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Learning from Pandemics: 3 Rs and 7Ds

December 6, 2020

David Waltner-Toews

We can’t control everything, but, using three general Rules (Rs) to guide us, and seven areas where we can DO something (Ds), we can minimize the chances that we will have another pandemic. The proposals below are based on several decades of research and field work around the world on the causes and prevention of epidemic pre-pandemic infectious diseases in animals and people.

The Three Rs

Revise our understanding of food, agriculture, health, economics and conservation

Restructure our institutions to reflect those understandings and

Regulate in such a way that we can implement our re-vision of a resilient future

The Seven Sectors where we can have both immediate and long term impact are: Science, Surveillance, Healthcare, Agrifood, Trade, Wildlife, and Education

Introduction

A pandemic occurs when a virus or bacterium emerges from its natural reservoir or habitat, where it rarely causes problems and 1) is transmitted to people and adapts itself to replicating in people and 2) mutates to be able to spread from one person to another directly and/or 3) because people create environments where the microbes can thrive, spread, and multiply. With rare exceptions, most efforts to control pandemics have focused on 2 (quarantine, masks, vaccines, drugs). Cholera, which helped motivate the creation of large-scale public interventions in water supplies, waste disposal and sewage treatment, is one of the few exceptions. For SARS-CoV-2, most of the scientific and technological effort has gone into developing vaccines and therapeutics.

Going forward, if we wish to minimize the probability of new pandemics, we need to become better at addressing 1 and 3. Historically, all pandemics, such as Covid-19, and “pre-pandemics” such as Ebola Disease and Avian Influenza, have emerged from a combination of international trade, travel, social disruption, and land use changes. Almost all these changes have been stimulated, and rapidly expanded, by changes in agriculture, urbanization (and its attendant rural depopulation), and economic development. Since the late twentieth century, these changes have been accelerated based on highly focused scientific work and technology. Between 1961 and 2018, world chicken production increased from 4 billion to 20 billion, pork from 200 million to over 100 billion pigs, human populations doubled from 3.5 billion to more than 7 billion, and life expectancy (on average) from 52 to 72 years. All of these positive trends have been accompanied by a dramatic fracturing of how wealth and access to food health services and meaningful work are distributed across and within societies. These inequities, which express themselves as “pre-existing conditions” (diabetes, obesity, etc), both cause pandemic emergence and worsen their outcomes. Linking equity in access to health services, meaningful work, conservation of landscapes and distribution of wealth are not separate add-ons to preventing pandemics. They are the foundations upon which good responses can be built.

The Seven things we can Do: Activities for Creating a more resilient, convivial post-pandemic world.

1. Improve Peripheral Vision Good science for vaccine and drug development depends on being able to focus clearly on details. Preparing to prevent or minimize the next pandemic depends on Post-Normal Science, which is science that by drawing on knowledge from a wide variety of sources, improves our peripheral vision –the ability to be aware of many trends at once, and how they interact. A person who has lost peripheral vision stumbles around, bruising themselves. As societies, we have been so focused on what is in front of us, what is easily measurable, that we have lost our collective peripheral vision.

To regain our collective balance, we will need to expand our peripheral vision through strategic partnerships with a wide variety of experts and ordinary, observant, people. These partners include people who are focused on our food supplies, particularly food demands in critical geographic areas and critical times (eg pre-holidays). This will require more explicit sharing of expertise and information across government and university departments, and across scales (community, provincial, national).

2. Surveillance has often been put forward as a way to prevent and manage infectious diseases. Screening wildlife, domestic animal and human populations for classes of viruses and bacteria that have caused trouble before is a place to start, a base-line. But going beyond this assumes that we have some idea what we are looking for, and that we have good tests. How can we develop surveillance tests for the unknown? For new pandemics, we cannot be sure we are looking in the right places for the right things. But even the best surveillance, with the best peripheral vision, is insufficient. Surveillance tells us what is happening but offers no guidance on what to do. So we need both 1 & 2.

3. Healthcare delivery will require a shift from single-minded efficiency to nimbleness, deftness, agility. This will require global, regional and national policies that enable sharing of resources, people, and information across political and geographic boundaries. In the health system this means a national policy that allows for shifting expertise and equipment to where it is needed in the country. This will require some standardization of health-service training for nurses, physicians, lab workers, veterinarians, and other health professionals. This may also require re-writing certification for health professionals so the political obstructions to professional certification are suspended or modified in a pandemic.

4. Food & Agriculture & Economic Development Policy: The agri-food system (including food safety, food security) is based on trust. Trust is more easily gained among everyone if the producers and consumers have a good fundamental understanding of biology and know each other, or are at least in the same regulatory system. Therefore re-localizing food growing as much as possible, which shortens food chains, will enable better synchronization of environmental/ habitat protection and food security/ safety, and give opportunities for consumers, farmers and regulators to get to know each other and develop trust. Local foodsheds have limitations of climate, technology, soil, and so on. For foods that cannot be produced locally, trust is based on the creation and enforcement of better laws that address issues of quality and safety in managing trade (see 5 below) .

5. Trade: Any company that produces meat/ food in North America or Europe and/or ships meat & other food must have paid sick leave and health plans for all workers. Otherwise there is every incentive for workers to bring diseases into workplaces and back out into the community. We saw this with H1N1 in 2009 and again with SARS-CoV-2 in 2020. Similar safeguards can be negotiated not only for food and feeds, but also for equipment and other commodities. These things could be made requirements for entering the WTO and other multilateral trade deals.

6. Wildlife: Although pandemics are often mediated through food and agricultural practices, many emerging diseases and pandemics have originated in wildlife. There are many actions we can take with regard to that. Regulate wildlife trade and wildlife markets, both legal and illegal (not banning wet markets). Decriminalize – harm reduction, manage, control. Targeted banning only if this is enforceable. For interactions with wildlife, regulating trade (legal & illegal) is important, and/ but maintaining habitats is essential. This requires links among selected environmental & development organizations. Focus less on individual species such as bats, and more on maintaining habitats where multiple species can interact with less human interference. People who live near the protected areas need to have a strong vested interest in maintaining them & are themselves protected.

7. Education: Academia will require restructuring to create more open spaces for information sharing across academic, institutional and national boundaries. This requires more than just a move to open-access journals. It will require that all scientific disciplines work together with researchers in social sciences, communications, and humanities, as well as public health workers in government and private business. It is in everybody’s best interest that we have a citizenry well-educated in public health, ecology (including human and microbial ecology), economic development and trade.


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