Not If, But When: Preparing for the Next Pandemic

The last thing anyone wants to do in the immediate aftermath of one pandemic is imagine what the next one will look like.

But for doctors and other health care professionals, it’s not only prudent to do so, it’s part of their job.

One of the biggest lessons of the COVID-19 crisis was that a global pandemic is not an abstract, remote possibility, but rather an all-too-real likelihood, something that not only might happen again but, rather, certainly will happen again.

With the lessons of the pandemic still fresh in everyone’s minds, now is the time to look ahead and game out what the next similar crisis could hold. While the prospect of that is daunting, there is plenty of good news and several indicators that the country and the rest of the world will be much better prepared for the international health crisis.

A ‘New Era for Vaccinology’

The speed with which mRNA vaccines were developed and rolled out in the midst of the COVID-19 pandemic was nothing short of extraordinary, and completely unprecedented. In a New York Times Magazine article published in June of this year, David Wallace-Wells points out that “the mRNA sequence of the first shot was designed in a weekend, and the finished vaccines arrived within months, an accelerated timeline that saved perhaps several million American lives and tens of millions worldwide — numbers that are probably larger than the cumulative global death toll of the disease.”

Immunologist Barney Graham, the former deputy director of the Vaccine Research Center who was deeply involved in the development of mRNA vaccines, has said the world is in a “new era for vaccinology.”

This, of course, is a huge game changer when it comes to being prepared for the next pandemic.

Dr. Martin Backer is a physician and clinical researcher with NYU Langone and does his clinical research at NYU Langone’s clinical research center in Mineola. He has been doing clinical trials on vaccines since early on in the pandemic. He’s also working with his colleagues on studies of a potential Lyme disease vaccine, evaluating it in pediatric patients.

He spoke about what recent advances in vaccinology can mean for the next pandemic.

“The fact that we will have another pandemic — nobody in the field questions that,” he said. “The uncertainty is when it will occur and what it’s going to look like.”

While it was a steep price to pay, Dr. Backer said that the pandemic provided a boon for the field of vaccine development in many ways.

“The vaccine research and development field benefited in some ways, with a lot of resources being poured into the field, because they were desperately needed,” he said. “It became a very high priority, understandably, to develop a safe and effective vaccine. A lot of resources poured in both in terms of dollars and the people working on it, and with that, we are learning a lot.”

Backer said that while much of the focus has been on how quickly the vaccine was developed and brought to market, the real emphasis should be on the fact that that speed was only made possible because of the work that had been done long before the pandemic by Katalin Kariko and Drew Weissman, who recently won the Nobel Prize in medicine for their work, which made mRNA vaccines possible.

Backer said their work is a prime example of why there needs to be continued investment in scientific research, even if it is unclear at the moment where that research might lead or what major future problem or health crisis it might address.

“They did their work long before we knew of SARS-Cov-2,” he said. “We were able to apply the knowledge from their work and the work of others, people at the National Institutes of Health, and put those things into practice for a vaccine that was eventually shown to be safe and effective, and that was done before the pandemic. It emphasizes the importance of continuing to advance the field.”

The next level that requires continued investment, Backer said, is developing next generation COVID vaccinations, ones that can require broader protection against different variants. He said the development of intranasal vaccines is key too, as it may be another option for people who do not want to get shots and have avoided being vaccinated because of that.

Dr. Sharon Nachman an international leader in the area of pediatric infectious disease and the treatment of children with AIDS, flu and measles. She has been the principal investigator of more than 30 clinical trials of promising medicine for patients treated at Stony Brook University Hospital and conducted international trials in the areas of new vaccines, Lyme disease and AIDS. She agrees with Backer’s insistence that one of the biggest takeaways from the pandemic should be the value of supporting scientific research.

“No science innovation is ever wasted,” she said. “You need to spend money on scientific research, because you don’t know where scientific research will translate into an advantage we’ll need for another field. The mRNA vaccine is a great example. When they started working on them, it wasn’t, ‘OK, we’re going to build this great vaccine.’ It was, ‘Oh, this could be useful scientifically and medically,’ and that turned into, ‘Oh, we could use this as a vaccine.’”

Lessons Learned, and Planning Ahead

The ability to create new vaccines rapidly is without a doubt a huge tool in fighting the next pandemic, but there were plenty of other lessons learned from COVID-19 that are unrelated to vaccines that can be applied to the next crisis.

Dr. Fredric Weinbaum is chief medical officer, chief operating officer and interim chief administrative office of Stony Brook Southampton Hospital.

He said that private patient rooms, creating the capacity for negative pressure within rooms — so infected air flows out rather than circulating back in — making sure non-ICU rooms are set up so they can be easily converted into ICU rooms if necessary, and more were some of the takeaways after going through the pandemic.

“What we learned is that there’s really a huge advantage to flexibility,” he said.

Taking even simple steps ahead of time to make sure the hospital is well-stocked with the kinds of items it will need when a similar crisis arrives — extra ventilators, and deep inventory of personal protective equipment, for example — is another lesson that was learned, particularly when hospitals were scrambling because of shortages of those necessary items.

“Now we’re always prepared to get through a 90-day wave of serious respiratory infections,” Weinbaum said.

One big takeaway for Weinbaum was how imperative it is to take care of the caregivers. That means not only ensuring there is enough PPE, but engaging in ongoing training to make sure everyone knows how to use it effectively and properly.

All these lessons are being taken into consideration as Stony Brook Southampton looks forward to building a new hospital, Weinbaum said.

New and updated measures for procedures like forward triage, identifying patients who are at risk before bringing them into the ER, and having access to rapid PCR testing, so staff know as soon as possible what they’re dealing with, are all key to success in the future, so that the hospital can provide the “optimal level of care for every patient,” Weinbaum said.

Taking all those measures not only helps mitigate the number of people dying and suffering from severe illness with a communicable disease like COVID-19, it also helps the hospital remain equipped to take care of patients with other issues and health challenges as well.

“The better you can manage the pandemic, the better you’re going to be able to keep everyone else healthy,” Weinbaum said.

Keeping morale high and ensuring there is successful collaboration and solid teamwork from everyone on the hospital team is another key element of success, and Weinbaum said setting the example for that starts at the top.

“Two critical things we learned is that we had to be very transparent and widely disseminate information as quickly and completely as possible, so our staff knew what was going on, and leadership had to stay on site and involved,” Weinbaum said. “I think it was extraordinarily helpful for people in patient rooms and on the floor to see that the head of the hospital and the medical director were all there on the floors, putting on PPE, going into rooms to see if anything was needed, showing that they were exposing themselves to the same risks that every health care worker was. You can’t ask your staff to do what you won’t do as leadership. That doesn’t work. It’s far easier to tell people ‘we have to do this’ if you’re willing to do it with them.”