The Irish woman leading an EU-wide system being set up to detect future pandemic risks has warned another one could strike at any time.
Prof Máire Connolly, who co-ordinates Pandem, dismisses any suggestion we are emerging from a once-in-a-lifetime public health crisis.
“We don’t know when the next pandemic will be,” she says. “It is like waiting for a bus: there could be two coming at the same time.”
Prof Connolly of NUI Galway's school of medicine, who spent the best part of two decades with the World Health Organisation working on pandemic preparations, cautions that the world is more at risk from a global outbreak than at any time in history.
Unabated encroachment on virgin forests as well as Asian “wet markets” that sell wild animals and their meat threaten a major “spillover” event, in which an unknown pathogen jumps from animal to human, while lax biosecurity in some countries runs the risk of a virus being released in a “lab leak”.
“We don’t know what is out there,” she says. “There are probably tens of thousands of viruses that could potentially infect man.
“If you put together all of the risk factors out there at this point in time, the human population is at greater risk now than at any other point in history.”
Prof Connolly says there is also “no reason why a pandemic of a novel influenza strain can’t happen in the next five to 10 years”.
“That’s just a phenomenon of the natural world, where there is a massive change in an influenza virus.
“If there is a massive mutation where humans have no prior immunological memory, that’s where you get a pandemic of influenza.”
Connolly says we remain under threat of a strain such as the 1918 pandemic, which had an estimated death toll of 50 million worldwide.
“While we have more advanced healthcare facilities at this point, it could cause huge mortality and morbidity among younger age groups ... It remains a significant threat.”
On Covid-19, Connolly says all the evidence is that it “will be with us for some time to come”.
“It will remain a threat to human populations. I would envisage there will be a situation where, like with seasonal influenza, there will be a vaccine that will be updated on an annual basis, based on the genetic sequence of the circulating strain.”
The lack of vaccination programmes in low-income countries “has made it almost impossible to eradicate it”.
While we are “definitely over the worst”, she suggests public health measures such as wearing a mask when feeling ill “will become part of our cultural practice here too”.
Connolly, who also sits on a sub-group of the National Public Health Emergency Team (Nphet), is reluctant to be drawn on Ireland’s response to the crisis, but says some decisions could have been made earlier.
"The epidemiological data shows Ireland along with other European countries has done quite well, but as in any emergency response, particularly one that lasts for 18 months, there are decisions that may have been made earlier.
"I think the pandemic has shown that Europe as a whole was not that well prepared."
In Ireland, she says data collection and IT management “took a while” while contact tracing, in common with other European countries, was an issue.
Overall, she says, “the funding was made available, the problem was the infrastructure that was there had to be rapidly scaled up, be it on laboratory side, on contact tracing side, or on hospital care side, in terms of isolation wards and ICU beds and that”.
In a global context, Connolly says if there had been earlier warnings of the initial outbreak in Wuhan in China, "then perhaps we could have avoided" the pandemic altogether.
“Even with higher transmissibility, and pre-symptomatic and asymptomatic transmission, if the initial cases were isolated very rapidly, then it could have been avoided,” she says.
One theory is that the Covid outbreak emerged from a wet market in Wuhan. Connolly says banning the markets “should be looked at for sure” or they should at least be subject to much greater regulation.
Pandem began its work in February, and it is expected an EU-wide prototype system – akin to a Europol to police pandemics – will be up and running next year, and fully operational in January 2023.
On lessons learned over the past 18 months that will instruct the development of the EU system, Connolly says countries best prepared for the pandemic – such as South Korea, Japan, Laos and Vietnam – had gone through other outbreaks such as Sars, Mers and bird flu.
They had all invested in laboratory and public health capability.
Smaller countries were also found to have had higher levels of trust and better communications between scientists, policy makers, governments and citizens, which helped galvanise broader support for public health measures.
Connolly cites New Zealand as an example where "there was a very high level of trust and compliance".
It is “crucial” that any public health infrastructure built up to deal with Covid is not lost once the pandemic recedes, she adds, warning of the human nature to “go back to the way we were once a crisis is over”.
“We will need yearly pandemic planning scenarios and planning exercises, government authorities running simulations of a pandemic, so we don’t lose structures and the expertise we have at the moment,” she says.
“We need to make sure that we don’t go back to business as normal. We need to be like South Korea and Japan. We need to ensure there is a capacity there in the laboratory sector, capacity in hospitals, and in GPs the ability to scale up if there was a pandemic of this scale in the future.”