A Proposal for the Cause of the Next Great Pandemic and Recommendations for Preparing to Survive It

Main Article Content

James D Hearn, J.D., LL.M, D.Bioethics, MPH, D.Min

Abstract

May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency. COVID-19 resulted in the death of almost seven million people. After such an ordeal, it is normal to feel a sense of relief, the need to relax. Some are afforded this luxury but not so for those who must prepare us for the next pandemic. A pandemic of the same, or greater, magnitude is not statistically expected for some time. Yet, it is a fact that the next pandemic can occur at any time. Thus, we must be ever vigilant and in a state of constant preparation. The benefits of such preparation will be greatly enhanced if the most likely type and magnitude of the next pandemic can be anticipated. The author believes that there are signs pointing to this source.


In pandemic preparation the worst-case scenario employed by many planners is based on the 1918 Spanish influenza. The highest mortality estimates indicate that the pandemic resulted in the death of between 50 and 100 million people. It is difficult to imagine a more intense pandemic. Yet we must. While the 1918 pandemic was the most intense we have experienced, it is certainly not the most intense that we can experience.


“Disease X” is a placeholder name which represents a hypothetical pathogen that the World Health Organization lists as a priority disease on its R&D Blueprint which is a global strategy and preparedness plan. The author believes that it is both naïve and dangerous to employ the 1918 pandemic as a worst-case scenario. It is necessary to think beyond this level. Granted when one does so one is venturing into hypothetical territory. Yet, this must be done to even have a chance at adequately preparing for the next pandemic. This article proposes avian influenza as Disease X. The virus is known but is not currently transmissible between humans. If this becomes possible (and nature is working to make this a reality) the estimated death toll can be expected to exceed a world-changing 1.3 billion.


While this article looks at avian influenza as Disease X it also recommends the preparations necessary to be made for the global society to even hope to survive it.

Keywords: Virus, Influenza, Pandemic, Preparedness, Avian, Disease “X”

Article Details

How to Cite
HEARN, James D. A Proposal for the Cause of the Next Great Pandemic and Recommendations for Preparing to Survive It. Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4731>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v11i11.4731.
Section
Research Articles

References

1. Hearn JD. Social utility and pandemic influenza triage. Med Law. 2013;32(2):177-189.

2. Our COVID-19 Research Summary - 2021. Published May 6, 2022. Accessed October 9, 2023. https://www.acsh.org/news/2021/12/31/our-covid-19-research-summary-2021-%C2%A0%C2%A0%C2%A0%C2%A0%C2%A0%C2%A0%C2%A0%C2%A0-16031.

3. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. Who.int. Published 2020. https://covid19.who.int

4. End of Federal COVid-19 Public Health emergency (PHE) Declaration. Accessed October 9, 2023. https://www.cdc.gov/coronavirus/2019-ncov/your-health/end-of-phe.html.

5. Preparing for the Next Influenza Pandemic by Leveraging Lessons from COVID-19 Is Focus of Four New Reports from the National Academy of Medicine. National Academy of Science. Published November 17, 2021. Accessed October 9, 2023. https://www.nationalacademies.org/news/2021/11/preparing-for-the-next-influenza-pandemic-by-leveraging-lessons-from-covid-19-is-focus-of-four-new-reports-from-the-national-academy-of-medicine.

6. Timeline: WHO’s COVID-19 Response. Accessed October 9, 2023. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline.

7. WHO Coronavirus (COVID-19) Dashboard. Accessed October 9, 2023. https://covid19.who.int
8. Penn M. Statistics Say Large Pandemics Are More Likely Than We Thought. Duke Global Health Institute. Published August 24, 2021. Accessed October 9, 2023. https://globalhealth.duke.edu/news/statistics-say-large-pandemics-are-more-likely-we-thought.

9. Sands P, Winters J, Countering the Pandemic Threat through Global Coordination on Vaccines : The Influenza Imperative. National Academies Press; 2022.

10. Statistics Say Large Pandemics Are More Likely Than We Thought. Published August 23, 2021. Accessed October 9, 2023. https://www.sciencedaily.com/releases/2021/08/210823151033.htm.

