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Making Pandemics History

If we work together, COVID-19 could be the last pandemic. If we don’t, the next one could be much worse. The choice is ours.

Emergency hospital during influenza epidemic, Camp Funston, Kansas. Emergency hospital during influenza epidemic (NCP 1603), National Museum of Health and Medicine

In November 2019, my 2-year-old son got really sick. We took him to a doctor. Diagnosis: flu — a determination made with only a basic physical examination and no tests. He was prescribed rest and fluids.

It had been a century since the infamous 1918 pandemic. Science and technology had advanced dramatically.

  • Why couldn’t we quickly determine what virus was making my son so ill?
  • Why were there so few antiviral therapeutics available to incorporate into the standard of care (SOC)?
  • Why does it take so long to formulate and manufacture new flu vaccines?
  • Why were these flu vaccines so ineffective, typically only 50% effective?
  • Why weren’t we collectively trying harder to prevent the tens of thousands of deaths that the flu caused each year?

I left so unimpressed that I wrote an essay about how we needed to end flu season once and for all.

If we couldn’t beat the flu, what would happen if something worse came along?

I didn’t have to wait long to get an answer. Just a few weeks later, a new coronavirus outbreak appeared in Wuhan, China.

Epidemics happen all the time. What caught my attention was that the Chinese authorities were responding so aggressively. On January 23, 2020, they quarantined the entire metropolis of Wuhan, a city of 11 million people. They built a new 1000 bed hospital in just 10 days. This wasn’t normal.

US media framed the outbreak as a Chinese-specific problem. At the end of January, the Trump Administration suspended entry of foreign nationals who had traveled in China over the previous two weeks but still allowed citizens, close family members, and permanent residents to come in. But viruses don’t care about one’s nationality. They just go wherever people go, and people move around a lot.

Johns Hopkins Covid tracker. Photo by Martin Sanchez on Unsplash

In fact, the virus was spreading.

The Diamond Princess cruise ship became a floating petri dish. International conferences and trade shows were canceled. Clusters appeared in Iran and Italy. In late February, just a few days before the first US death was reported, I gave a presentation at a Department of Defense event, in Washington DC, noting the organization didn’t have many tools to defend against a spreading microbe — except maybe for washing hands. Even more troubling, it didn’t have any real-time detection systems in place. It could track a missile launch anywhere on the planet, but not a virus.

By the time the true nature of COVID-19’s threat was realized, meaningful containment was impossible. New York — a major tourist destination and a densely packed city — became ground zero.

At the start of the pandemic, New York subways kept operating but only for essential workers. Photo by Daniel Lee on Unsplash

America’s pandemic defenses — pre-COVID-19 considered some of the best in the world — buckled quickly.

The strategic national stockpile, a bank of medical supplies that can be deployed in the event of a health threat, was quickly overwhelmed. Hospitals didn’t have enough gloves, masks, or ventilators to handle the surge of patients that needed isolation and life-saving intervention. Health systems lacked centralized coordination. States were left to develop their own response plans and procure supplies — a decision that resulted in bidding wars for supplies and staff.

The internet allowed people to shop for supplies, keep the kids entertained or in school, and stay employed. But there was no single source of reliable, unbiased information. It didn’t help that the President was the biggest driver of pandemic misinformation. Many people were left overwhelmed and confused. Misinformation, skepticism, and mistrust proliferated.

Today, two years later, we’re starting to come out of the lockdowns and mask mandates and jabs and restarting our lives.

We’re not completely out of the woods. Workplace dynamics, international trade, and cross-border travel are still wonky. Only 64% of Americans are fully vaccinated. Kids under 5 won’t be eligible for vaccination for several more months.

We know now that we were lucky. The 1918 flu killed as many as 100 million people, about 5% of the population at that time. Deaths from COVID-19 are less than 6 million worldwide. The power stayed on. Essential services like public transportation, grocery stores, and mail and package delivery kept operating through lockdowns. Global supply chains bent but they didn’t break.

If there was a bright spot, it was how quickly new vaccines were developed, approved, and deployed — recently called a “freaking miracle” by STAT news. It was nowhere near a perfect development program or rollout, but it blew the doors off earlier attempts to make vaccines quickly.

Photo by CDC on Unsplash

The most poignant lesson? We had grown complacent and overconfident about epidemic threats.

Moving forward, we need to take pandemic preparation and response more seriously. It needs significantly more investment and technology development. And it should probably be under the umbrella of national defense. Because nature is always shuffling genomes and creating new virus variants. This means it’s always a matter of when — not if — another pandemic will appear. We can’t just go back to the way things were in 2019.

This is more important now than ever before. Advances in synthetic biology and biotechnology have made virus engineering surprisingly easy and affordable. This is accelerating the development of effective new vaccines, cancer treatments, genetic therapies, and more. But it elevates the risk that someone — by accident or on purpose — will make a virus with high infectivity and high mortality. This combination of features is almost never seen in natural viruses because of evolutionary constraints — they tend to kill all their susceptible hosts.

But natural selection’s guardrails don’t exist for engineered viruses.

Imagine a lab-made Virus X as infectious as a cold but as deadly as Ebola, which can kill up to 90% of the people that catch it. Imagine if it had been this virus that had appeared in early 2020. Who would have dared to venture outside? Who would have staffed the hospitals, the grocery stores, or power plants? Who would have collected the dead? Overnight, civilization would resemble the zombie wastelands we see in movies.

Photo by Mads Eneqvist on Unsplash

Making such a virus isn’t as farfetched as one might think.

Biological weapons development is a real and growing threat. And it’s not for just nation-states anymore. It’s within reach of a small terrorist group, or even a well-financed evil genius.

The solution isn’t technological prohibition. Biotechnologies are like the internet or electricity. Once they’re available, they’re never going to go away. Moreover, engineered biology is our best hope yet to solve our biggest global challenges like climate change or feeding and clothing billions more people. But to realize this massive potential, we will first have to neutralize the threat of viral pandemics, whatever their origin.

This isn’t something that can be done unilaterally by one political party, country, or company. It demands species-level participation. Eventually, representatives from all nations must come to the table and figure out how to construct a global biological defense network — basically, a planetary immune system to complement our body’s immunity. What will this look like? It’s too early to tell, but it will almost certainly involve better sensors, automated monitoring systems, and rapid countermeasure deployment. The result? It will relegate pandemics (and perhaps many other diseases) to the history books.

If this seems hard to imagine right now, remember that just about everything electronic that we use today didn’t exist just a handful of decades ago, and that the very first electric lights in New York were switched on in 1882. Or that no one had landed a rocket until 2015, and now SpaceX has done it over 100 times.

We can and will do incredible things when we put our collective mind to it.

Andrew Hessel is the co-author of The Genesis Machine: Our Quest to Rewrite Life in the Age of Synthetic Biology. He’s also the co-founder of Humane Genomics, a company that makes artificial viruses that target cancer, and the Genome Project-write, an international consortium focused on whole-genome engineering. He loves thinking about possible futures through the lens of biology.

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