CLINICAL MATTER

As the Covid-19 pandemic winds down and people go about their daily lives, the question that many people are asking is,” Can this happen again?” A new pandemic occurring is not a question of if but a question of when. There are things that can be done to delay the next pandemic and there are things that can be done to mitigate the effect of the next one. To maximize the impact of these measures, however, planning must start now. Here are three steps that we can take to achieve this.

1. Crack down on the illegal wildlife trade and stay away from wild animals.

New genetic information from China points to the raccoon dog, or tanuki, as the source of the first infections from the Wuhan seafood market. Raccoon dog DNA was found and mixed with ancestral SARS-CoV-2 genetic material from the wild animal storage areas in the Huanan Seafood Market from the earliest days of the pandemic. This strongly supports a zoonotic origin of the virus and effectively debunks the laboratory leak theory. Analysis of the earliest SARS-CoV-2 genomic material points to at least two separate transmission events with distinct lineages. This is consistent with a natural origin where multiple transmission events are more likely to occur. There is no evidence of genetic manipulation of the SARS-CoV-2 genome and the unique mutations found in different parts of the virus can be explained through natural selection processes.
This is not the first time that a coronavirus of pandemic potential was transmitted by an animal host in a seafood market. This scenario is nearly identical to the origins of SARS-CoV, the causative agent of SARS. In the case of SARS, the animal implicated was the palm civet, although raccoon dogs were also found to have been infected. The original reservoir was likely bats in the forest from which those animals were captured and they served as an intermediary to transmitting the disease to humans.
The lesson that should have been learned the first time around is to avoid close contact with wild animals who could be harboring viruses that can easily jump to humans. Keeping multiple species of wild animals together in close quarters increases this risk exponentially. Unfortunately, much of this trade in wildlife is illicit and difficult to regulate. Aside from the authorities cracking down on this illegal activity, people need to be educated regarding the risks of contracting potentially fatal diseases from interacting with or consuming wild animals. Closer to home, many cases of rabies still occur because of Filipinos eating stray dogs. The risk of rabies and other zoonotic viruses is also high for those who eat bats, especially in provinces where these are considered a delicacy. Ebola Reston, which is related to the deadly Ebola virus, was originally found in monkeys imported from the Philippines and has caused local outbreaks in pigs.

2. Establish the Philippine Centers for Disease Control the right way.

Early in the pandemic, people were scrambling to respond to the many problems that cropped up as Covid-19 cases rose. There were many logistical crises, and the implementation of quarantine and isolation was not ideal. There was sometimes duplication of responsibilities between the LGUs and the national government, and other times no one seemed to be in charge. While the overall pandemic response has been quite successful, we can do much better when the next pandemic comes along.
The United States Centers for Disease Control (CDC) is the premier public health institution in the world, and yet its personnel were knee-capped by politicians who had partisan agendas. I’ve written about what I think the Philippine CDC should be in a separate column ([https://mb.com.ph/2022/09/06/a-philippine-cdc-what-it-should-and-shouldnt-be/](https://mb.com.ph/2022/09/06/a-philippine-cdc-what-it-should-and-shouldnt-be/)) and I will summarize it here. Aside from a technically sound CDC with ample resources and expertise, it is important to give the CDC leadership direct access to the policy makers. As part of the Technical Advisory Group during the pandemic, we were regularly called to Malacañang to directly brief the President on the latest developments. After the report given by DOH Secretary Duque, President Duterte usually called each one of the scientists present for their opinion, no matter how many of us there were. He carefully considered each position before making a major decision. This kind of direct access gave us scientists the confidence to speak our minds without any reservations.
The Philippine CDC should not replicate the US CDC because the latter is much too big and bureaucratic. The Philippine CDC should concentrate on communicable diseases of pandemic potential, should be run by technocrats as well as academics, and should have direct access to the decision makers. This enables a rapid response when time is of the essence since any delay can cause an exponential loss of lives.

3. Improve science communication and empower people to consume correct health information.

Along with Covid-19 was a parallel pandemic of misinformation and disinformation. Vaccines were attacked and dubious cures for Covid-19 were pushed. Scientists who tried to correct erroneous reports were vilified on social media and evidence-based policies were ignored. Education of the public on how to discern the truth remains the most potent weapon in ensuring that only reliable facts are believed. Proper curation of information, tougher laws on spreading inaccurate information, and holding social media providers accountable for misinformation on their platforms should all be done to reduce the deadly impact of fake news.
This is easier said than done, particularly when recommendations change as more data is gathered. It is not enough to leave this to chance. The government and the private sector must invest in tools and strategies to ensure that the impact of misinformation and disinformation is mitigated. These include identifying reliable sources of data like the DOH, US CDC and the World Health Organization. It also means cracking down on unscrupulous individuals and organizations who exploited the desperation and anxiety of the public during the pandemic for their own profit. Doctors and other healthcare workers who pushed unproven treatments despite mounting evidence that these did not work should be investigated by their professional organizations and their licenses revoked if found to have engaged in unethical and unprofessional practices.
These are just three among many, many steps that can be taken to ensure we are better prepared for the next pandemic. One very important weapon we now have in our arsenal is that we know it is possible to create a safe and effective vaccine in less than a year from the time a causative agent is identified. The Virology and Vaccine Institute of the Philippines is already being set up by the Department of Science and Technology and will enable our country to produce our own vaccines in such an instance so that we are no longer dependent on limited production from other countries. The lessons of the Covid-19 outbreak were hard won and cost many precious lives. With hope, we can institutionalize these lessons so that when the next “big one” comes along, it will have a much smaller impact on our lives.