Handling the Next Pandemic

Now is a great time for deep introspection and technical analysis on how to handle the next pandemic by a group of qualified people in relevant leadership positions.

But unfortunately, I’m all you’ve got.

Why now? Because society’s memory is short, and people’s memories are shorter. Now is absolutely a good time to review what worked, what didn’t, and build new institutions before the next pandemic.

So first, what worked? Some ideas:

  • vaccines
  • masks
  • remote work
  • lockdowns (EDIT: maybe? I need to review the evidence on this)

What didn’t work? Actually ask yourself, what seemed like it would work but didn’t? These things are important to remember as we prepare for the next pandemic. Some suggestions:

  • Travel bans. Perhaps these would work better if they were stricter, but the actual travel allowances for citizens allowed the new strains in, even though we saw them coming.
  • Individual compliance with guidelines
  • Mass testing
  • Contact tracing
  • Top-down governance and regulations
  • Fast vaccine authorization
  • Fast vaccine rollout

So what should we do next? What are some ideas you wish were tried? What worked in some places even if it wasn’t widespread? Some suggestions:

  • Supply chain management. Creating stockpiles of masks, disinfectant and vaccine inputs is a good start, but more sophisticated policy is needed. Subsidizing companies which maintain more robust supply chains might also help.
  • Testing new possibilities with immunizations: mix and match vaccines, half doses of vaccines, variolation, intradermal delivery of vaccines, and first doses first should all be seriously considered in the future (EDIT 4/22: Convalescent Plasma Therapy also seems valuable)
  • Human challenge trials
  • Much less regulation in pandemic-related medicine. Existing regulations slowed down every step of the response to the pandemic, from medical devices, to masks, to testing, and vaccines.
  • More and better public information. There needs to be robust systems in place to outline local laws, list local advisories, report case counts, deaths, hospital capacity, current research, and activity based risk factors for people to be able to make informed decisions.
  • Better handling of misinformation
  • Right-to-try legislation. People should be allowed to try out plausible treatments. Everyone gains from risk-takers willing to give an experimental therapy a shot.
  • More individualized laws. By giving localities more flexibility in choosing laws to deal with the pandemic, can better adapt policy to the local environment and increase local compliance by ensuring that there is buy-in from key groups.
  • More effective, cheaper, and better-supplied masks.
  • Contact tracing
  • Cheap, frequent, and less-regulated testing
  • Global surveillance of existing pathogens and potentially zoonotic strains. The Emerging Pandemic Threats program should be improved on and expanded.
  • National guard of medics. Why not have many people with basic medical training? This team could be called upon during a pandemic to monitor patients, distribute medical supplies, administer vaccines, disinfect surfaces, run testing centers, set up field hospitals, and administer basic treatments.
  • Advance market commitments for vaccines, antimicrobials, and other treatments.
  • Market supporting legislation in all medical supplies and services.
  • Better handling of national economies using targeted, automatic stimulus. Studying the legacy of this pandemic will help identify which forms of stimulus worked, and which were superfluous.
  • Supported markets for pandemic insurance to allow individuals, companies, and governments better cover their risk.
  • Country-level reparations for pandemic damages. This is more speculative, but it seems like there is room for a sort of international tort law where countries can demand payment from the countries who’s public health practices increase global pandemic risks or cause pandemics. International agreements of this sort would give countries better financial incentives to prevent the spread of diseases outside their borders.
  • Fight vaccine hesitancy.
  • Airflow management. By better controlling the way air flows through a building, we can reduce the likelihood of aerosol transmission, especially in hospitals.
  • Better prediction. Currently, pandemic modelling is not very good. But I still think it is worth much more research. Even a slight edge in predicting outbreaks could pay for all the research put in. Some gains could be had from working on predictions beyond simple spread. Understanding supply chains, understanding the conditions for herd immunity, doing inference on R0, predicting virulence, or predicting mutations would all help.
  • Consider what additional preparations are needed if an engineered pandemic or bioweapon is used.

There are certainly other good ideas out there which I couldn’t list here, such as the countless, ground-level improvements made in hospitals, factories, and other places. Recording the details of these innovations will help people adapt more quickly the next time around.

There are also important questions which need to be answered by looking carefully at the data in the future. How much will a loss of schooling effect children’s wellbeing and future earnings? What are the long term health effects of COVID? Precisely how much did lockdowns work? The pandemic changed our world in so many ways, and it is important to learn from all of them.

As politicians say, “don’t let a good crisis go to waste”. This is our chance to virtually eliminate pandemics as a catastrophic risk by learning from our collective mistakes. Building robust safety measures and following through on some of the many good ideas that have been proposed could save millions of lives in the future. The time to implement these changes is now, not during the middle of the next pandemic.

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