11. Penn M. Statistics Say Large Pandemics Are More Likely Than We Thought.

12. Penn M. Statistics Say Large Pandemics Are More Likely Than We Thought.

13. Statistics Say Large Pandemics Are More Likely Than We Thought.

14. Reed C, Biggerstaff M, Finelli L, et al. Novel Framework for Assessing Epidemiologic Effects of Influenza Epidemics and Pandemics. Emerging Infectious Diseases. 2013;19(1):85-91. doi:https://doi.org/10.3201/eid1901.120124

15. Types of Influenza Viruses. Published March 30, 2023. Accessed October 9, 2023. https://www.cdc.gov/flu/about/viruses/types.htm.

16. Types of Influenza Viruses.

17. Types of Influenza Viruses.

18. Types of Influenza Viruses.

19. Types of Influenza Viruses.

20. Types of Influenza Viruses.
21. Type of Influenza Viruses.

22. Austin M. A. Historical Perspective: How Covid-19 Compares to Other Epidemics. NBC Connecticut. Published October 14, 2021. Accessed October 24, 2023. https://www.nbcconnecticut.com/news/local/a-historical-perspective-how-covid-19-compares-to-other-epidemics/2602525

23. Austin M. A. Historical Perspective: How Covid-19 Compares to Other Epidemics.

24. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Bio-Medica: Atenei Parmensis. 2020;91(1):157-160. doi:https://doi.org/10.23750/abm.v91i1.9397

25. Health P. World Health Organization (WHO) Pandemic Definition - Public Health. Published April 19, 2021. Accessed October 24, 2023. https://www.publichealth.com.ng/world-health-organization-who-pandemic-definition

26. Pandemic Basics. Published November 3, 2016. Accessed October 9, 2023. https://www.cdc.gov/flu/pandemic-resources/basics/index.html.

27. Pandemic Basics.

28. Past Flu Pandemics. Published August 10, 2018. Accessed October 9, 2023. https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html.

29. Andrews E. Why Was It Called the “Spanish Flu?” HISTORY. https://www.history.com/news/why-was-it-called-the-spanish-flu.

30. The 1918 Flu Pandemic: Why It Matters 100 Years Later | | Blogs | CDC. Cdc.gov. Published May 14, 2018. https://blogs.cdc.gov/publichealthmatters/2018/05/1918-flu

31. Roos D. Why the Second Wave of the 1918 Spanish Flu Was So Deadly. HISTORY. Published March 3, 2020. https://www.history.com/news/spanish-flu-second-wave-resurgence

32. Editors H com. 1918 Flu Pandemic. www.history.com. https://www.history.com/topics/world-war-i/1918-flu-pandemic.

33. Li C, Hatta M, Nidom CA, et al. Reassortment between avian H5N1 and human H3N2 influenza viruses creates hybrid viruses with substantial virulence. Proceedings of the National Academy of Sciences. 2010;107(10):4687-4692. doi:https://doi.org/10.1073/pnas.0912807107

34. He C, He M, He H, Wang H, Ding N. The matrix segment of the “Spanish flu” virus originated from intragenic recombination between avian and human influenza A viruses. Transboundary and Emerging Diseases. 2019;66(5):2188-2195. doi:https://doi.org/10.1111/tbed.13282

35. Taubenberger JK, Morens DM. Influenza: The Once and Future Pandemic. Public Health Reports. 2010;125(3_suppl):15-26.
doi:https://doi.org/10.1177/00333549101250s305

36. Taubenberger JK, Morens DM. Influenza: The Once and Future Pandemic.

37. Information on Swine/Variant Influenza. CDC. Published 2019. https://www.cdc.gov/flu/swineflu/index.htm

38. Jennings B. From Birth to Death and Bench to Clinic: Bioethics Briefing Book for Journalists, Policymakers, and Campaigns. Vol 41. (Crowley M, ed.). The Hastings Center; 2008.

