Dr. David Alland, director of the Rutgers Center for Covid-19 Response and Pandemic Preparedness, says we were unprepared “on so many levels” for the Covid-19 pandemic. Photo by Frank Veronsky
As you read this, a worker in a tropical rainforest is clearing brush in preparation for a commercial agricultural operation. He’s far from the markets of home, and so he takes his food as he finds it, likely killing a bird or small mammal—a monkey, say, or a bat—to consume alone or share with coworkers. He isn’t paid much, so maybe, before he leaves, he traps a few more animals to sell in the markets. And maybe, in one of the animals he’s eaten or snared, there’s a pathogen that’s genetically ready to leap from its wild host to the worker, and from the worker to his family, and from his family to the world at large.
Habitat loss and the wildlife trade don’t just threaten wildlife. They’re two of the main reasons Covid-19 isn’t likely to be the last pandemic we see in the coming decades. In fact, Andrew Dobson, a professor of ecology and evolutionary biology at Princeton, lays the odds of a near-future pandemic at 100 percent, should we fail to put in place the systems to stop it.
Dobson explains his certainty with chilling economy: “More deforestation, more trade in wildlife, many more people on the planet.” We are all, he says, potential petri dishes for the next emerging virus.
It’s widely believed that SARS-CoV-2, the virus that causes Covid-19, had a zoonotic origin—that is, it crossed into the human population from an animal species, most likely a bat. In fact, according to the Centers for Disease Control (CDC), 60 percent of infectious diseases in people are zoonotic in origin. The percentage is even higher among new and emerging diseases—nearly 8 out of 10—including four recent epidemics that had the potential to spread globally: HIV, SARS-CoV-1, Avian Flu in Asia, and MERS. As it happens, the only one of the four that approached pandemic status, pre Covid-19, was HIV. But David Alland, director of the Rutgers Center for Covid-19 Response and Pandemic Preparedness (CCRP2), warns that “we dodged a bullet” with SARS-CoV-1, the coronavirus that infected some 8,000 people worldwide in 2003 but failed to reach pandemic proportions, largely because, unlike SARS-CoV-2, it wasn’t infectious until patients developed symptoms. That meant transmission could be more easily halted.
Clearly, we were lucky then, but we were distinctly unlucky in the case of Covid-19, and our luck could continue to ebb as the gaps between epidemics become increasingly short. “We’ve had one almost every year in the last decade,” Dobson observes. “Who knows? The next one may even have crossed now, and we just haven’t picked it up.”
Around the world, researchers are already preparing for future pandemics—and a significant amount of that research is being conducted in the Garden State. If we can act quickly enough here and globally, we may be able to predict the next big one and halt its spread or mitigate its effects.
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LEARNING FROM COVID
Most experts would agree we were not well prepared for Covid-19, as evidenced by a global death toll that now exceeds 2 million people and by the pandemic’s stubborn refusal to recede, even now. From a dearth of personal protective equipment to flawed diagnostic tests to an underfunded system of public health, a series of stumbling blocks kept us from moving against the disease with sufficient speed and efficiency. It’s likely that tens of thousands of lives were lost as a result.
To minimize the risk of that recurring, New Jersey Democratic senator Robert Menendez, along with senator Susan Collins, a Republican senator from Maine, introduced legislation in June that could help us learn from our mistakes through the establishment of an independent blue-ribbon commission—similar to the 9/11 Commission that investigated security lapses related to the terrorists attacks. The new commission would seek to determine where our public-health system remains vulnerable and recommend ways in which we can better prepare for future pandemics. “This isn’t about pointing fingers…but learning from our experiences and promising to do better,” Menendez said when introducing the bill in February.
Dr. Padmapriya Banada, of the Rutgers Center for Covid-19 Response and Pandemic Preparedness, has worked to develop a Covid-19 test that can be processed quickly—at the point of care—rather than sent to a lab. Photo by Frank Veronsky
We have a great deal to learn. We were unprepared, Alland says, “on so many levels.” Just as our system of public health was underfunded, so too were the nation’s 14 National Institutes of Health (NIH)-funded biosafety laboratories, established in the early 2000s to support research into novel pathogens emerging naturally or through bioterrorism. (These include the Rutgers Regional Biocontainment Laboratory on the Newark campus of the New Jersey Medical School.)
“The whole field of infectious disease has been the poor stepchild of science,” Alland says. Consider that infectious disease specialists are among the lowest paid physicians in the country and that, nationally, 40 percent of fellowship slots for trainees in the field go unfilled. Alland hopes that the so-called Fauci effect—the recent rise in medical school applications, possibly inspired by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease and a nearly ubiquitous presence during the pandemic—will lead to new interest in the specialty.
