Five years ago, the world was hearing the first reports of a mysterious flu-like illness emerging from Wuhan, China, now known as Covid-19.
The pandemic that followed broughtmore than 14 million deaths, and sentshock wavesthrough the world economy. About400 million peopleworldwide have had long Covid. World leaders, recognising that another pandemic was not a question of “if” but “when”, promisedto work togetherto strengthen global health systems.
But negotiations on a new pandemic agreement stalled in 2024, even asfurtherglobal public health threats and emergencies were identified. If a new pandemic threat emerges in 2025, experts are yet to be convinced that we will deal with it any better than the last.
While experts agree that another pandemic is inevitable, exactly what, where and when is impossible to predict.
New health threats emerge frequently. World health leadersdeclaredan outbreak of mpox in Africa an international public health emergency in 2024. As the year ended, teams of specialists wereprobing a potential outbreakof an unknown illness in a remote area of the Democratic Republic of the Congo, now thought to be cases of severe malaria and other diseasesexacerbated by acute malnutrition.
Maria van Kerkhove, interim director of epidemic and pandemic preparedness and prevention at the World Health Organization (WHO), is concerned aboutthe bird flu situation– the virus is not spreading human to human but there have been an increasing number of human infections in the past year.
While there is a well-established international monitoring system specifically focused on influenza, surveillance in sectors such as trade and agriculture, where humans and animals mix, is not comprehensive enough, she says. And she stresses that the ability to properly assess the risk “depends on the detection, the sequencing, the transparency of countries to share those samples”.
The Covid-19 pandemic left health systems worldwide “really shaky” and has been followed by a long list of other health crises, she says. “Seasonal influenza started circulating, we had an mpox emergency, we’ve hadMarburg, we’ve had cholera, we’ve had earthquakes, we’ve had floods, measles, diphtheria, dengue,Oropouche. Health systems are really buckling under the weight and our health workforce globally has really taken a beating. Many have left. Many are suffering from PTSD. Many died.”
What keeps her up at night, she says, is “complacency”, worrying that the response to a new threat will be hampered by “the notion that ‘it’ll just go away’, or ‘it’ll burn itself out’”.
The world has never been in a better position when it comes to the expertise, technology and data systems to rapidly detect a threat, Van Kerkhove says. The expansion of genomic sequencing abilities to most countries worldwide, and better access to medical oxygen and infection prevention and control, remain “really big gains” after the Covid-19 pandemic, she adds.
It means her answer to whether the world is ready for the next pandemic “is both yes and no”.
“On the other hand, I think the difficulties and the trauma that we’ve all gone through with Covid and with other outbreaks, in the context of war and climate change and economic crises and politics, we are absolutely not ready to handle another pandemic,” she says. “The world doesn’t want to hear me on television saying that the next crisis is upon us.”
The world of public health is “fighting for political attention, for fiscal space, for investment” – rather than nations working to stay in “a steady state of readiness”, she says.
The long-term solution, she says, is “about getting that level of investment right. It’s about getting that sense of urgency correct. It’s about making sure that the system isn’t fragile.”
Rwanda’s minister of health, Dr Sabin Nsanzimana, found himself dealing with two major disease outbreaks in 2024: Africa’s mpox public health emergency, and66 casesof Marburg virus in his own country.
He also co-chairs the governing board of thePandemic Fund, set up in November 2022 as a financing mechanism to help poorer countries prepare for emerging pandemic threats.
If the next pandemic arrives in 2025, he warns: “Sadly, no, the world is not ready. Since the Covid public health emergency ended last year, too many political leaders have turned their attention and resources toward other challenges. We are entering once again what we call the cycle of neglect. People are forgetting just how costly the pandemic was to human lives and to economies and are failing to heed its lessons.”
He says the Pandemic Fund “urgently needs more resources to fulfil its mission” – it has received requests from low- and middle-income countries totalling $7bn (£5.6bn) to fund pandemic preparation and response investments, against $850m available.
In 2022 the WHO began negotiations for a new pandemic accord that would provide a firm basis for future international cooperation. But talks failed to yield a result by an initial deadline of the annual World Health Assembly in May 2024. Negotiators are now aiming for a deadline ofthis year’s May meeting.
So far the talks have actually worsened trust levels between countries, says Dr Clare Wenham of the department of health policy at LSE.
There is no agreement on what Wenham calls “the big elephant in the room” of “pathogen access and benefit sharing” – essentially, what guarantees poorer countries are given that they will have access to treatments and vaccines against a future pandemic disease, in exchange for providing samples and data that allow those therapies to be created.Researchsuggests more equal vaccine access during the Covid-19 pandemic could have saved more than a million lives.
“[Governments] are just so far apart, and no one is really willing to budge,” says Wenham, with only 10 days of actual negotiating time scheduled before the World Health Assembly deadline. Practical questions remain about the feasibility of what is being proposed, she adds, “even if you get over the fundamentals of how unwilling governments are to compromise”.
Her assessment is blunt: “We’ve had the biggest pandemic of our lifetimes, and we’re worse prepared than we were when we went in.”
She is among commentators who fear that any accord pushed through in May will lack real teeth, agreeing only a top-level framework, with trickier detailed decisions delayed.
But those involved in the process have rebutted that idea. Anne-Claire Amprou, co-chair of the WHO’s Intergovernmental Negotiating Body,saidas December talks drew to a close: “We need a pandemic agreement which is meaningful, and it will be.”