Comments on “Lessons From the Global SARS-CoV-2 Health Emergency for Potential Future Pandemics”

Nicola Abrescia et al highlight important considerations about future infectious disease risks in their manuscript entitled, "Lessons From the Global SARS-CoV-2 Health Emergency for Potential Future Pandemics."1 As the title indicates, the complacency of the world regarding infectious diseases was shattered by the rapid spread, susceptibility, and severity of the SARS-CoV-2 pandemic. It is human nature to minimize the concern for infectious diseases with the successes of vaccine programs, hygiene, and antibiotics until the problem becomes more personal or it severely affects the workforce and economy. Vaccines are the most beneficial treatment a health provider can provide, but for vaccines to be successful, they have to be implemented and utilized. The COVID-19 pandemic fast-tracked and got approval for novel vaccine technologies, such as the mRNA and adenovirus hybrid vaccines, whose efficacies had been demonstrated decades earlier. Implementation of alternatives to egg-based vaccines for influenza required fear of avian influenza viruses and their ability to decimate the supply of eggs and potentially reassort to infect and cause disease in man. This led to tissue culture and genetically engineered vaccines and the use of adjuvants to increase potency and immunogenicity of vaccines. This acceptance of adjuvants and their ability to enhance the immunogenicity of subunit and protein-based vaccines to elicit both humoral and cell-mediated protections for vaccines have extended their use into other vaccines, including hepatitis B virus, varicella-zoster virus, and respiratory syncytial virus (RSV). Opportunities for developing new vaccines for other diseases have arisen from these and other new technologies. Even with new technologies, utilization of a new vaccine requires clear demonstration of efficacy and safety in humans, and human trials are expensive and take time. Development of appropriate model systems and approaches to human trials can potentially speed up and cut the cost of the process. The success of vaccine programs depends on establishing herd immunity. With the increase in complacency and misinformation toward vaccination, we are seeing an increase in vaccine hesitancy and with it more frequent outbreaks of diseases that were previously well controlled by good vaccines, such as measles and mumps. Just consider the number of mortalities that could have been reduced by vaccination within the COVID-19 at-risk populations. Complacency toward bacterial infections also developed due to the success of antibiotics until antibiotic resistance and opportunistic infections became problematic. Despite the need for new antibiotics, antibiotic development has stalled because it is expensive and requires extensive testing, and the return on investment is not as great as for treatment of a chronic disease. Government intervention has facilitated some development, but more needs to be applied to improve the profit margin and facilitate the path for development and implementation of new antibiotics. Abrescia et al warn that overuse of antibiotics, environmental changes (deforestation, wildlife habitat encroachment), climate change, and increasing global connectivity are drivers of disease emergence by increasing human exposure to arthropods and animals and the pathogens that they harbor. The more humans change the environment and encroach upon animal or insect habitats, the greater the potential for infection with zoonotic diseases including influenza; Ebola, Marburg, Nipah, and Hendra viruses; Lassa fever and other arenaviruses; hantaviruses; yellow fever virus; and Zika virus. As such, constant surveillance for these and other pathogens is important using the best possible means and systems for surveillance. Newer methods of microbial detection and identification are more efficient, more rapid, and less expensive and highlight the analysis of microbial genomes and proteins matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) and use of immunological assays. Ongoing programs for screening of arthropods, birds, and bats for arbovirus, influenza, coronavirus, and other pathogen genomes should become standard procedures. Similarly, monitoring of waste water from buildings and cities for the genomes of pathogens can provide early warning of an outbreak to allow rapid response. The technology to rapidly progress from isolation of the causative pathogen of an outbreak to genome sequence analysis and vaccine development has been around for over 15 years.2 It is feasible to progress within 6 months from isolation of a new influenza strain, to determination of genome sequence, conversion of the sequence into an mRNA vaccine, efficacy testing in an animal model or correlate of human protection, and then scale-up of synthesis to amounts appropriate for protecting a city utilizing a mobile laboratory and production facility that can bring development to the region of need. In summary, the technology for detecting, preventing, and treating future pandemics is available. Implementation requires interest and complicity of the populace and the concerted national and international effort and funding to implement and maintain such an effort.