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FORECASTING
As we assess our failures and successes, researchers are actively imagining and working on ways to address the next pandemic—ideally, by detecting it before it unfolds. In a paper published in the June 2020 issue of the science journal eLife, C. Jessica Metcalf, a disease ecologist at Princeton University, and her colleagues have proposed a way to do that, through what they term a Global Immunological Observatory (GIO). Just as a weather observatory looks at global data to predict the next potential hurricane, a GIO would monitor human antibodies—the proteins created in our bodies in response to viral and other invaders—to alert the world to a looming pandemic.
To do that would require blood from a large sampling of the world’s population, to be monitored for the presence of unusual pathogens (or familiar pathogens, such as measles, in larger-than-expected numbers). Such a sampling, says Metcalf, “could inform public health questions, such as targeting vaccination efforts for vaccine-preventable infections or identifying anomalies suggestive of pathogen emergence.” If the system had been in place before 2019, it would likely have detected antibodies to a novel coronavirus emerging in Wuhan, China, before that virus had a chance to gallop across the globe.
Of course, creating a system in which nations and individuals donate blood specifically for the purposes of a GIO represents a considerable challenge, requiring extensive international collaboration. But, says Metcalf, the GIO could begin surveilling existing samples from blood banks and blood tests, “which can provide clues as to the immune status of populations.” In fact, Metcalf and her coauthors are exploring ways to create an early-stage GIO with colleagues at the NIH.
As it happens, we’re already monitoring body fluids for signs of disease—in this case, Covid-19—in the form of wastewater. Rutgers, for example, is looking at the wastewater from dorms to determine whether Covid levels are rising (or falling) in the university population; other schools, including Michigan State University and the University of California at Merced, are doing the same. In 2020, the state of Maryland began testing the wastewater from institutions that were particularly vulnerable to Covid-19 outbreaks, like nursing homes and correctional facilities. CCRP2 is investigating the feasibility of wastewater monitoring as a tool to detect emerging pathogens, though at present, Alland says, the techniques used to do this are very expensive.
RESPONDING RAPIDLY
Detection is essential to mounting a successful defense against a potential pandemic, but it’s equally important to move quickly once that threat has been recognized. Dobson and his colleagues have suggested a method for doing that, in a paper published in the journal Science in July 2020 (a follow-up to which is in the works). Given that the wildlife trade and the destruction of tropical forests have contributed to four of the emerging diseases that have appeared in the last half-century (Covid-19, Ebola, SARS and AIDS), Dobson and his team have called for stopping wildlife markets and tropical deforestation. The former would allow for the creation of a database of the viruses circulating in animals that come into close contact with humans in the form of food or pets.
The database would include the genetic sequence of each virus, as well as information on where, geographically, each is found and in what host species. When a novel virus is detected in humans, Dobson says, the database would allow scientists to quickly develop diagnostic tests and potential vaccines for that virus.
Dobson estimates that the price for creating the database, including expanding and improving the monitoring of the wildlife trade, would be roughly $500 million annually. That sounds exorbitant only until you do the math. A year ago, for example, two Harvard economists estimated that the current pandemic could end up costing the United States $16 trillion. And that $500 million is a fraction of the Pentagon’s annual budget of around $700 billion. “The Pentagon pours billions into protection against things that might not happen,” says Dobson. “You wouldn’t be pouring as much into this, and we now know that pandemics have the potential to have a huge impact on the global and national economy.”
Alongside such a database, we need to find ways to create vaccines that would be ready to go with a single alteration—something that researchers at CCRP2 are working on. One of the reasons we were able to develop vaccines against Covid-19 so quickly is that scientists had already done much of the necessary prep work. The SARS-CoV-1 epidemic of 2003 spurred research into the spike proteins that protrude from all coronaviruses, eventually leading to a new vaccine technology that enlists a molecule known as messenger RNA (mRNA) to “teach” the body to produce those spikes in order to provoke an immune response. The technology was intended to be customizable to any coronavirus, and indeed, within weeks of the publication of the genetic sequence of SARS-CoV-2, scientists at Moderna had designed and manufactured what would become one of the three major vaccines against Covid-19. The hope, at CCRP2 and elsewhere, is that we can eventually produce vaccines that would be quickly customizable to other types of viruses.
TESTING BETTER
Diagnostic testing for a particular virus or variant is an essential element in controlling the spread of disease. The two countries that were most successful at early testing, Taiwan and South Korea, have also been notably successful at keeping Covid-19 levels low throughout the pandemic. Unfortunately, the United States botched attempts at early testing, in part because the CDC insisted on developing its own test, rather than using one already developed by the World Health Organization (WHO), a decision that cost us valuable time early in the pandemic. And when the CDC finally released its tests in early 2020, some were faulty. Testing in the United States was also stymied by a lack of supplies—notably, a particular type of nasal swab.
Centers like CCRP2, Alland says, are well-equipped to play a key role in the development of diagnostic tests. “We can take human samples of the virus and test which swabs work well and which ones don’t,” he says, “and we can understand very rapidly what the best body fluid to test is.” In addition, the center is hoping to create a facility that will allow it to develop future tests within a week after the genetic sequence of a new pathogen is released. “We have the knowledge and skills to do this, however, we haven’t quite landed the necessary funding. We will certainly not stop trying,” notes Alland, who, along with Drs. Padmapriya Banada and Sukalyani Banik, developed a test for Covid-19 that can be processed quickly—at the point of care—rather than sent to a lab.
