the biggest surprise about pandemics is that we remain surprised that they happen.
Seasonal influenza strikes millions of people each year while the virus mutates and changes each year, often outpacing the anti-viral drugs we have at our disposal. In the context of rapidly ageing populations around the world together with rapidly expanding urban areas, a virulent flu virus could wreak havoc and kill millions.
The flu pandemic of 1918-19 affected 500 million people around the world and killed as many as 100 million, this at a time before intercontinental air travel and globalisation. In today's globally interconnected world where almost 4 billion people fly each year and with more and more cities' populations approaching the 20 million mark, vulnerability to infections like flu have markedly increased.
Earlier this century SARS dominated the world's headlines and caused extraordinary human panic and hysteria. Since then the world has experienced major outbreaks of bird flu and swine flu as well as Ebola and Zika.
Plague is also still with us and today is more geographically spread than at any time in human history with almost half of the USA one giant natural reservoir of the disease where plague is permanently entrenched among the burrows of ground-living animals. Closer to home, Madagascar is currently experiencing a major outbreak of plague, not only the bubonic form but also the more deadly pneumonic form. Like parts of the USA plague is endemic to Madagascar with outbreaks among the human population becoming a regular event.
Of the 400 or so emerging infections that we have managed to identify over the last 80 years, more than 70% are zoonotic or animal diseases and this is just the tip of the zoonotic iceberg. The bacterial and viral world associated with wild and domestic animals is vast and we continue to under-estimate and ignore both its significance in our lives and its ability to adapt and change in relation to changes in our behaviour and environment.
The sooner we realise that we are not the dominant species on the planet and that our total reliance on a magic bullet approach of anti-bacterial and anti-viral drugs does not provide complete and permanent security, the sooner we will be able to come to full grips with the microbial world and the threat that it offers to our health.
So what lies ahead? Are we well prepared for the next epidemic/pandemic?
The way we responded to the Ebola crisis and the way we initially chose to ignore Zika suggests that we have learnt very little over the last decade. There is little doubt that our understanding and approach to preparing for and managing epidemic and pandemics of infectious disease, remains a neglected dimension of human security.
What, when and where are the questions that dominate our pre-pandemic world. There is little doubt that predicting the emergence of new infectious diseases and pandemics is somewhat like predicting earthquakes – we know that at some stage they will happen and that there are plenty of viral tremors which only occasionally translate into something more threatening.
Outbreaks of infectious disease are still surrounded by a host of uncertainties. We really need to know much more about what diseases are out there, what animal hosts are involved, how the diseases spread and what we can do to protect ourselves.
Human behaviour is in many ways the critical factor in all of this. More people are on the move than ever before, more remote exotic places are being visited, national and international trade is changing our world, our intrusion on the biophysical environment has produced widespread changes in land-use and deforestation, as well as the intensification of agriculture and our persistent intrusion into animal bio-systems, are all modifying our world and making us more susceptible to zoonotic infections.
Ebola and Zika have retreated from the world's headlines but it is time to consider what might come next and how well we are prepared to deal with such threats. Have we learnt anything over the last 100 years? We are certainly better informed and medically more advanced, yet we still neglect to understand how infections emerge and spread, the role of the animal world and the way ordinary people respond and react to such events. Most importantly we need pandemic plans which address such things. Evidence also suggests that during pandemics most people have little confidence in their Government's ability to protect them and fall back on family support, seclusion and popular cures.
We also continue to believe that we dominate the world and that infectious diseases are just a minor hiccup that can be addressed by anti-microbial drugs. Given the rise of anti-microbial resistance it is time to take a much closer look at the emergence of infectious diseases, particularly those emanating from the animal world.
But can we translate all this into productive surveillance, control and response? Regrettably the answer remains no. We still tend to ignore outbreaks of disease in remote areas in the belief that they will burn themselves out and do not threaten us and we still cannot deliver appropriate measures of surveillance and control in a timely and effective manner. Finally, we should also not lose sight of what Louis Pasteur remarked – "…c'est les microbes qui auront le dernier mot". (it is the microbes who will have the last word). The sooner we come to realise this the better will our defence and response mechanisms be.