A host of recent developments makes future pandemics far worse than COVID inevitable---every pillar of impact calculus flips affirmative.

The COVID-19 pandemic was met with rapid, unprecedented global collaboration and action. Even still, the public health, societal, and economic impact may be felt for years to come. The risk of another pandemic occurring in the next few decades is ever-present and potentially increasing due to trends such as urbanization and climate change. While it is difficult to predict the next pandemic pathogen threat, making reasonable assumptions today and evaluating prior efforts to plan for and respond to disease outbreaks and pandemics may enable a more proactive, effective response in the future. Lessons from the COVID-19 response and pandemic influenza preparedness underscore the importance of strengthening surveillance systems, investing in early-stage research on pandemic pathogens and development of platform technologies, and diversifying response plans across a range of tactics to enable earlier access to safe and effective interventions in the next pandemic. Further, sustaining the robust vaccine manufacturing capacity built because of COVID-19 will keep it ready for rapid response in the future. These actions will not be successful without improved global coordination and collaboration. Everyone, including the biopharmaceutical industry, has a role to play in pandemic preparedness, and working together will ensure that the most lives are saved in the next pandemic.

The substantial public health and societal costs of the COVID-19 pandemic are wide-ranging and have been observed across the world. As of August 2023, COVID-19 has infected over 770 million people and resulted in over 6.9 million reported deaths globally1, although the World Health Organization (WHO) estimates mortality could be much higher based on global excess mortality2. It has contributed to a reduction in global life expectancy; in the United States alone, life expectancy fell by an estimated 1.8 years, with a disproportionate drop among racial minorities. Many of those infected with COVID-19 still suffer from long-term COVID, with symptoms remaining months after the initial illness.

More broadly, COVID-19 led to substantial indirect health effects. Mental health declined worldwide, with a 25% increase in the global prevalence of anxiety and depression in the first year of the pandemic4. Disruptions to routine immunization programs in at least 68 countries affected more than 80 million children worldwide, likely resulting in higher rates of vaccine-preventable diseases5,6. Delays and avoidance of medical care contributed to more severe observed health outcomes; for example, delayed cancer screening and treatment have resulted in increased cancer mortality rates7. Beyond direct and indirect health effects, the pandemic challenged conventions around how people learn, work, and play. For example, delivering quality education virtually posed a challenge in some parts of the world, while in other parts of the world, formal education stopped altogether, setting back learning and development for an entire generation of children8,9,10. The negative health and societal impacts of COVID-19 may be felt for years to come. Unfortunately, many of these statistics and estimates will likely increase in magnitude with post-pandemic analyses, and as of the date of this publication, the entirety and extent of the pandemic’s impact are still not known.

The resulting global economic impacts of the COVID-19 pandemic were also unprecedented and may continue for years. Across countries, gross domestic product (GDP) fell by 2–4% in 2020, and the US had the worst contraction in national GDP since World War II11,12. This decline pales in comparison to the global economic losses extending through to 2024 which are estimated to be $13.8 trillion13. The effect on productivity and livelihood left governments around the world juggling priorities to quickly implement response initiatives.

Despite major economic shocks, the economic burden of the pandemic may have been worse if not for at least some prior spending on pandemic preparedness and response tactics. For example, the US National Institutes of Health (NIH) spent $17.2 billion in vaccine technology research—more than $500 million toward mRNA, virus-like particle, and nanoparticle vaccines—before 2020 with specific attention to diseases with pandemic potential14. These early initiatives set some of the foundational work on which new COVID-19 vaccine candidates were based. However, even with these investments, a report by a WHO-established panel found that on the whole, investment in pandemic preparedness before COVID-19 was inadequate, prompting efforts to revisit how the world prepares for the next pandemic, an ongoing risk15.

The risk of another pandemic

Smaller-scale outbreaks or large-scale pandemics related to emerging infectious diseases have increased over the past century, and are projected to do so over time16. Evidence suggests the probability of another pandemic occurring within one’s lifetime is roughly 17% and may even grow to 44% within the next couple decades. This means that in any given year, the chance of another pandemic occurring is over 2%. Yet, it is difficult to determine exactly what pathogen will cause the next pandemic.

Most emerging infectious diseases with pandemic potential are initially transmitted from animals to humans—zoonotic spillover—and those that have or evolve the ability to move from human to human have the potential to become dangerous. In fact, zoonotic spillover has likely been the trigger for most of the viral pandemics in the 20th century19. Meanwhile, societal trends are increasing the likelihood of zoonotic spillover. Urbanization and habitat destruction are placing humans and animals in closer contact, giving pathogens more opportunities to migrate to humans. Climate change is also altering animal habitats and forcing them to migrate to new territories, causing many species to meet for the first time20. Pathogens may travel between several animal species before reaching humans; therefore, novel species interactions driven by climate change also increase the risk of zoonotic spillover20.

Under the right circumstances, a newly emerged pathogen can grow from a disease outbreak to pandemic proportions. The balance of a pathogen’s characteristics, including transmissibility, case fatality rate, replication rate, and mutability—among other factors—will influence the likelihood of becoming a widespread pandemic21. For example, pathogens with a higher case fatality rate and lower transmissibility, combined with pronounced symptomology (e.g., Ebola), are more likely to be more limited in geographic footprint. Meanwhile, SARS-CoV-2 had comparably moderate case fatality, and higher transmissibility through airborne transmission and asymptomatic spread, which led to an exponential growth in the number of infections. Additionally, societal trends that increase connectiveness between countries, like globalization and travel, can further accelerate the spread of high-risk pathogens. Lastly, high pathogen mutation rates—as seen in particular with RNA viruses—also contribute to a greater risk because random mutations are a source of potential adaptations that benefit the virus. Altogether, given their high mutation rates and transmissibility, evidence suggests the next pandemic will likely be a respiratory RNA virus like a coronavirus or influenza (flu) virus, though the threat from other pathogen types remains.