ESWI Chair and Professor in Virology, Ab Osterhaus, gives a captivating explanation on why we need to stay vigilant and properly prepare for the next pandemic.
This podcast is kindly sponsored by Viatris.
ESWI Chair and Professor in Virology, Ab Osterhaus, gives a captivating explanation on why we need to stay vigilant and properly prepare for the next pandemic.
This podcast is kindly sponsored by Viatris.
Episode: Pandemic Preparedness in Peacetime with Ab Osterhaus
00:00:15
Ms Taylor: Hello and welcome to ESWI Airborne. This is your host, Clare Taylor, and this is
the place where we meet the members of ESWI, the European Scientific Working Group on
influenza.
00:00:27
Ms Taylor: To kick us off today, I have the great pleasure of talking with ESWI's leading light
member of the board since its inception and chairman since 2001, Professor Ab Osterhaus.
Professor Osterhaus, along with many other accomplishments, is the director of the Center
of Infection Medicine and Zoonosis Research at the University of Veterinary Medicine in
Hannover, Germany. Professor Osterhaus, may I call you Ab? It's wonderful to be with you today. Welcome.
00:00:59
Professor Osterhaus: Thank you very much, Clare, and especially, I would like to thank you
for hosting this series about a very important subject. I think it's quite timely we are
addressing this point now that we are at the tail of the current pandemic, hopefully.
00:01:18
Ms Taylor: That's great, Ab. It's my pleasure to talk with such expert gentleman. So let's get
started then with the first question. Ab, with all of your knowledge and experience, did you
and other experts see the coronavirus pandemic coming, and how did you first become
aware of the outbreak in Wuhan?
00:01:40
Professor Osterhaus: Thank you for that question, Clare, because it's the most important
thing we should be discussing today. When we talk about pandemic preparedness, I can say
that we, and that is ESWI, have been campaigning for pandemic preparedness from the last
century onward. I remember organizing the first meetings in WHO in Geneva where there
have been a lot of discussion. At that time I remember there was very little appreciation in
the scientific community for the pandemic threat.
00:02:14
Professor Osterhaus: Being a veterinarian, having worked in the veterinary profession for
some time and then becoming a virologist, I have realized quite clearly that we are being
threatened by zoonotic events all the time; viruses that cross the species barrier as such are
bad enough. Still, viruses like the influenza viruses that can start spreading from human to
human after having crossed the species barrier. Then we may end up with a pandemic.
00:02:49
Professor Osterhaus: I remember gradually, more and more meetings were also being
organized in the WHO setting. I remember that not too long before this pandemic started,
we had a meeting in Geneva with a number of experts on how to be prepared. It was quite
interesting what we were discussing about broader active vaccines and quite a number of,
let's say scientific issues.
00:03:15
Professor Osterhaus: At a certain point, I had to give my lecture, and I realized that if it were
to happen tomorrow, what are we going to do? During the discussions, I asked, Well, I can
give my talk, and I can say what we can do in terms of making better vaccines, et cetera. It's
kind of the obligatory talk I should be giving, but what are we going to do if it happens
tomorrow? We all agreed that was the most important thing, but we didn't address it any
further.
00:03:44
Professor Osterhaus: So, basically, we were aware. Gradually, we became aware that there is
a threat from the animal world. The Mexican flu, the swine flu, and the last pandemic there
have really raised awareness a little bit, but because it was considered to be a wimpy
pandemic, most people in the scientific community and the public at large thought these
huge pandemics, like the Spanish flu, were of the past. I did not and do not believe that
because the predisposing factors that have led to the previous pandemics are still there, and
they are even increasing to a certain extent. So it is an illusion to think that we cannot be
confronted by the next severe pandemic.
00:04:38
Professor Osterhaus: The interesting thing, of course, is when this particular pandemic, the
COVID-19, had started. I remember quite vividly at the very beginning, I had picked up an
infectious disease is spreading in Wuhan from person to person. We don't know what was it.
It is not flu because we have the flu network. We were quite keen to pick up flu in people
and new viruses, and rightly so. For that particular event, it was clearly stated that the
Chinese researchers guaranteed that this was not influenza.
00:05:15
Professor Osterhaus: I remember discussing with my students at that time what was the
likeliness that this was going to become a pandemic? We dwelled on it. We didn't even know
at that time yet it was the coronavirus. I gave the examples of the SARS coronavirus and the
MERS coronavirus that we discovered. I said, basically, look into this situation. Why were
these infections? Why were these outbreaks? Why do they cause a real pandemic?
00:05:51
Professor Osterhaus: The answer that we found out with the group at large. I said, let's
discuss it. What does a virus need to become a pandemic virus? In the end, we all concluded
that if this would be a virus that is transmitted from human to human before or without any
clinical signs, if that were to be the case, then it might have pandemic potential.
