Viruses: Kawaoka & Neumann on `Which Virus Will Cause the Next Pandemic?'

Credit UK HAIRS 

#17,221

Although few people wanted to hear it before the emergence of COVID - and fewer still are receptive to the message now - the next pandemic crisis is probably a lot closer than we think.  The causative agent is likely a novel virus - and it, or its parental strain - is probably already circulating somewhere in the world in a bat, a rodent, a bird, a pig, or even an insect vector. 

The above map, taken from the UK HAIRS report we looked at a few days ago, illustrates nicely how much `viral chatter' there has been reported around the globe over the past 20 years.  

As busy as this map is, 18 months ago in PNAS Research: Intensity and Frequency of Extreme Novel Epidemics, we looked at a study where researchers suggested that the probability of novel disease outbreaks will likely grow three-fold in the next few decades.

It's not a new idea.

Thirty years ago anthropologist and researcher George Armelagos (May 22, 1936 - May 15, 2014) of Emory University posited that humans were entering the age of newly emerging infectious diseases and re-emerging diseases carried over from the 2nd transition, and a rise in antimicrobial resistant pathogens (see The Third Epidemiological Transition). 

While once considered a once-in-a-generation event,  I've already seen 4 declared pandemics (1957, 1968, 2009, 2000) in my lifetime, and as a paramedic was heavily involved in the preparations for the fizzled  `Swine Flu' pandemic of 1976 (see Deja Flu, All Over Again), and worked the `Russian Flu' pseudo-pandemic the following year. 

And even though I'm pushing 70, there's a pretty good chance I'll see another. 

Our track record of pinpointing the next pandemic virus has been abysmal, but we do have a (long, and growing) list of potential candidates.  Novel influenza remains a strong contender, as do an array of bat-borne viruses, including Nipah, Hendra, and novel coronaviruses. 

But enteroviruses, adenoviruses, and even arboviruses are possibilities.  And of course, there is always Virus X - the one we don't know about - yet. 

Today we've an opinion piece by frequent collaborators Gabriele Neumann and Yoshihiro Kawaoka from the University of Wisconsin-Madison (see here, here, here and here) which reviews the history of modern pandemics and recently declared PHEICS (Public Health Emergencies of International Concern) and discusses likely candidates for the next pandemic. 

Due to its length I've only posted some short excerpts.  You'll want to follow the link to read the report in its entirety.  I'll have a brief postscript when you return. 

Which Virus Will Cause the Next Pandemic?

by
Gabriele Neumann 1 and Yoshihiro Kawaoka 1,2,3,4,*

Published: 10 January 2023

Abstract

One of the most pressing and consequential problems in infectious disease research is to better understand the potential of viruses to cause a pandemic, or, in simple terms, determine which virus will cause the next pandemic. We here define pandemics as WHO-declared pandemics, or disease outbreaks commonly referred to as pandemics that predate the WHO pandemic framework. Despite extensive research in the field of infectious diseases in recent decades, all pandemics have found us unprepared, with enormous losses of human lives, tremendous costs for public health, and vast and potentially long-lasting economic losses. Here, we discuss viruses that may cause a pandemic in the future.

(SNIP)

4. What Will Cause the Next Pandemic?

The next pandemic will likely result from a zoonotic event caused by a virus introduced into humans from mammals including bats (which harbor the highest proportion of zoonotic viruses among mammals) [28] and rodents, or from avian species. While Table 1 lists past and current pandemic viruses, PHEIC agents, and WHO priority diseases, it is also conceivable that the next pandemic will be caused by another zoonotic virus, such as yellow fever or the chikungunya virus. 

However, we suggest that a pandemic virus will have to transmit among humans via the air, which reduces the number of candidate PHEIC agents and WHO priority disease-causing viruses with pandemic potential.

Could the next pandemic be caused by a close relative of viruses endemic in humans?

Most respiratory infections in humans are caused by respiratory syncytial virus, rhinoviruses, coronaviruses, parainfluenza viruses, influenza viruses, metapneumoviruses, adenoviruses, measles virus, mumps virus, enteroviruses, bocaviruses, and parvoviruses (Table 2). Except for influenza, measles, and mumps viruses, vaccines are not available for these viruses (Table 2). Close relatives of these viruses circulating in non-human reservoirs could infect humans and acquire the ability to replicate in humans and spread among them.

To prepare for future pandemics, the international research community needs to continue and further strengthen research efforts in various areas, including the following: (i) cataloging the landscape and animal reservoirs of (human-infecting) viruses through surveillance and metagenomics; (ii) development of animal models for viruses that may cause pandemics; (iii) basic research to better understand the molecular virology of such viruses; (iv) early stage vaccine development and testing in animal models; and (v) development of broad antivirals as a first line of defense. The US National Institute of Allergy and Infectious Diseases has suggested that prototype pathogens (selected from virus families that may cause pandemics) be selected for basic research and early stage development of countermeasures [29]. With reasonable resources and advanced technologies, the global community could be much better prepared for future pandemics.

(Continue . . . )

While it is true we could go years, or even decades, before the next severe pandemic arrives - it could just as easily emerge before the dust from our current pandemic has settled.  

With the world still reeling from three years of COVID-19, supply chains disrupted - and many economies teetering on the brink - we find ourselves in a precarious position.

One that would be only worsened if we get blindsided by another emerging disease threat anytime soon. Yet our visibility of potential threats continues to erode (see Flying Blind In The Viral Storm). 

Whether `reasonable', unavoidable, or simply politically expedient, the growing lapses in disease reporting around the world should give us all pause. As should our general lack of preparedness for the `next one'.

The notion that we won't get hit again may be comforting, but it is only a continuation of the years of magical thinking that left us woefully unprepared for COVID-19.

And given we are solidly in the age of emerging infectious diseases, that is a luxury we can ill afford going forward.