39. Hick JL, Rubinson L, O’Laughlin DT, Farmer JC. Clinical review: Allocating ventilators during large-scale disasters – problems, planning, and process. Critical Care. 2007;11(3). doi:https://doi.org/10.1186/cc5929

40. White DB. Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions. Annals of Internal Medicine. 2009;150(2):132. doi:https://doi.org/10.7326/0003-4819-150-2-200901200-00011

41. White DB, Lo B. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. 2020;323(18). doi:https://doi.org/10.1001/jama.2020.5046

42. Kinlaw K, Barrett DH, Levine RJ. Ethical Guidelines in Pandemic Influenza: Recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention. Disaster Medicine and Public Health Preparedness. 2009;3(S2):S185-S192. doi:https://doi.org/10.1097/dmp.0b013e3181ac194f

43. Kass NE, Otto J, O’Brien D, Minson M. Ethics and Severe Pandemic Influenza: Maintaining Essential Functions through a Fair and Considered Response. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 2008;6(3):227-236. doi:https://doi.org/10.1089/bsp.2008.0020

44. Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States: Early, Targeted, Layered Use of Nonpharmaceutical Interventions. Accessed October 9, 3023. https://stacks.cdc.gov/view/cdc/11425.

45. Daugherty Biddison EL, Faden R, Gwon HS, et al. Too Many Patients. A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters. Chest. 2019;155(4):848-854. doi:https://doi.org/10.1016/j.chest.2018.09.025

46. White DB, Lo B. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic.

47. Roser M. The Spanish Flu: The Global Impact of the Largest Influenza Pandemic in History. Our World Data. Published July 2023. Accessed October 10, 2023. https://ourworldindata.org/spanish-flu-largest-influenza-pandemic-in-history.

48. Tahir MJ, Sawal I, Essar MY, Jabbar A, Ullah I, Ahmed A. Disease X: A hidden but inevitable creeping danger. Infection Control and Hospital Epidemiology.:1-2. doi:https://doi.org/10.1017/ice.2021.342

49. Published Sep 27 2023. What Is Disease X? How Scientists Are Preparing for the Next Pandemic. The Transmission. Published September 27, 2023. https://www.unmc.edu/healthsecurity/transmission/2023/09/27/what-is-disease-x-how-scientists-are-preparing-for-the-next-pandemic/

50. The 1918 Flu Pandemic: Why It Matters 100 Years Later | | Blogs | CDC. Cdc.gov. Published May 14, 2018. https://blogs.cdc.gov/publichealthmatters/2018/05/1918-flu
51. Nypaver C, Dehlinger C, Carter C. Influenza and Influenza Vaccine: A Review. Journal of Midwifery & Women’s Health. 2021;66(1):45-53. doi:https://doi.org/10.1111/jmwh.13203

52. For Healthcare Professionals - Diagnosing and Treating Measles. Published November 5, 2020. Accessed October 10, 2023. https://www.cdc.gov/measles/hcp/index.html.

53. Coburn BJ, Wagner BG, Blower S. Modeling influenza epidemics and pandemics: insights into the future of swine flu (H1N1). BMC Medicine. 2009;7(1). doi:https://doi.org/10.1186/1741-7015-7-30

54. Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses. Emerging Infectious Disease Journal - CDC. 2021;27(4). Accessed October 10, 2023. https://wwwnc.cdc.gov/eid/article/27/4/20-3945_article.

55. Prioritizing Diseases for Research and Development in Emergency Contexts. Accessed October 10, 2023. https://www.who.int/activities/prioritizing-diseases-for-research-and-development-in-emergency-contexts.

56. Rahman MdT, Sobur MdA, Islam MdS, et al. Zoonotic Diseases: Etiology, Impact, and Control. Microorganisms. 2020;8(9):1405.

57. Technical Report: Highly Pathogenic Avian Influenza A(H5N1) Viruses. Published July 7, 2023. Accessed October 10, 2023. https://www.cdc.gov/flu/avianflu/spotlights/2022-2023/h5n1-technical-report_june.htm.

58. The Next Pandemic: H5N1 and H7N9 Influenza? GAVI. Accessed October 10, 2023. https://www.gavi.org/vaccineswork/next-pandemic/h5n1-and-h7n9-influenza.
59. Technical Report: Highly Pathogenic Avian Influenza A(H5N1). Accessed October 10, 2023. https://www.cdc.gov/flu/avianflu/spotlights/2022-2023/h5n1-technical-report_september.htm.

