Reprint: Preventing Another Pandemic

 From the NY Times Opinion newsletter:

The Covid-19 pandemic exploited a narrow gap in humanity’s outbreak prevention barriers. As the world now knows, SARS-CoV-2 spreads through the air via respiratory transmission. Spread can occur even before people develop symptoms. Our modern, mostly indoor lifestyles constructed the optimal environment for a fast-moving respiratory pandemic. Clean water, clean hands, clean food and clean surfaces did not stop the virus from hitching a ride on airplanes or spreading at packed concerts, bars and restaurants.

As in the past, we need to develop technologies that will fundamentally change our environment. In the United States, all modern buildings are built with fire prevention in mind, despite the last city-burning fire occurring over a generation ago. We provide piped water and sewer systems, electricity to boil water and refrigerate food, and window screens to stop pests. The goal today should be to take respiratory pandemics entirely off the table.

This starts with cleaning the air. The most ambitious version of clean indoor air technology would be capable of rapidly suppressing transmission for even the most contagious pathogens, like measles, at a cost affordable enough to install in all the places people gather and cross paths. Accomplishing this will require innovation beyond better ventilation and ways to filter air. ‌This could include light bulbs that also emit germ-killing wavelengths that are still safe for humans. With this type of innovation, society can reduce transmission and maybe even make the common cold a relic. The Biden administration has declared improving ventilation a priority, but simply upgrading out-of-date filtration systems to the current standard probably won’t be enough to prevent pandemics.

Researchers have made ‌progress toward‌‌ other advanced pandemic-fighting capabilities. It is now possible to take any type of sample from a possibly infected person and sequence the genome of every microorganism in that sample ‌‌ — bacteria, viruses, fungi and all. All pathogens have genomic material, and sequencing allows us to read that material. This method, metagenomic sequencing, functions as a universal pathogen detector. It is beginning to be used to monitor patients for known pathogens, as well as bugs we have never seen before.

Vaccines are, of course, a mainstay of prevention, and even these have seen incredible improvements with the advent of mRNA vaccines. Work is ongoing to deliver pandemic vaccines within 100 days. Efforts toward‌‌ making vaccines effective against entire groups of viruses, such as all coronaviruses, are underway. But for modern vaccines to truly prevent rapid respiratory pandemics, they must be deployed widely and quickly and, when possible, in advance.

The U.S. government‌‌ is investing in microneedle vaccine patches and nasal spray vaccines that can be self-administered. These could be quickly mailed to every household, eliminating the need for clinic- and pharmacy-based administration by trained health care workers. Scientists think that skin patches and nasal vaccines may be able to elicit mucosal immunity, something current injectable vaccines don’t do very well. Mucosal immunity prevents viruses that land on our mucus membranes — in the nose, mouth and lungs — from causing an infection entirely.