COVID-19 is Waning — But Are We Ready for the Next Pandemic?

Photo illustration by Jeffrey E. Tryon

By Donald Gilpin

As the United States and the world gradually, unevenly, haltingly emerge from the COVID-19 pandemic after 18 months, there is ample cause for relief, joy, even celebration. People are coming out of their homes to reconnect with family and friends. Vacation spots, resorts, and recreation areas are alive again. Restaurants, shops, theaters, sports complexes, and entertainment centers are welcoming large numbers of visitors.

But there have been pandemics in the past, and COVID-19 won’t be the last. After the initial exuberance dies down, will the nation and the world be able to embrace lessons learned from this pandemic that might help humanity survive the next one and the one after that?

Jessica Metcalf, a disease ecologist and professor of ecology and evolutionary biology at Princeton University’s School of Public and International Affairs, already has a plan that might have saved hundreds of thousands of lives in the early days of COVID-19 and could save millions of lives in battles against future epidemics.

A research team, led by Metcalf and Harvard epidemiologist Michael Mina, is on track to detect, define, and defeat disease outbreaks faster by testing for antibodies to infectious agents in millions of blood samples.

Blood samples. (Shutterstock.com)

Metcalf is working to create an observatory which would collect tiny samples of blood from blood banks, plasma collection centers, and elsewhere, identifying the samples only by geographical area. The samples would be tested for thousands of different antibodies and screened for signs of pathogens that might be spreading.

Jessica Metcalf, professor of ecology and evolutionary biology at Princeton University’s School of Public and International Affairs.

“The big idea I’m really excited about at the moment, which I think would have put us in a much better place for dealing with this pandemic, but will also leave us in a better place for future pandemics, is a Global Immunological Observatory (GIO),” said Metcalf in a May 2021 Princeton University interview. 

She went on to explain how our immune system, examined through a small blood sample, can reveal an understanding of whether we have been exposed to a particular virus and how the spread of pathogens can occur.

Antibodies in the human immune system that fight against pathogens can serve as a record of those pathogens, and scientists can determine, through blood (serological) testing, what viruses we have had, even if some of them never made us sick.

“By going and taking samples from everyone we can get an extraordinary window into the past of what pathogens have circulated where and who has been exposed and who hasn’t,” Metcalf noted, “but we also have a sense of what vulnerabilities are in the future because that pathogen exposure tells me whether I’m protected or not and it also tells us something about whether that pathogen, whether that influenza virus, will be able to spread or not.”

She added, “So our own immune systems contain the data that we want, and what we’d like to be able to do is capture that information and put it into our data systems and capture it routinely across seasons and across years and capture it globally.”

Antibodies in the human immune system that fight against pathogens can serve as a record of those pathogens. (Shutterstock.com)

“An Early Warning System”

Metcalf compared the way that sea surface temperature data has been collected into a single data base by buoys, sensors, weather stations, and satellites across all the oceans of the world and how that data enables scientists to examine and predict weather patterns and chart indications of climate change. “The real value of a GIO will come if we can combine all this data into a single location and make it available to researchers around the world.  It would be a single data base that contains a sense of what the global landscape immunity is.”

The necessary investment would pay off richly in billions of dollars and hundreds of thousands of lives saved if predicting the next pandemic could become as routine and reliable as predicting tomorrow’s weather. The GIO could alert the world to the emergence of dangerous pathogens like COVID-19, and coordinated responses from governments, public health, and citizens across the globe could be initiated early enough to control outbreaks.

A few years ago a measles study that Metcalf was involved with in Madagascar found, through investigation of blood serum samples, that immunity to measles was dangerously low. Vaccinations had succeeded in almost eliminating the disease earlier in the century, but a portion of the population remained susceptible because they hadn’t been vaccinated.

The available data was incomplete and the samples were not from a representative cross-section of the population, but the imperfect data did reveal that many people in Madagascar lacked immunity to measles, and the researchers predicted a future outbreak. Unfortunately that outbreak came in 2018 with an epidemic that was especially severe among young children. 

Further investigation of blood serum antibodies would have provided definitive early warning of the danger long before the outbreak occurred. Susceptible individuals could have been vaccinated, and the effort could have saved Madagascar from the deadly effects of the 2018 measles outbreak.

Metcalf and her colleagues wrote, in a June 2020 eLife article, “Science Forum: A Global Immunological Observatory To Meet a Time of Pandemics,” that “as this pandemic has repeatedly shown, early warning and rapid response can make dramatic differences that translate directly to immensely favorable outcomes.”

In her May 2021 interview Metcalf also noted, “There are many potential advantages to a Global Immunological Observatory. The first would simply be detecting where there are gaps in immunity to pathogens for which we know we have the ability to fill those gaps, for example by vaccination for measles or rubella or other vaccine preventable diseases.”

She continued, “The other thing we can do is detect anomalies. So if we suddenly see an uptick in coronavirus immunity in a part of the world which doesn’t normally have that immunity, we might wonder if there has been a pathogen emergence event, or it might be an early warning system.”

The GIO, Metcalf noted, will also provide scientists and medical professionals with a better understanding of “the central mystery of how the immune system works.”

Blood donation. (Shutterstock.com)

Challenges Ahead

Metcalf and her team face a number of challenges in the ongoing development of the GIO. Mina, who is a physician at Harvard’s T.H. Chan School of Public Health, has hundreds of thousands of blood samples from across the country in his lab and is seeking funding to expand testing capacity and pursue the necessary ongoing research.

Interpreting the samples is difficult. “More fundamentally,” Mina, Metcalf, and their team wrote, “despite huge recent progress in immunology, the complexity of the immune system remains a barrier: a revolution in the infrastructure of immune surveillance and systems immunology to generate new understanding and resultant techniques is required.”

Perhaps even more troublesome than the scientific and financial concerns are the challenges of overcoming the foibles of human nature. As masks are removed, social distances eliminated, and normal life resumes, will the lessons of this pandemic be forgotten? Will we all be able to work cooperatively and collaboratively with each other to achieve coordination among nations across the globe?

Getting scientists, doctors, government leaders, and citizens working together to prepare for the future has never been easy, and it remains to be seen if the COVID-19 pandemic has transformed society and opened doors for cooperation and progress on life-saving endeavors like the GIO.

“There’s a host of infections from which we should no longer be dying,” Metcalf noted in Princeton University’s Discovery research magazine.

“The COVID-19 pandemic has been an extraordinarily difficult time for all of us,” she added. “As a scientist it has also been amazing how much all of us have learned. Of course I would have preferred to learn these things in any other way, but it is undeniable that the progress that has been made in vaccinology and also immunology has been utterly remarkable.”