With the ability to test early and rapidly, the United States could make better use of contact tracing—the system of locating individuals who have been exposed to infection, then requesting that they quarantine. New Zealand, Taiwan, South Korea and Israel, for example, instituted robust systems of contact tracing early on in the pandemic, while the U.S. approach to tracing was scattershot at best. Kurt Rohloff, a professor at the New Jersey Institute of Technology and co-founder of the tech firm Duality Technologies, blames this, at least in part, on the U.S. system of governing, in which power—over public health and other sectors—is shared among the federal, state and local governments. “I think the federal government overall,” he says, “has not necessarily been as effective at public health coordination”—including the coordination of contact-tracing efforts—“early in the pandemic, as other countries have.”
Another impediment to our efforts at contact tracing has been a widespread concern about privacy, which helps explain why many Americans balked at installing tracing apps on their smartphones. Their concern isn’t unfounded: It’s difficult to engage in contact tracing without exposing personal information. But Rohloff has developed software that would allow the processing of private information without decrypting it or exposing sensitive data. If that could make the U.S. government and its departments of public health more likely to institute wide-ranging contact tracing in the early days of a future pandemic, it could be a very good thing indeed. After all, it was contact tracing, coupled with vaccinations, that eradicated smallpox, one of humankind’s deadliest scourges.
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DEVELOPING BETTER TREATMENTS
If we aren’t able to prevent the next pandemic, we can go a long way toward making it far less deadly with an expanded arsenal of broad-spectrum antiviral medications that have the potential to work against a number of different viral illnesses. That turned out to be the case with Remdesivir, an antiviral originally developed to treat hepatitis C and the cold-like virus known as RSV. Though it wasn’t particularly good at treating either of those diseases, it turned out to be effective against Covid-19, especially in those patients receiving supplemental oxygen. Research facilities, including CCRP2, are working on developing new broad-spectrum antivirals. As part of the recently enacted Antiviral Program for Pandemics, for instance, the Biden administration is set to spend $3.2 billion to develop an antiviral medication that can work against Covid-19 in its early stages. The program will also pursue the development of platforms that could support treatments against future viruses with pandemic potential.
REBUILDING PUBLIC HEALTH
America’s public health system—a collection of local, state and federal health departments and other agencies, with the CDC at the top—has been chronically underfunded, leaving it grossly unprepared to deal with a pandemic on the scale of Covid-19. Over the past decade, spending for state public health departments overall has fallen 16 percent, with the decline in New Jersey’s spending conforming roughly to the national average. If Covid-19 has generated any good news, it’s the light it has shone on the crucial importance of public health—the aspect of health care that focuses not on individual patients, but on the community as a whole.
“The pandemic has brought to light the vital role public health plays in keeping us all safe and healthy,” says Dawn Thomas, deputy director of communications at New Jersey’s Department of Health. And, she adds, “it’s pointed out deficiencies in the public health system.”
It has also brought $1.6 billion in increased federal funding to the state, which will be used to enhance public health lab capabilities, improve disease surveillance, support contact tracing, and fund positions at local health departments, as well as promote Covid-19 testing and vaccination. It remains to be seen whether funding for state health departments will contract as soon as the current pandemic recedes—something that happened after both the Zika and H1N1 epidemics.
PROMOTING COLLABORATION
The Covid-19 pandemic generated unprecedented collaboration among scientists and government agencies, most notably, in the production of vaccines. The federal government, for instance, contributed more than $1 billion to fund Johnson & Johnson’s vaccine efforts. To promote collaboration and communication among scientists, state officials, and human, animal and environmental health professionals, New Jersey established the One Health Task Force in June 2020, inspired by the One Health Steering Committee at Rutgers. With a mission to prevent, monitor and control zoonotic health threats, the task force is the first of its kind in the nation.
Dr. Gloria Bachmann, director of the Women’s Health Institute at Rutgers, an ob-gyn and the founder of the One Health steering committee, believes the task force can help prevent future pandemics by “bringing all the puzzle pieces together: insects, animals, agriculture, climate, public health. It breaks down silos.”
There’s certainly no place for silos in a pandemic—a word, after all, whose roots (pan and demic) translate to “all the people.” The pandemics of the future will not only affect all the people, they will also require extraordinary collaboration and communication among them, in a network that bridges the world’s rainforests and its genomic laboratories, local health departments and WHO, individual freedoms and the greater public good.
In New Jersey and around the world, we have the intellectual capital to create the innovations that can protect us against future pandemics. What’s unknown is whether we have the social and political will to put that capital to work for all the people, statewide and across the globe.
Leslie Garisto Pfaff is a longtime contributor on health, education and other topics.