Pandemic Preparedness Planning in Peacetime

ESWI Chair and Professor in Virology, Ab Osterhaus, gives a captivating explanation on why we need to stay vigilant and properly prepare for the next pandemic.

Ms Taylor: Hello and welcome to ESWI Airborne. This is your host, Clare Taylor, and this is the place where we meet the members of ESWI, the European Scientific Working Group on influenza.

Ms Taylor: To kick us off today, I have the great pleasure of talking with ESWI's leading light member of the board since its inception and chairman since 2001, Professor Ab Osterhaus. Professor Osterhaus, along with many other accomplishments, is the director of the Center of Infection Medicine and Zoonosis Research at the University of Veterinary Medicine in Hannover, Germany. Professor Osterhaus, may I call you Ab? It's wonderful to be with you today. Welcome.

Professor Osterhaus: Thank you very much, Clare, and especially, I would like to thank you for hosting this series about a very important subject. I think it's quite timely we are addressing this point now that we are at the tail of the current pandemic, hopefully.

Ms Taylor: That's great, Ab. It's my pleasure to talk with such expert gentleman. So let's get started then with the first question. Ab, with all of your knowledge and experience, did you and other experts see the coronavirus pandemic coming, and how did you first become aware of the outbreak in Wuhan?

Professor Osterhaus: Thank you for that question, Clare, because it's the most important thing we should be discussing today. When we talk about pandemic preparedness, I can say that we, and that is ESWI, have been campaigning for pandemic preparedness from the last century onward. I remember organizing the first meetings in WHO in Geneva where there have been a lot of discussion. At that time I remember there was very little appreciation in the scientific community for the pandemic threat.

Professor Osterhaus: Being a veterinarian, having worked in the veterinary profession for some time and then becoming a virologist, I have realized quite clearly that we are being threatened by zoonotic events all the time; viruses that cross the species barrier as such are bad enough. Still, viruses like the influenza viruses that can start spreading from human to human after having crossed the species barrier. Then we may end up with a pandemic.

Professor Osterhaus: I remember gradually, more and more meetings were also being organized in the WHO setting. I remember that not too long before this pandemic started, we had a meeting in Geneva with a number of experts on how to be prepared. It was quite
interesting what we were discussing about broader active vaccines and quite a number of, let's say scientific issues.

Professor Osterhaus: At a certain point, I had to give my lecture, and I realized that if it were to happen tomorrow, what are we going to do? During the discussions, I asked, Well, I can give my talk, and I can say what we can do in terms of making better vaccines, et cetera. It's kind of the obligatory talk I should be giving, but what are we going to do if it happens tomorrow? We all agreed that was the most important thing, but we didn't address it any further.

Professor Osterhaus: So, basically, we were aware. Gradually, we became aware that there is a threat from the animal world. The Mexican flu, the swine flu, and the last pandemic there have really raised awareness a little bit, but because it was considered to be a wimpy pandemic, most people in the scientific community and the public at large thought these huge pandemics, like the Spanish flu, were of the past. I did not and do not believe that because the predisposing factors that have led to the previous pandemics are still there, and they are even increasing to a certain extent. So it is an illusion to think that we cannot be confronted by the next severe pandemic.

Professor Osterhaus: The interesting thing, of course, is when this particular pandemic, the COVID-19, had started. I remember quite vividly at the very beginning, I had picked up an infectious disease is spreading in Wuhan from person to person. We don't know what was it. It is not flu because we have the flu network. We were quite keen to pick up flu in people and new viruses, and rightly so. For that particular event, it was clearly stated that the Chinese researchers guaranteed that this was not influenza.

Professor Osterhaus: I remember discussing with my students at that time what was the likeliness that this was going to become a pandemic? We dwelled on it. We didn't even know at that time yet it was the coronavirus. I gave the examples of the SARS coronavirus and the MERS coronavirus that we discovered. I said, basically, look into this situation. Why were these infections? Why were these outbreaks? Why do they cause a real pandemic?

Professor Osterhaus: The answer that we found out with the group at large. I said, let's discuss it. What does a virus need to become a pandemic virus? In the end, we all concluded that if this would be a virus that is transmitted from human to human before or without any clinical signs, if that were to be the case, then it might have pandemic potential.

Ms Taylor: Ab, the word zoonosis, meaning a disease which can be transmitted to humans from animals has become more familiar to many of us during the pandemic of the past two years, but for you, this is nothing new. In the course of your career, you have discovered more than 70 new viruses of humans and animals. Can you tell us what first attracted you to this field of work?

