#19,406
While the next pandemic could arise from a wide variety of sources (see WHO 2024 Pathogens Prioritization Report), the most obvious contender today is HPAI H5Nx, which continues to expand its host range as it spreads around the globe.
Despite the near-inevitability of another pandemic crisis, the world remains slow to embrace that stark reality, and prepare seriously.
Three years after the start of the last pandemic, in 2023's Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries, the authors found that the self-reported 66% readiness score for detecting and dealing with novel viruses was not supported by the available evidence. They wrote:
`A minority of countries have public evidence of novel disease consideration, and significant geographical heterogeneity exists in where this is located.'
Today, most surveillance is passive, and much of what is detected, isn't readily shared. There are often long delays in submitting viral sequences (see Nature: Lengthy Delays in H5N1 Genome Submissions to GISAID) - averaging 7 months - but sometimes taking 1 to 2 years.
We've also seen repeated warnings from public health agencies that our surveillance systems are not designed to detect novel viruses.
In 2024 the ECDC issued guidance for member nations on Enhanced Influenza Surveillance to Detect Avian Influenza Virus Infections in the EU/EEA During the Inter-Seasonal Period., which cautioned:
Sentinel surveillance systems are important for the monitoring of respiratory viruses in the EU/EEA, but these systems are not designed and are not sufficiently sensitive to identify a newly emerging virus such as avian influenza in the general population early enough for the purpose of implementing control measures in a timely way.
While they cite progress, they urge that Europe strengthen preparedness now, because an emerging human outbreak would likely far outpace our ability to manufacture and deploy vaccines.Today we've a review article in the International Journal of Infectious Diseases (IJID) that examines the current H5N1 threat, and Europe's readiness to deal with it.
Lone Simonsen 1, Tyra Grove Krause 2 3, Anders Gorm Pedersen 4, Lars E Larsen 5, Marlies Jilles Francine Goedknegt 1, Ramona Trebbien 2, Olav Hungnes 6, Preben Aavitsland 6, Otto Helve 7, Richard J. Webby 8, Marc-Alain Widdowson 9, Bolette Søborg 2, Marion Koopmans 10 11 12, Eskild Petersen 1
10.1016/j.ijid.2026.109220
Highlights
• Surveillance must strengthen One Health with closer collaboration between human and veterinary public health.
• Functional assays measuring H5N1 binding to α2,3- or α2,6 sialic acid will help.
• Detect early receptor switching.
• Novel vaccine platforms like the mRNA and Adenovirus must be developed to seasonal influenza to be available for rapid manufacture in a pandemic situation.
Abstract
H5N1 influenza clade 2.3.4.4b has spread from South East Asia through migratory birds since 2020. The expansion seeded frequent spillovers into wild and domestic mammals including cattle in the United States. While the risk for humans not in direct contact with infected animals is low, the widespread presence and opportunities for evolution constitutes a pandemic threat.
If sustained human-to-human transmission (H2H) would emerge, there is limited time to mount a public health response. Initially, non-pharmaceutical interventions (NPIs) are needed until vaccines are available. Experience with H5N1 viruses since 1997 suggests that infections are seen mostly in people born after 1968, indicating that people under sixty may be at particular risk.
Closely monitoring viral diversity and evolution in wild life, and at the human animal interface, using integrated One Health surveillance and genome-based selection of viruses for further characterization for instance receptor affinity of H5N1 to human receptors is mandatory.
(SNIP)
An influenza A pandemic in our lifetime is highly likely, given there were four in the last 100 years. However, the severity of a future influenza pandemic remains uncertain - it could be as devastating as 1918 or as mild as 2009.[73]
A robust European strategy must be developed during “peace time”, with sustained investment in diagnostics, surveillance, and flexible vaccine manufacturing. Additionally, it is crucial to anticipate, address and counter anti-science and anti-vaccine sentiments, which posed significant challenges during COVID-19. Effective mitigation and vaccination efforts depend on public trust in health authorities.
Although this review focused on the H5N1 threat, the next pandemic could be caused by another influenza A subtype, a coronavirus, or an entirely different pathogen. Given this uncertainty, preparedness efforts should prioritize surveillance anticipating a broad range of pathogens.
While it remains to be seen how the world responds to growing calls for pandemic preparedness (see UN High-Level Meeting on Pandemic Prevention, Preparedness and Response (PPPR)), there are things you can do as an individual to reduce your risk from a pandemic.
- Get Your Household Ready For Pandemic Flu {PDF - 16 pages]
- Get Ready for Pandemic Flu: Educational Settings [PDF – 16 pages]
- Get Ready for Pandemic Flu: Workplace Settings [PDF – 16 pages]
Even if a pandemic doesn't come in the near future, these are all things that would benefit you and your family during any prolonged emergency.
