There ” mysterious chinese pneumonia “. This is how it all started three years ago: an unknown virus discovered in a market in Wuhan, China, at the end of December 2019. On January 24, 2020, the very first French cases were identified. At the time, authorities and scientists wanted to be confident: there was no risk of an epidemic in France. The rest, everyone knows. Pandemic, confinementPCR, barrier gestures, masks, curfew, vaccines and successive waves have permeated our vocabulary and our daily lives in the time of the Covid-19.
But three years later, what lessons have we learned from the health crisis? Are we prepared for the next pandemic threat?
“It’s not if, but when” the next pandemic will take place
First lesson learned: “the question of the next pandemic is not whether it will take place, but when, indicates Professor Bruno Lina, virologist and member of the covars, the Committee for monitoring and anticipating health risks which succeeded the Scientific Council. Previously, this was not an opinion shared and understood by the population or even by a certain number of decision-makers. When we were working on the pandemic plans, people said “this is science fiction, it will never happen”. It was esoteric”.
However, in view of what has happened in recent years, “with the H1N1 epidemics, chikungunyaZika, Ebola and then Covid-19, we had to face the facts, agrees Professor Yazdan Yazdanpanah, head of the infectious diseases department at Bichat hospital and director of ANRS Emerging infectious diseases. Urbanization, global warming, evolution of the contact of man with his environment, and rapid and massive human displacements: the probability of a next pandemic is all the more important because of these factors”. For the two scientists, this observation “shows today how important it is to prepare for this risk”.
Key tools born out of the crisis
And three years ago, when the first Covid cases were detected in Professor Yazdanpanah’s department, no one was prepared for this risk. “We very quickly knew that it was a coronavirus very close to the SARS, severe acute respiratory syndrome, he recalls. But at one point, we were wrong: by mimicry, we thought that the Covid was only transmitted between symptomatic people, when not. And the magnitude of the pandemic has been very much linked to this factor”. It has also been linked to lack of masks. “There is a fairly acute awareness that maintaining strategic stocks has an interest and that they should not be reduced outside of periods of crisis”, assures Professor Lina. Contacted by 20 minutesthe Directorate General of Health (DGS) did not respond to our requests on the reconstitution of these State stocks.
At that time, “the situation was so complex that politicians needed scientific support in addition to that provided by health agencies, with the creation of the Scientific Council, a means of enlightening politicians who inscribed in the long term”. In addition, “we have multiplied our diagnostic capabilities, both in terms of volume and diversity and sequencing, insists Prof. Lina. And we can capitalize on this: if a new pandemic were to break out, we would be better off than before the Covid. Also on epidemiological monitoring, thanks to databases which allow very precise monitoring in terms of incidence, regional variations and vaccination”.
Identify and monitor pathogens
However, to be really ready, “we must anticipate, by identifying in advance the pathogens that are most likely to evolve into a pandemic: coronaviruses, but also arboviruses, such as dengue or zika, transmitted by mosquitoes, recalls Professor Yazdanpanah. We must monitor these pathogens, study their modes of transmission and their severity, this is part of our roadmap”.
But for it to be effective, surveillance must be global, and “be part of international cooperation”, insists Professor Yazdanpanah. And articulate “with a monitoring system that includes animal, human and environmental monitoring, adds Professor Lina. This is decisive in order to hope to control an emergence before it impacts humans”. Since 2022, the world health organization (WHO) is thus working on the development of a text aimed at “strengthening prevention, preparation and response in the event of a pandemic”. “The lessons of the pandemic should not be ignored,” commented WHO Director-General Tedros Adhanom Ghebreyesus.
Innovate and build bridges
Then, “once the pathogens at pandemic risk have been identified, we must innovate,” explains Professor Yazdanpanah. By developing upstream diagnostic and therapeutic tools and vaccines, the development of which would then be accelerated in the event of the emergence of a pandemic”. Because the time factor is a key element. “During the Covid crisis, research and innovation did not work together,” he underlines. You have to build bridges between the two.
Of course, some vaccines have emerged in record time, but if tomorrow a new pandemic breaks out and humanity must be vaccinated, the criteria of production, conservation, cost and equity will have to be understood from the outset. Vaccines that are too expensive to produce or difficult to store affect the effectiveness of the response provided”.
Another bridge to be established: that between the databases, “which are not connected, deplores Professor Lina. Today, you have to consult a database to find out if an individual is vaccinated, and another to find out if he has already been infected, but there is no centralization of information. It would take, on the Danish model, a unique identifying number of health which would make it possible to have a tool of health follow-up really powerful and efficient”.
Prevention and the right mix of measures
In the meantime, “we must focus on prevention”, urge the two scientists. “The key element that has made it possible to control this pandemic is vaccination, recalls Professor Lina. Membership was very strong in the most acute phase of the health crisis, but once the health pass was abandoned, vaccination rates for recall campaigns have falled. We have considerable work to do in France to restore confidence in vaccination, ”said the virologist. Especially since “we know that the most affected by these emergences are the most vulnerable populations, adds Professor Yazdanpanah. Hence the importance of finding how to promote the acceptance of these measures among this public”.
If at the worst of the health crisis, the French respected confinement, wore the mask and got vaccinated en masse, “to promote adherence to these barrier measures over time, they must be used in good wisely, only when they are needed, insists Professor Lina. Which implies knowing how to say when they are no longer so”.