00:06:15
Ms Taylor: Ab, the word zoonosis, meaning a disease which can be transmitted to humans
from animals has become more familiar to many of us during the pandemic of the past two
years, but for you, this is nothing new. In the course of your career, you have discovered
more than 70 new viruses of humans and animals. Can you tell us what first attracted you to
this field of work?
00:06:41
Professor Osterhaus: I was educated as a veterinarian. I was working as a veterinarian for
some time. Then I realized that infectious diseases are not under control in the animal
world. Also, in the human world, they're not under control. I was quite intrigued by the fact
that foot and mouth diseases that we still had at that time, but also a disease like rabies,
which is a zoonosis going from animals to humans, were not under control. Still, a lot of
people die from rabies, for instance.
00:07:11
Professor Osterhaus: We know that every year it's more than 40,000 to 50,000 people die
from that disease in a terrible way, so that's when I realized that viruses are not under
control. When I started my career studying virology after becoming a veterinarian, I was
discouraged by all my colleagues. They said this was not the way to go. Everything is under
control. I realized that that was not the case at all. That, for me, was the start, indeed, to see
that viruses of animals cross the species barrier to humans. At the end of the day, these may
even end up in a pandemic, a virus that goes all over the world, affecting all people.
00:08:00
Ms Taylor: Today, our topic is pandemic preparedness or pandemic readiness in peacetime,
shall we say. Ab, we're just emerging from a pandemic. Is this not a once in a lifetime event?
Why should we get ready for another one?
00:08:16
Professor Osterhaus: If you look back over the last hundred years, we have had five or six
pandemics, so we have had the influenza pandemics, which were four. We have the still
ongoing HIV AIDS pandemic, and now we are in the middle of a coronavirus pandemic. So
you can say it's once in a lifetime. Indeed, my predecessor in Rotterdam was working on
influenza all his life. He regretted that he had never faced- I shouldn't say regret it but he
had prepared for that. I should say in my career, so to say, I've gone through three
pandemics. So it is the HIV, which was the first AIDS pandemic. Then we had the Mexican flu,
the swine flu, and then now we are in the middle or at the tail of a coronavirus pandemic.
00:09:12
Ms Taylor: How likely is it that the next pandemic will be caused by an influenza virus? Do
we have any evidence for this?
00:09:22
Professor Osterhaus: As I said, in the last century, we have seen four real big influenza
pandemics. In a century, having four pandemics means that if we extrapolate that to the
future, the likeliness that we are going to have another one in the next decade is rather
great. Even the conditions that we have today, if you're talking about influenza specifically, if
I see this at this time what's happening in the animal world, especially when we look at birds
at this moment, we see outbreaks of a new H5 influenza virus in birds that cross the species
barrier to humans limitedly though.
00:10:11
Professor Osterhaus: Still, we see it happening in different other mammalian species. We see
it in seals, we see it in foxes, and the virus may tend to spread there as well. So the key issue
is that if a virus crosses the species barrier to humans, and this avian virus is all over the
place now; then in principle, it can adapt to humans by starting to spread from humans to
humans. We have done a lot of work to look into what the virus needs to become a
pandemic virus?
00:10:43
Ms Taylor: So in getting ready, there's much I'm sure that can be done in terms of pandemic
preparedness. First, early warning systems, knowing that this is happening. Now, what does
an early warning system look like in practice?
00:11:01
Professor Osterhaus: Well, what I said before about the history of this coronavirus
pandemic, that when we first learned about it was very important, because what our
Chinese colleagues did when they saw this disease emerging in humans, they were very
quick on the ball. They characterized this particular virus in a matter of a week.
00:11:30
Professor Osterhaus: The important thing is that, on the one hand, we get the information
from the population. Is anything happening? Do we see anything that's not the normal
background infections that we see in humans but also in animals? So we have to be very
vigilant, follow on a day-to-day basis what's happening in the animal world, what's
happening in the human world in terms of new infections, things that we don't expect like
what we are seeing normally. The whole epidemiology there is quite important.
00:12:05
Professor Osterhaus: So early warning means to keep your ear on the ground, look very
carefully at what is happening there and have that reported internationally. We have to
follow that up on the one hand, not just in humans but also in animals.
00:12:24
Ms Taylor: The increased risk of zoonosis has been linked to intensive agriculture, especially
intensive meat production. Would you say that curbing or limiting intensive meat production
is an important factor in reducing risk?
00:12:41
Professor Osterhaus: That's an interesting question. I think meat production as such, and
especially when we talk about influenza, it is mainly about chickens. Indeed, the way we
produce chickens has changed completely. I think it is important that if you have a
completely industrialized way of producing chickens, chicken meat and eggs with hundreds
of thousands of animals together and if you don't have the proper biosecurity there, of
course, it's like lighting a haystack. So many animals together, so that increases the risk
especially if you do that in areas where you have a lot of migratory birds.
