The USA is failing to learn lessons from COVID-19 as the world reconciles with a possible future bird flu pandemic, experts have warned. In a recent Perspective article, public health specialists have laid out their concerns that mistakes made during the response to COVID-19 may be repeated next time around, and that leaders in the country “seem unprepared” for such an eventuality.
H5N1 avian influenza has long been considered to have pandemic potential. In recent months, the rapid spread of the virus among dairy cows in 14 states (at time of writing) and the handful of resulting cases in farm workers has stoked those fears further. Although this strain of the virus has not yet displayed the ability to spread between humans – which would be the real red flag – health authorities are monitoring the situation closely.
The 14th case of human H5N1 infection in the USA this year was recently confirmed by the Centers for Disease Control and Prevention (CDC). Importantly, this individual had no known history of contact with infected animals. Again, it doesn’t mean a pandemic is definitely around the corner; but all of these signs do mean that the potential threat, however remote, should be taken seriously.
Luckily for us, you might say, we’ve gained a lot of very recent experience dealing with a pandemic. COVID-19 hasn’t yet gone away, and governments are still picking over their initial responses to the virus and facing up to their missteps. If a new pandemic were to emerge soon, surely we’d be in a stronger position to tackle it than we could ever have hoped?
Unfortunately, according to the three public health experts behind the recent Perspective, “the federal government’s initial response suggests that, rather than heeding the lessons from [COVID-19], elected officials and other key decision makers may be relying on a dangerous type of revisionism that could lead to more deaths, should H5N1 cause a pandemic.”
Instead of getting on the front foot with H5N1, co-author Gregg Gonsalves argued in an interview with the Guardian, “We have not really done anything to address what’s happening in terms of the onward spread of bird flu across the US – we’re back to the same old mistakes.”
Gonsalves and co-authors Michael S. Sinha and Wendy E. Parmet explain that despite the US being ranked highest among 195 countries on pandemic preparedness in 2019, when COVID-19 came onto the scene only months later, it “fared terribly by most measures”.
They highlight weaknesses in testing and surveillance, which they say are now being repeated with H5N1, meaning we don’t have a true picture of how many workers in the dairy industry have actually been infected. A lack of clarity over the remit of different government bodies that plagued the COVID-19 response hasn’t fully been cleared up, even now.
On top of that, they point out, living through the last pandemic has changed people. Anti-vaccine and anti-mask sentiment could make mounting a coordinated infection control response more difficult in certain communities. The economic circumstances are much altered from early 2020, meaning that investment in large-scale research and development and social safety nets for people affected by a pandemic may be harder to come by.
Health authorities may also be hamstrung by newly enacted state laws limiting their power to respond to a public health emergency, such as legislation preventing schools in some areas from initiating mask mandates.
All this to say, according to the authors, “a new pandemic could potentially spread even faster than COVID-19 did […] – even if the causative virus isn’t more lethal than SARS-CoV-2.”
“Most troubling, we believe, is the apparent inability of politicians and pundits to understand that a new pandemic may look different from the previous one, threatening different populations and presenting different trade-offs.”
This last point is key. If H5N1 were ever to reach pandemic status – or if another, totally different disease comes along – it likely wouldn’t be a case of rolling back the clock to mid-2020 and putting all those same mitigations back in place. Rather, governments would need to take what they learned from those times and adapt it to suit a possibly very different threat.
According to these experts, at least, the US is not quite there yet.
The Perspective is published in The New England Journal of Medicine.