Professor Osterhaus: I was educated as a veterinarian. I was working as a veterinarian for some time. Then I realized that infectious diseases are not under control in the animal world. Also, in the human world, they're not under control. I was quite intrigued by the fact that foot and mouth diseases that we still had at that time, but also a disease like rabies, which is a zoonosis going from animals to humans, were not under control. Still, a lot of people die from rabies, for instance.

Professor Osterhaus: We know that every year it's more than 40,000 to 50,000 people die from that disease in a terrible way, so that's when I realized that viruses are not under control. When I started my career studying virology after becoming a veterinarian, I was discouraged by all my colleagues. They said this was not the way to go. Everything is under control. I realized that that was not the case at all. That, for me, was the start, indeed, to see that viruses of animals cross the species barrier to humans. At the end of the day, these may even end up in a pandemic, a virus that goes all over the world, affecting all people.

Ms Taylor: Today, our topic is pandemic preparedness or pandemic readiness in peacetime, shall we say. Ab, we're just emerging from a pandemic. Is this not a once in a lifetime event? Why should we get ready for another one?

Professor Osterhaus: If you look back over the last hundred years, we have had five or six pandemics, so we have had the influenza pandemics, which were four. We have the still ongoing HIV AIDS pandemic, and now we are in the middle of a coronavirus pandemic. So you can say it's once in a lifetime. Indeed, my predecessor in Rotterdam was working on influenza all his life. He regretted that he had never faced- I shouldn't say regret it but he had prepared for that. I should say in my career, so to say, I've gone through three pandemics. So it is the HIV, which was the first AIDS pandemic. Then we had the Mexican flu, the swine flu, and then now we are in the middle or at the tail of a coronavirus pandemic.

Ms Taylor: How likely is it that the next pandemic will be caused by an influenza virus? Do we have any evidence for this?

Professor Osterhaus: As I said, in the last century, we have seen four real big influenza pandemics. In a century, having four pandemics means that if we extrapolate that to the future, the likeliness that we are going to have another one in the next decade is rather great. Even the conditions that we have today, if you're talking about influenza specifically, if I see this at this time what's happening in the animal world, especially when we look at birds at this moment, we see outbreaks of a new H5 influenza virus in birds that cross the species barrier to humans limitedly though.

Professor Osterhaus: Still, we see it happening in different other mammalian species. We see it in seals, we see it in foxes, and the virus may tend to spread there as well. So the key issue is that if a virus crosses the species barrier to humans, and this avian virus is all over the place now; then in principle, it can adapt to humans by starting to spread from humans to humans. We have done a lot of work to look into what the virus needs to become a pandemic virus?

Ms Taylor: So in getting ready, there's much I'm sure that can be done in terms of pandemic preparedness. First, early warning systems, knowing that this is happening. Now, what does an early warning system look like in practice?

Professor Osterhaus: Well, what I said before about the history of this coronavirus pandemic, that when we first learned about it was very important, because what our Chinese colleagues did when they saw this disease emerging in humans, they were very quick on the ball. They characterized this particular virus in a matter of a week.

Professor Osterhaus: The important thing is that, on the one hand, we get the information from the population. Is anything happening? Do we see anything that's not the normal background infections that we see in humans but also in animals? So we have to be very vigilant, follow on a day-to-day basis what's happening in the animal world, what's happening in the human world in terms of new infections, things that we don't expect like what we are seeing normally. The whole epidemiology there is quite important.

Professor Osterhaus: So early warning means to keep your ear on the ground, look very carefully at what is happening there and have that reported internationally. We have to follow that up on the one hand, not just in humans but also in animals.

Ms Taylor: The increased risk of zoonosis has been linked to intensive agriculture, especially intensive meat production. Would you say that curbing or limiting intensive meat production is an important factor in reducing risk?

Professor Osterhaus: That's an interesting question. I think meat production as such, and especially when we talk about influenza, it is mainly about chickens. Indeed, the way we produce chickens has changed completely. I think it is important that if you have a completely industrialized way of producing chickens, chicken meat and eggs with hundreds of thousands of animals together and if you don't have the proper biosecurity there, of course, it's like lighting a haystack. So many animals together, so that increases the risk especially if you do that in areas where you have a lot of migratory birds.

