Article by Natalia de la Figuera – Co-Founder and COO of GENESIS Biomed

• The departure of the US from the WHO in 2026 could generate a number of significant risks in the event of a new pandemic.

• It is necessary to reinforce the territorial cohesion of the health system that would allow access to data from all the Autonomous Communities with the same criteria and in time.

• Research is a basic instrument for combating epidemics/pandemics. Spain spends 1.49% of its GDP, well below the European average (2.3%).

The COVID-19 pandemic has been an unprecedented event in recent history, with far-reaching health, economic and social impacts. Since its emergence in 2019, the SARS-CoV-2 virus has challenged health systems globally, tested international cooperation and generated a transformation in the perception of the risk of new emerging diseases. Now that the world has moved beyond the critical phase of the pandemic, it is critical to reflect on what we have learned and assess whether we are prepared for future global health crises.

Despite the lessons learned, the world still faces significant challenges in preparing for future pandemics. Some key areas to be strengthened include:

1. Strengthening global surveillance

The risk of emerging diseases, and thus the risk of pandemics, has increased significantly due to factors such as deforestation, climate change and global mobility. The destruction of natural habitats forces species into contact with human populations, facilitating the transmission of zoonotic pathogens. At the same time, climate change expands the breeding grounds of vectors such as mosquitoes, increasing the incidence of diseases such as dengue, Zika and chikungunya in regions where they were not previously endemic.

To mitigate these risks, organisations such as the WHO (World Health Organisation), the ECDC (European Centre for Disease Prevention and Control) and the US CDC (Centers for Disease Control and Prevention) monitor the evolution of outbreaks in real time. Initiatives such as GeoSentinel, an international surveillance network, track the spread of infectious diseases in travellers, enabling a rapid and coordinated response. Without a sustained global effort in surveillance and prevention, the world will remain vulnerable to new pandemics. The departure of the United States from the World Health Organisation (WHO) in 2026 could create a number of significant risks in the event of a new pandemic, affecting both the global response and the capacity for international coordination and assistance.

2. Capacity for rapid production and distribution of PPE (Personal Protective Equipment), treatments and vaccines.

It is essential to establish national and European production chains, both for PPE and for instruments, treatments and vaccines, to avoid dependence on a few manufacturing countries (e.g. China). This was one of the reasons why the European Commission approved the Next Generation EU Resilience and Recovery Funds, a financial instrument created to help countries recover from the economic crisis and strengthen their resilience to future challenges.

Within the scope of these funds, in Spain, on 30 November 2021 the Council of Ministers approved the PERTE for Cutting-Edge Health, one of whose strategic lines was to promote and strengthen the pharmaceutical and healthcare products industries, in order to increase European autonomy and avoid dependence on third parties for an essential material, which has suffered an unusual rise in the markets due to high demand and reduced supply.

3. Sustained funding for research into emerging diseases

A global commitment is required to sustain investment in research, even in the absence of immediate crises. The speed with which COVID-19 vaccines were developed was unprecedented. This was made possible by decades of research on vaccine platforms such as mRNA, but also due to massive investment by governments and pharmaceutical companies. The creation of rapid response funds and continued support for science are key to developing more effective solutions to future pathogens. As discussed in the first bullet point of this article, the threat of continued outbreaks is a real challenge. In addition to global surveillance and coordination to contain these outbreaks, progress needs to be made in research into new diagnostic methods, treatments and vaccines to provide us with the tools to control and eradicate them.

Let us not forget that Spain, in 2023, allocated 1.49% of its Gross Domestic Product (GDP) to Research and Development (R&D) activities, below the European Union (EU) average, which in 2022 was 2.3% of GDP, and well below the 3.46% allocated by the USA.

4. Strengthening National Health Systems

Hospitals and health centres need to improve their infrastructure and prepare for high-demand scenarios. This implies having strategic stocks of protective equipment, improving the training of healthcare personnel and ensuring a rapid response in emergencies. Within this objective, the PERTE para la Salud de Vanguardia, mentioned above, included a priority strategic line aimed at strengthening and developing the capacities of the National Health System’s centres, as well as another aimed at reinforcing the territorial cohesion of the health system, incorporating all the autonomous communities. However, after 2026, when the funds associated with this PERTE come to an end, it is not known whether these changes will continue to be promoted. Moreover, the system is currently showing signs of weakness, with a fragmented structure in autonomous communities where the transfer of data with the Ministry of Health is not sufficiently agile and collapsed care services, with waiting lists on the rise.

Another pending issue revealed by the COVID-19 pandemic was the need to join forces between public and private health care in the event of a health emergency. Resources, including private ones, are crucial for dealing with a crisis of such magnitude.

5. Regulations to deal with new pandemics

During the COVID-19 pandemic, mechanisms for fast-track drug approval were put in place to allow rapid market access for new treatments and vaccines. These mechanisms were mainly the Rolling Review and approval through Conditional Marketing Authorisation (CMA). Rolling Review is a regulatory tool implemented by the EMA to speed up the evaluation of data for a medicine or vaccine during a public health emergency. This mechanism allowed, for example, to authorise vaccines with preliminary data from Phase 3 clinical trials and to reduce post-vaccination monitoring times to three months, provided that the evidence indicated that the benefits outweighed the risks. This Rolling Review tool is still in place at the EMA, which can activate it if emergency situations arise again. Moreover, the CMA is a procedure that has been in place for more than 15 years to facilitate access to innovative medicines for diseases for which no other treatment is available and can also be used in case of a health emergency.

Therefore, streamlining the regulatory approval processes for medicines is key in the containment of pandemics, where time is a crucial factor.

6. International cooperation and equitable access to vaccines and treatments

International cooperation was critical to the rapid development of vaccines. During the COVID-19 pandemic, numerous collaborative drug discovery and development initiatives were activated, with pharmaceutical companies and researchers sharing data, tools and expertise. One example of such an initiative was COVID-19 Host Genetics, launched globally in early 2020 to investigate the genetic determinants of COVID-19 susceptibility and severity. The initiative brought together a large number of researchers and institutions from around the world, with the aim of identifying genetic factors that could influence the risk of COVID-19 infection, as well as disease severity and clinical outcomes. In addition, pharmaceutical companies received substantial financial support from governments to accelerate the development, production and distribution of vaccines and treatments.

Also, to promote equity in the distribution of vaccines in lower-income countries, the WHO launched the COVAX initiative. However, in the early stages of distribution, rich countries monopolised a large part of the doses. For the future, therefore, more effective mechanisms should be put in place to ensure that all nations have access to prevention and treatment tools.

Although we have highlighted six key aspects that need to be further strengthened to face new pandemics, countries are rapidly forgetting what happened just five years ago. Unfortunately, the pre-war context is contributing to this and, in addition to the risk of new pathogens, there is the danger of the more negative side of human nature, which insists on prevailing from our origins.