Handling Pandemics: Next Steps
What we should be learning from the coronavirus pandemic in order to prepare for a more serious pandemic within the next two decades
We ought to count ourselves extremely fortunate. Despite endless media sensationalism and equally endless flailing by hapless politicians, the fact is that SARS-COV2 has been nearly harmless. Compared to seasonal flu, covid-19 is actually quite difficult to catch even in its new variant forms. Compared to illnesses like smallpox (variola major), marburg, hps, and ebola, it’s per-capita fatality rate is a rounding error, being no more than 0.25% in even the worst-hit countries. After more than 15 months, around 250 million people have been infected and around 2.5 million have died — almost all of them very old, very sick, or obese. If covid-19 spread like the flue we’d be looking at around 4 billion infected people by now and if it were as lethal as variola major or hps we’d have at least 900 million deaths across all ages and health categories.
Contrary to mass media nonsense which presents every new virus as a unique threat, we’re actually full of viruses all the time. Indeed, several have contributed to our evolutionary path. It’s believed that the mammalian placenta, so essential for protecting a fetus from its mother’s immune system and vice-versa, is the result of viral genes being absorbed into mammalian DNA. Other viral genes have become so-called “junk DNA” that has been co-opted by our chromosomes to play a useful physical role as spacers between gene sequences. Furthermore, nearly all the viruses we encounter have no meaningful adverse impact on our health. To understand why this is the case we have to understand evolution. We begin by remembering that viruses cannot self-replicate. They depend entirely on the DNA replication mechanisms inside host cells.
From the perspective of a virus, which wants to replicate as much as possible using human cellular DNA replication mechanisms, the ideal host remains unaffected by infection, thus enabling the virus to go on replicating instead of being attacked by the human immune system or the host dying. So viruses and hosts co-evolve over time, generally trending towards this endpoint.
Unfortunately when a virus jumps from one species to another the process begins afresh and the new host often falls ill and may die. From the perspective of a virus, this is very suboptimal— a dead host means no more ability to use the host’s DNA-replication mechanisms to further its own ends. As virologists know, this creates very strong selection pressure favors the success of mutants than are more infectious (so they can reach more hosts) but less harmful (so they can avoid killing the host and thereby create more copies of themselves).
We’re already seeing this in action with SARS-COV2, as more infectious variants emerge and spread. Again, contrary to media sensationalism, these new variants are likely to be less lethal for the reason outlined above.
Unfortunately, it’s probable that sometime in the next 20 years we won’t be anywhere near as fortunate. Wet markets are proliferating around the developing world and so-called bushmeat is increasingly popular. This means that domesticated animals like goats and chickens and humans are increasingly being exposed to the potential of viruses jumping from host species to new species. If we’re unlucky — and the odds are not in our favor — we’ll be hit by a virus that is as infectious as flu but hundreds of times more lethal than covid-19. And if that happens, we’re going to see tens or even hundreds of millions of deaths.
So what should we be doing about it? What lessons can we learn from our pathetically inappropriate responses to SARS-COV2?
First of all it seems pretty obvious that instead of panicking and flailing around in clueless catchup mode, we should have contingency plans prepared in advance. If we’d moved quickly to isolate the tiny percentage of people who are truly vulnerable to covid-19 we’d have limited fatalities without destroying the global economy and throwing 1.5 billion people out of work. We wouldn’t have printed trillions of dollars of debt that our children and grandchildren will be struggling to pay off 50 years from now.
Secondly, we should develop logistics plans so that when vaccines are developed we can get them to the right people as quickly as possible instead of thrashing and floundering incompetently at every turn.
Thirdly, we should recognize that if we’re trying to minimize fatalities then old-style business models don’t work very well. When confronting a major challenge, new ways of operating are often required. When the USA was desperate to develop and build a ¼ ton light reconnaissance vehicle in preparation for World War II, it was clear than no one company could meet the need. Bantam, Willys, and later Ford entered the fray, each developing models to submit for evaluation. So far, so traditional. Bantam came up with the basic design, which spurred Willys to try to create something similar. But because the program managers insisted on sharing information, the eventual winning design from Willys incorporated superior features from the Bantam and Ford prototypes, resulting in a vehicle that was better than any of the single-company test models. And because Willys couldn’t manufacture at the scale the US Army required, production contracts were given to Willys and Ford (Bantam lacked the resources necessary to manufacture at scale). The result: the right vehicle in the right quantities at the right time.
Although research scientists share information (and the relatively rapid response to SARS-COV2 was made possible by Chinese scientists sharing their early research with Western companies), their sharing is limited by confidentiality agreements and worries about protecting intellectual property. Elsewhere in the supply chain there’s no sharing at all. What this means is that it is infeasible for a successful new vaccine to be manufactured by multiple pharmaceuticals companies, so the supply is bottlenecked through the company that developed the vaccine. Today many countries are screaming for supplies of vaccine and Pfizer, Astra-Zeneca, Moderna, Sanofi, and others are all rushing to scale up manufacturing as best as they can, but supply is nowhere near adequate to meet demand. Meanwhile other large pharmaceuticals companies such as Roche and Bayer are on the sidelines; without their own vaccines to produce, their manufacturing capacity cannot contribute to the effort.
This kind of all-or-nothing approach will serve humanity ill when we’re faced with a serious pandemic in future. It would be better if we could begin to put in place now the legal agreements and procedures and information technology integrations that will all be essential to enable manufacturing of vaccines to be distributed to companies that can produce quickly at scale during a real crisis. We need the vaccine equivalent of the Jeep program: the right vaccines in the right quantities at the right time.
There is, alas, precisely zero sign that we’ve learned anything at all from our encounter with SARS-COV2. The media is reveling in the success of its sensationalism to generate juicy revenues. Politicians are convincing themselves that increasingly absurd and harmful measures are winning them future votes and nicely covering up their incompetence. Nobody has even begun to think about how to move towards the ability to integrate pharmaceutical manufacturing and supply-chain capabilities to meet a crisis. As for attempting to regulate or reduce wet markets in developing nations where corruption is the overwhelming reality of life– forget about it.
So the overwhelming probability is that the next time round we’re going to see a much worse scenario unfold. Which is a shame because with the necessary will and intelligent planning, we have nearly all the components we need. Information technology systems are far more flexible and adaptable than even five years ago. New applications and gateways can be developed much faster than could have been imagined a decade ago. As for logistics, FedEx and UPS can be tapped for their considerable expertise as well as for the power of their computerized logistics management systems.
Unfortunately voters don’t reward politicians for forward planning, and thoughtful intelligent politicians are as rare as the Yeti — and just as apocryphal. We vote for buffoons, braggarts, and bumbling imbeciles who entertain us and tell us the lies we want to hear. The result: our “leaders” are the least fit people imaginable to prepare for a serious emergency. Meanwhile there’s no motivation for any corporation to take steps that would undermine its competitive advantages in intellectual property and manufacturing capacity, so no impetus will come from the private sector. As for tech billionaires, they’re too busy imagining they’re going to be Captain Kirk zooming off to Mars to give any thought to far more serious matters here on boring old Earth.
As is sadly always the case, we’ve learned nothing whatsoever from our experience. Which is a real shame, because at some point in the next few decades a great many people are going to die as a result of our collective persistent folly and incompetence. We should have taken advantage of the lessons learned from the relatively harmless SARS-COV2 to prepare ourselves for the future but instead: we’ll do nothing at all.