Professor Osterhaus: There are two sides to the coin because we also want to have a more animal-friendly way of raising the animals. You can imagine if you have free-range animals, that the chance of them getting in contact with the feces of wild birds is much higher. So it's very easy to say the mass production of meat and eggs and other species like pigs, et cetera, it's at the basis of it. It is related to that, but it's not the whole story.

Ms Taylor: How can a one health approach lower pandemic risk?

Professor Osterhaus: A one health approach means understanding that human health, animal health, ecological health, and environmental health are very closely linked. We just talked about the viruses that cross the species barriers from animals to humans, and sometimes they go back again.

Professor Osterhaus: To understand these things better, look at the environment. What is changing? Are there major changes in the way we produce our meat or eggs? Are there major changes in the way we produce other animals or grow crops? So all these major differences there have a profound impact on the environment. If you see how complex these interactions are, it will be very difficult to understand them properly, but the more we know, the better we can be prepared.

Professor Osterhaus: So my message would be to invest in one health-based research, understanding how these things are interacting, and that may help us in the future to prevent new pandemics from starting or being quick on the ball and then being very rapid in taking our intervention methods.

Ms Taylor: Then how about this term, non-pharmaceutical interventions, NPIs? Now it sounds fancy, but it's what we've all been doing: wearing masks, staying at home, limiting our social contacts. Is this something that is effective in the prevention or limiting of an outbreak? What can we do to improve social acceptance? Because we have seen pushback from populations in the Netherlands. In the UK, we have examples of politicians failing to follow the rules. How effective are social distancing and wearing masks, and so on?

Professor Osterhaus: I think, in terms of preparation, we should have plans ready. Non- pharmaceutical interventions, as you said, mean having the possibility to stop the virus from circulating before we have pharmaceutical interventions; obviously, that's making a vaccine, making antivirals, and making biological response modifiers.

Professor Osterhaus: Non-pharmaceutical intervention methods mean you have to be prepared. For instance, you have to stockpile your facial masks. You have to have gowns for the hospitals. You have all these kinds of things which are not our specialty, of course. These are relatively simple things, but they cost money, of course. Also, your hospital capacity.

Professor Osterhaus: At the beginning of a pandemic, usually, you don't have a vaccine yet. It will be difficult to come up with specific pharmaceutical measures. So that initial time is very important to slow the pandemic down and make sure you buy time, so to say, and there are two extremes. So if you look at China, on the one hand, very effectively, but to a lesser extent, countries like Korea that had experienced the MERS epidemic and still has. Also, Australia and New Zealand had very stringent methods on the one hand.
Professor Osterhaus: On the other hand, when you look at a country like Brazil or the UK at the beginning, they just let it go, they ignored it, and you see the differences there. The number of people dying, the number of people turning up in hospitals, et cetera. So we are somewhere in the middle.

Professor Osterhaus: When we are talking about preparedness, it's quite important that these aspects are also taken into account. It's a social science. How do you convey the message to the public at large that they have to do this and that and that and that? That is a matter of communication on the one hand. Of course, our society does not accept measures taken in China, for instance. If that is the case, I think what we have learned, and that was missing to a large extent, apart from increasing our hospital capacity, having all these practical things in place, that basically the measures that should be taken should be accompanied by a good explanation to the public at large. Even then, there will be refractory.

Ms Taylor: It's a very interesting point because, as you say, it's at the intersection of a number of different issues. I suppose one of them is the suspicion of government or medical authority in relation to vaccines. It's not your specialty, but do you have an opinion on what the best response is? The best counter-response to this is? What does the scientific community need to do to get ready? We've been talking about these different aspects that have societal acceptance. You are sure the next pandemic will come, but you're not sure from where or how. How do those scientists get ready?

Professor Osterhaus: The first conclusion, of course, is that we did not do a very good job. We more or less failed. We could have done much better. I think what we need to do is a collective action in all sectors of life, because it's not an issue just of the virologist or the epidemiologist, it is really the whole sector. It goes all the way from scientists to public at large, politicians, et cetera. We have to be aware that there is a role for all to play. We have to see it more or less as an insurance policy.

Professor Osterhaus: If you ask a virologist like myself, what should we do? We obviously will say invest more money in broadly active vaccine, broadly active antivirals and those kinds of things, which we have to do. That's not the whole story, as we have seen, because acceptance of the vaccination is an important thing as well. If you see what we have spent in this pandemic in terms of financial resources that we have had to use to counter this particular pandemic, it has cost us so many billions of euros, dollars, what have you.