00:13:28
Professor Osterhaus: There are two sides to the coin because we also want to have a more
animal-friendly way of raising the animals. You can imagine if you have free-range animals,
that the chance of them getting in contact with the feces of wild birds is much higher. So it's
very easy to say the mass production of meat and eggs and other species like pigs, et cetera,
it's at the basis of it. It is related to that, but it's not the whole story.
00:13:56
Ms Taylor: How can a one health approach lower pandemic risk?
00:14:01
Professor Osterhaus: A one health approach means understanding that human health,
animal health, ecological health, and environmental health are very closely linked. We just
talked about the viruses that cross the species barriers from animals to humans, and
sometimes they go back again.
00:14:23
Professor Osterhaus: To understand these things better, look at the environment. What is
changing? Are there major changes in the way we produce our meat or eggs? Are there
major changes in the way we produce other animals or grow crops? So all these major
differences there have a profound impact on the environment. If you see how complex
these interactions are, it will be very difficult to understand them properly, but the more we
know, the better we can be prepared.
00:14:56
Professor Osterhaus: So my message would be to invest in one health-based research,
understanding how these things are interacting, and that may help us in the future to
prevent new pandemics from starting or being quick on the ball and then being very rapid in
taking our intervention methods.
00:15:19
Ms Taylor: Then how about this term, non-pharmaceutical interventions, NPIs? Now it
sounds fancy, but it's what we've all been doing: wearing masks, staying at home, limiting
our social contacts. Is this something that is effective in the prevention or limiting of an
outbreak? What can we do to improve social acceptance? Because we have seen pushback
from populations in the Netherlands. In the UK, we have examples of politicians failing to
follow the rules. How effective are social distancing and wearing masks, and so on?
00:15:59
Professor Osterhaus: I think, in terms of preparation, we should have plans ready. Non-
pharmaceutical interventions, as you said, mean having the possibility to stop the virus from
circulating before we have pharmaceutical interventions; obviously, that's making a vaccine,
making antivirals, and making biological response modifiers.
00:16:24
Professor Osterhaus: Non-pharmaceutical intervention methods mean you have to be
prepared. For instance, you have to stockpile your facial masks. You have to have gowns for
the hospitals. You have all these kinds of things which are not our specialty, of course. These
are relatively simple things, but they cost money, of course. Also, your hospital capacity.
00:16:47
Professor Osterhaus: At the beginning of a pandemic, usually, you don't have a vaccine yet. It
will be difficult to come up with specific pharmaceutical measures. So that initial time is very
important to slow the pandemic down and make sure you buy time, so to say, and there are
two extremes. So if you look at China, on the one hand, very effectively, but to a lesser
extent, countries like Korea that had experienced the MERS epidemic and still has. Also,
Australia and New Zealand had very stringent methods on the one hand.
00:17:27
Professor Osterhaus: On the other hand, when you look at a country like Brazil or the UK at
the beginning, they just let it go, they ignored it, and you see the differences there. The
number of people dying, the number of people turning up in hospitals, et cetera. So we are
somewhere in the middle.
00:17:44
Professor Osterhaus: When we are talking about preparedness, it's quite important that
these aspects are also taken into account. It's a social science. How do you convey the
message to the public at large that they have to do this and that and that and that? That is a
matter of communication on the one hand. Of course, our society does not accept measures
taken in China, for instance. If that is the case, I think what we have learned, and that was
missing to a large extent, apart from increasing our hospital capacity, having all these
practical things in place, that basically the measures that should be taken should be
accompanied by a good explanation to the public at large. Even then, there will be
refractory.
00:18:40
Ms Taylor: It's a very interesting point because, as you say, it's at the intersection of a
number of different issues. I suppose one of them is the suspicion of government or medical
authority in relation to vaccines. It's not your specialty, but do you have an opinion on what
the best response is? The best counter-response to this is? What does the scientific
community need to do to get ready? We've been talking about these different aspects that
have societal acceptance. You are sure the next pandemic will come, but you're not sure
from where or how. How do those scientists get ready?
00:19:32
Professor Osterhaus: The first conclusion, of course, is that we did not do a very good job.
We more or less failed. We could have done much better. I think what we need to do is a
collective action in all sectors of life, because it's not an issue just of the virologist or the
epidemiologist, it is really the whole sector. It goes all the way from scientists to public at
large, politicians, et cetera. We have to be aware that there is a role for all to play. We have
to see it more or less as an insurance policy.
00:20:08
Professor Osterhaus: If you ask a virologist like myself, what should we do? We obviously will
say invest more money in broadly active vaccine, broadly active antivirals and those kinds of
things, which we have to do. That's not the whole story, as we have seen, because
acceptance of the vaccination is an important thing as well. If you see what we have spent in
this pandemic in terms of financial resources that we have had to use to counter this
particular pandemic, it has cost us so many billions of euros, dollars, what have you.