60. Published Sep 20 2023. H5N1 Bird Flu in Mammals Sparks Fears of Virus Spreading Among Humans. The Transmission. Published September 20, 2023. Accessed October 24, 2023. https://www.unmc.edu/healthsecurity/transmission/2023/09/20/h5n1-bird-flu-in-mammals-sparks-fears-of-virus-spreading-among-humans/

61. Kandeil A, Patton C, Jones JC, et al. Rapid evolution of A(H5N1) influenza viruses after intercontinental spread to North America. Nature Communications. 2023;14(1):3082. doi:https://doi.org/10.1038/s41467-023-38415-7

62. H5N1 Bird Flu Found in Polish Domestic Cats. Published July 21, 2023. Accessed October 10, 2023. https://www.cdc.gov/flu/avianflu/spotlights/2022-2023/bird-flu-polish-domestic-cats.htm.

63. Finland orders cull of 50,000 mink and foxes due to bird flu. Reuters. https://www.reuters.com/world/europe/finland-orders-cull-50000-mink-foxes-due-bird-flu-2023-08-01. Published August 1, 2023. Accessed October 25, 2023.

64. Published Sep 20 2023. H5N1 Bird Flu in Mammals Sparks Fears of Virus Spreading Among Humans. The Transmission. Published September 20, 2023. Accessed October 25, 2023. https://www.unmc.edu/healthsecurity/transmission/2023/09/20/h5n1-bird-flu-in-mammals-sparks-fears-of-virus-spreading-among-humans/

65. Influenza at the Human-Animal Interface: Summary and Risk Assessment, from 1 June to 14 July 2023. Published July 2023. Accessed October 25, 2023. https://cdn.who.int/media/docs/default-source/influenza/human-animal-interface-risk-assessments/influenza-at-the-human-animal-interface-summary-and-assessment--from-1-june-to-14-july-2023.pdf?sfvrsn=42692eec_1&download=true.

66. Analysis | Explainer: H5N1 Bird Flu in Mammals Sparks Fears of Virus Spreading Among Humans. Washington Post. https://www.washingtonpost.com/business/2023/09/20/h5n1-explainer-bird-flu-in-mammals-sparks-fear-of-virus-spreading-in-humans/678c894e-5783-11ee-bf64-cd88fe7adc71_story.html.
Published September 20, 2023.

67. Sun H, Li H, Qi T, et al. Airborne transmission of human-isolated avian H3N8 influenza virus between ferrets. Cell. 2023;186(19):4074-4084.e11. doi:https://doi.org/10.1016/j.cell.2023.08.011

68. Bendix A. If Bird Flu Starts to Spread Among People, Existing Vaccines May Be Inadequate, Experts Say: The Current U.S. Stockpile of H5N1 Flu Shots Likely Won’t Offer Much Protection in the Event of a Pandemic. NBC News. https://www.nbcnews.com/health/health-news/bird-flu-spreads-people-existing-vaccines-may-inadequate-rcna72973. Published May 21, 2023. Accessed October 25, 2023.

69. New Mutations in Bird Flu Virus May Signal Next Pandemic: Study. DT Next. Published September 5, 2023. Accessed October 25, 2023. https://www.dtnext.in/lifestyle/wellbeing/new-mutations-in-bird-flu-virus-may-signal-next-pandemic-study-734314.

