This is a demanding time of great international uncertainty. The war in Ukraine is putting pressure on European resources and testing our resilience. The now enduring abuses against the Palestinian population in Gaza show a world where international agreements and organisations have fallen short. The war in Sudan has barely hit the headlines in the Norwegian media, but the number of people living on the brink of famine is approaching one million. In addition, there are difficult conflicts in Myanmar, Syria, Mexico, Nigeria and Colombia, among others. There is a lot to tackle, but at the same time we can't afford to forget the prevention of crises that we know with reasonable certainty will have a major impact on our future. If we are to have any chance of dealing with the environmental and climate crises, the work on solutions cannot be postponed to an indeterminate future. Similarly, if we are to have an effective defense against the next pandemic, that work must begin now.
What do we need to learn in order to deal with future pandemics?
In some places, the impression has been created that we have learned a great deal about pandemic vaccination in connection with the SARS-CoV-2 pandemic. I regularly meet people who think that we can now create vaccines against almost anything, as we now have available technology such as mRNA. The reality is that prior to the pandemic, a number of clinical trials had been conducted using different mRNA vaccines against different viruses [1], as well as clinical trials with different vaccines against coronavirus[2]. Underpinning these clinical trials are years of basic research to understand both mRNA as a vaccine format and the characteristics of different coronaviruses. So, before the pandemic, we knew exactly how to design vaccines that were highly likely to work well for protection against SARS-CoV-2. In fact, I would argue that we didn't learn anything new about how to design and make vaccines during the SARS-CoV-2 pandemic. Several companies learned a lot about scaling up new vaccine production, and society learnt a lot about how to distribute vaccines to the population.
An important lesson learned from the SARS-CoV-2 pandemic is that it is important to continue research into the development of vaccines against viruses that could potentially represent future threats. One of the initiatives to which Norway is an important contributor is CEPI (Coalition for Epidemic Preparedness [3]), where one of the objectives is to conduct clinical trials with different vaccines against different viruses. This could give us the same starting point for protection that we had against SARS-CoV-2, but for several virus families. This is important work, but we mustn't forget that we also need basic research to design even better vaccines for the future.
So, what knowledge do we need to be able to design a vaccine against a completely new and unknown virus? For example, we need to learn more about which pathogens exist in the environment around us (ecology). We also need to better understand which parts of the virus our immune system will be able to detect (immunology), and we need to learn more about how different types of viruses infect and multiply (virology). We also need to learn more about what immune responses we may already have that could provide some protection against a new virus (immunology). Such knowledge could also provide greater insight into which population groups may be at higher risk of serious illness after infection. During the SARS-CoV-2 pandemic, it was observed early on that the elderly were more prone to serious illness, but this need not be the case the next time we encounter a virus with pandemic potential.
Whatever vaccine we end up designing against a potential new pandemic, it will take some time before it is available for use in the population. During this time, it will be critically important to understand how to manage the spread of infection if the risk of the virus is considered high (epidemiology). Effective implementation of any measures will also require knowledge of how the risk is perceived in different parts of the population (psychology) and, not least, knowledge of the effects and consequences of various measures (epidemiology). It will also be important to consider the consequences for the larger structures of our society (e.g. economics, pedagogy, law, anthropology, philosophy/ethics).
War increases the risk of infectious diseases
We don't know what the future will bring. However, we do know that we face several complex problems that will require us to work together across different disciplines to solve them, which was perhaps the most important lesson learnt from the pandemic. We also know that today's geopolitical situation increases the risk of virus transmission and subsequent disease. Elements that accelerate the damage potential of infectious diseases include changes in the environment and ecosystems, displacement of people, and wars that break down civil society and healthcare systems. For example, we have seen outbreaks of polio in both Gaza and Sudan in the past year. War also increases the threat from bacteria that are resistant to antibiotics [4]. In sum, it is in our common interest to work globally for a better future.
Complex problems can be solved one piece at a time
When working on large complex problems, it's important to break them down into smaller challenges where progress can be more clearly assessed. At the Centre for Pandemic and One-Health Research, one of the problems we are currently working on is that various Norwegian preparedness plans are still characterised by silo thinking, and where universities do not have a clear role as knowledge providers. When we look at the large and heavy contributions that came from various university environments during the SARS-CoV-2 pandemic, it should be obvious that the university must have a clear role in national preparedness strategies, both as a knowledge provider of relevant and updated knowledge and as a supplier of competent staff. We know that the next pandemic to come will be characterised by a lack of certain knowledge about several things, but based on the latest research, the University will be able to contribute knowledge that enables a better basis for assessments. In addition, employees at the University are a significant resource when it comes to possible contributions in a crisis, whether this is through increasing laboratory capacity, vaccinating the population, or contributing with other necessary work.
We live in a complex world, but together we can make a difference.
- Bahl, K., et al., Preclinical and Clinical Demonstration of Immunogenicity by mRNA Vaccines against H10N8 and H7N9 Influenza Viruses. Mol Ther, 2017. 25(6): p. 1316-1327.
- Modjarrad, K., et al., Safety and immunogenicity of an anti-Middle East respiratory syndrome coronavirus DNA vaccine: a phase 1, open-label, single-arm, dose-escalation trial. Lancet Infect Dis, 2019. 19(9): p. 1013-1022.
- https://cepi.net/.
- Pallett, S.J.C., et al., The contribution of human conflict to the development of antimicrobial resistance. Commun Med (Lond), 2023. 3(1): p. 153.