00:20:43
Professor Osterhaus: It is important to realize if we just pay a fraction of that towards
preparedness as we do in other sectors as well. For instance, if you look in the Netherlands,
after we had the flooding in 1953, everyone in the Netherlands was afraid of water. So we
are spending billions of euros every year to keep the levees at the right levels, and nobody
questions that. We should create a similar mindset for that. Spend money in peacetime on
all these different sectors, not only on vaccines but all these different things we were
mentioning, to be better prepared as an insurance for the next outbreak.
00:21:29
Professor Osterhaus: Last century, as we said, we had so many outbreaks. Then when I come
back to the pandemics, it's only a fraction of that. So we have six major pandemics now.
There is no reason to think that in the coming century, we will not have another six: It is easy
to say that at my age, but my prediction would be that we will get at least another six. Given
the changes in our society, the climatological changes, everything that's changing
worldwide, we'll have more than six now if we don't take the proper measures.
00:22:10
Ms Taylor: That is a really interesting point. So if we're thinking about getting ready for the
next pandemic, what are the lessons we can have learned from this one, from the successes
and failures in dealing with the coronavirus pandemic?
00:22:32
Professor Osterhaus: The most important thing we realized after or at the tail of the current
pandemic is that we need to come to collective actions for all sectors of life, all different
disciplines. That's the scientific part, but the public at large, politicians and policymakers
should realize there is a role for all to play as if it were an insurance policy that should be
made for the future.
00:23:02
Professor Osterhaus: We should invest, and that means investing in all these different things
that go from early warning to all the different ways to combat the disease proper, but also
the measures that should be taken for the public at large, the societal impact that can have,
and the acceptance in the population at large. In our response, it's very important that all
these different sectors become actively involved.
00:23:33
Ms Taylor: What is the single most important step, even change in mindset towards
becoming pandemic ready or pandemic preparedness?
00:23:44
Professor Osterhaus: It's very difficult to single out. One of the points is the integral
approach, I would say. So you have to take all these different things seriously. In two years'
time, hopefully, this virus will have become a seasonal virus that will pop up like influenza,
and nobody will bother anymore. Like influenza, thousands of people in the Netherlands die
every year from influenza because they have not been vaccinated.
00:24:15
Professor Osterhaus: We have to realize that life will go back to normal, but this threat is
always there. Definitely with the changes in the world that we are seeing today, with the
way we are keeping our animals, with the way things are changing, the climatological
change, all these different factors, there are too many to sum up, we are going to face new
pandemics and we have to be prepared. We can do it.
00:24:44
Professor Osterhaus: If you ask me to single out the most important thing, obviously, you ask
a virologist, and I will say we have to make vaccines that will protect against all viruses. We
can even do it at the end of the day, but that's not the whole story, as we have quite clearly
learned because our vaccines did not solve the whole problem. Of course, without the
vaccine, we would have been in a much more devastating situation. We can all agree on
that. Even the vaccines are not the panacea, so to say. There is much more to be done in
society at large. If alone, it would be about acceptance of vaccination, but there is much
more than that.
00:25:22
Ms Taylor: A collective and a societal response. This has been a really interesting
conversation. Ab, I could talk with you all day, but unfortunately that's all we've got time for.
00:25:32
Ms Taylor: A reminder to our listeners of the range of societal and collective actions needed
to prepare for the next pandemic. Ab, it's been such a pleasure. Thank you.
00:25:44
Professor Osterhaus: Well, thank you, Clare, for hosting this this podcast. I really enjoyed
speaking to you. You really provoked me into making some very bold statements, and I don't
regret it. Thank you very much.
00:25:57
Ms Taylor: Dear listeners, I hope you learned as much as I did about pandemic preparedness
from the dynamic, visionary and sometimes rather provocative Professor Ab Osterhaus, the
leading light of ESWI, the European Scientific Working Group on Influenza. Keep on tuning in
to this podcast series, ESWI Airborne, and until next time, dear listeners, stay safe.
00:26:20
Voice Over Female: ESWI Airborne is brought to you by ESWI, the European Scientific
Working Group on influenza and other acute respiratory viruses. These episodes would not
be possible without the team's efforts, and I would like to extend special thanks to our ESWI
secretariat, our technical and IT teams, our arts team, and our host, Clare Taylor.
00:26:44
Voice Over Female: The podcasts are recorded virtually, and we thank our guests for their
participation in this inspiring and educational series. Talks are adapted to a global audience
and are intended as recommendations and guiding principles. For any specific medical
questions you may have, these should be addressed to your local general practitioner.
00:27:05
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