70. Young LJ. Scientists behind mRNA COVID Vaccines Win 2023 Nobel Prize in Physiology or Medicine. Scientific American. https://www.scientificamerican.com/article/nobel-prize-medicine-2023-mrna-vaccine-tech/

71. Published Oct 4 2023. MRNA Could Reinvent Vaccines. The Flu Is Next. The Transmission. Published October 4, 2023. https://www.unmc.edu/healthsecurity/transmission/2023/10/04/mrna-could-reinvent-vaccines-the-flu-is-next/

72. Johnson NPAS, Mueller J. Updating the Accounts: Global Mortality of the 1918-1920 “Spanish” Influenza Pandemic. Bulletin of the History of Medicine. 2002;76(1):105-115. doi:https://doi.org/10.1353/bhm.2002.0022

73. Patterson K, Pyle GF. The geography and mortality of the 1918 influenza pandemic. PubMed. 1991;65(1):4-21.

74. Spreeuwenberg P, Kroneman M, Paget J. Reassessing the Global Mortality Burden of the 1918 Influenza Pandemic. American Journal of Epidemiology. 2018;187(12):2561-2567. doi:https://doi.org/10.1093/aje/kwy191

75. Dorsey C. Pandemic Leads To Urban Exodus As Families Turn To Self-Reliance And Off-The-Grid Living. Forbes. Published online June 10, 2020. Accessed October 25, 2023. https://www.forbes.com/sites/chrisdorsey/2020/06/10/pandemic-leads-to-urban-exodus-as-families-turn-to-self-reliance-and-off-the-grid-living/?sh=55f25741cdaa.
76. Rapidly Detecting and Responding to Health Emergencies. Accessed October 25, 2023. https://www.who.int/activities/rapidly-detecting-and-responding-to-health-emergencies/who-global-outbreak-alert-and-response-network-%28goarn%29.

77. R&D Blueprint and MERS-CoV & SARS. www.who.int. Accessed October 25, 2023. https://www.who.int/teams/blueprint/mers-cov-sars#:~:text=The%20R%26D%20Blueprint%20is%20a%20global%20strategy%20and

78. Pardi N, Hogan MJ, Porter FW, Weissman D. mRNA vaccines — a new era in vaccinology. Nature Reviews Drug Discovery. 2018;17(4):261-279. doi:https://doi.org/10.1038/nrd.2017.243

79. What is the Global Health Security Agenda? Published May 20, 2022. Accessed October 25, 2023. https://www.cdc.gov/globalhealth/security/what-is-ghsa.htm.

80. Universal Health Coverage (UHC). Accessed October 25, 2023. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc).

81. Johns Hopkins University. Pandemic simulation exercise spotlights massive preparedness gap. The Hub. Published November 6, 2019. Accessed October 25, 2023. https://hub.jhu.edu/2019/11/06/event-201-health-security

82. International Health Regulations (2005) – third edition. Accessed October 25, 2023. https://www.who.int/publications/i/item/9789241580496.

83. Who, FAO, and OIE Call for Stronger Coordination in Mitigating Health Threats. Published April 23, 2021. Accessed October 25, 2023. https://www.who.int/europe/news/item/23-04-2021-who-fao-and-oie-call-for-stronger-coordination-in-mitigating-health-threats.

84. New Vaccines for a Safer World. CEPI. Published April 4, 2022. Accessed October 25, 2023. https://cepi.net/

85. Diagnostics laboratory emergency use listing. www.who.int. Accessed October 25, 2023. https://www.who.int/teams/regulation-prequalification/eul

86. Risk communication and community engagement (RCCE) for monkeypox outbreaks: Interim guidance, 24 June 2022. www.who.int. https://www.who.int/publications/i/item/WHO-MPX-RCCE-2022.1

87. GPMB. www.gpmb.org. Accessed October 25, 2023. https://www.gpmb.org

88. Smoler F. Fighting the Last War and the Next. American Heritage. Published October 1, 2023. Accessed October 2023. https://www.americanheritage.com/fighting-last-war-and-next.

89. 33 Thought-Provoking Ferdinand Foch Quotes. Kidadl. Accessed October 8, 2023. https://kidadl.com/quotes/thought-provoking-ferdinand-foch-quotes.

90. Ripley W. The Influenza Imperative: An Urgent Need to Leverage Lessons from COVID-19 to Prepare for a Global Response to Seasonal and Pandemic Influenza. Ballou N, ed. National Academy of Medicine. Published online December 13, 2022. Accessed October 8, 2023. https://nam.edu/the-influenza-imperative-an-urgent-need-to-leverage-lessons-from-covid-19-to-prepare-for-a-global-response-to-seasonal-and-pandemic-influenza/.