Professor Osterhaus: It is important to realize if we just pay a fraction of that towards preparedness as we do in other sectors as well. For instance, if you look in the Netherlands, after we had the flooding in 1953, everyone in the Netherlands was afraid of water. So we are spending billions of euros every year to keep the levees at the right levels, and nobody questions that. We should create a similar mindset for that. Spend money in peacetime on all these different sectors, not only on vaccines but all these different things we were mentioning, to be better prepared as an insurance for the next outbreak.

Professor Osterhaus: Last century, as we said, we had so many outbreaks. Then when I come back to the pandemics, it's only a fraction of that. So we have six major pandemics now. There is no reason to think that in the coming century, we will not have another six: It is easy to say that at my age, but my prediction would be that we will get at least another six. Given the changes in our society, the climatological changes, everything that's changing worldwide, we'll have more than six now if we don't take the proper measures.

Ms Taylor: That is a really interesting point. So if we're thinking about getting ready for the next pandemic, what are the lessons we can have learned from this one, from the successes and failures in dealing with the coronavirus pandemic?

Professor Osterhaus: The most important thing we realized after or at the tail of the current pandemic is that we need to come to collective actions for all sectors of life, all different disciplines. That's the scientific part, but the public at large, politicians and policymakers should realize there is a role for all to play as if it were an insurance policy that should be made for the future.

Professor Osterhaus: We should invest, and that means investing in all these different things that go from early warning to all the different ways to combat the disease proper, but also the measures that should be taken for the public at large, the societal impact that can have, and the acceptance in the population at large. In our response, it's very important that all these different sectors become actively involved.

Ms Taylor: What is the single most important step, even change in mindset towards becoming pandemic ready or pandemic preparedness?

Professor Osterhaus: It's very difficult to single out. One of the points is the integral approach, I would say. So you have to take all these different things seriously. In two years' time, hopefully, this virus will have become a seasonal virus that will pop up like influenza, and nobody will bother anymore. Like influenza, thousands of people in the Netherlands die every year from influenza because they have not been vaccinated.

Professor Osterhaus: We have to realize that life will go back to normal, but this threat is always there. Definitely with the changes in the world that we are seeing today, with the way we are keeping our animals, with the way things are changing, the climatological change, all these different factors, there are too many to sum up, we are going to face new pandemics and we have to be prepared. We can do it.

Professor Osterhaus: If you ask me to single out the most important thing, obviously, you ask a virologist, and I will say we have to make vaccines that will protect against all viruses. We can even do it at the end of the day, but that's not the whole story, as we have quite clearly learned because our vaccines did not solve the whole problem. Of course, without the vaccine, we would have been in a much more devastating situation. We can all agree on that. Even the vaccines are not the panacea, so to say. There is much more to be done in society at large. If alone, it would be about acceptance of vaccination, but there is much more than that.

Ms Taylor: A collective and a societal response. This has been a really interesting conversation. Ab, I could talk with you all day, but unfortunately that's all we've got time for.

Ms Taylor: A reminder to our listeners of the range of societal and collective actions needed to prepare for the next pandemic. Ab, it's been such a pleasure. Thank you.

Professor Osterhaus: Well, thank you, Clare, for hosting this this podcast. I really enjoyed speaking to you. You really provoked me into making some very bold statements, and I don't regret it. Thank you very much.

Ms Taylor: Dear listeners, I hope you learned as much as I did about pandemic preparedness from the dynamic, visionary and sometimes rather provocative Professor Ab Osterhaus, the leading light of ESWI, the European Scientific Working Group on Influenza. Keep on tuning in to this podcast series, ESWI Airborne, and until next time, dear listeners, stay safe.

Voice Over Female: ESWI Airborne is brought to you by ESWI, the European Scientific Working Group on influenza and other acute respiratory viruses. These episodes would not be possible without the team's efforts, and I would like to extend special thanks to our ESWI secretariat, our technical and IT teams, our arts team, and our host, Clare Taylor.

Voice Over Female: The podcasts are recorded virtually, and we thank our guests for their participation in this inspiring and educational series. Talks are adapted to a global audience and are intended as recommendations and guiding principles. For any specific medical questions you may have, these should be addressed to your local general practitioner.

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Ab Osterhaus
Ab Osterhaus
ESWI Board Member, TiHO, Germany