Lessons Should Have Been Learned From Previous Pandemics

Source: Anna Shvets / Pexels

By Emma Collins

In December 2024, on the International Day of Epidemic Preparedness, UN-Secretary-General Antonio Guterres stated: “The COVID-19 crisis may have passed, but a harsh lesson remains: The world is woefully unprepared for the next pandemic."

Global pandemics are not a new phenomenon, with one of the first documented being the Black Death in the 1300s and, in more recent history, the Spanish Flu of 1918. So why were we not fully prepared to limit the impact of COVID-19?

There remain many current causes of concern such as the highly pathogenic avian influenza A (H5N1) virus. Indeed, since the 1980s, at least 30 new infectious disease threats have emerged (Buchy et al, 2021)—for example, HIV (1981), SARS-CoV-1 (2003), swine influenza (2009), MERS-CoV (2012), West African Ebola virus (2013), and Zika (2015).

The aim of declaring a pandemic is to create a global alert, for people to be aware of the risks that a virus or disease may pose and what they can do to protect themselves and others from it. Reflecting on the worldwide response to two of those: SARS and MERS—two potentially severe acute respiratory infections both caused by coronaviruses, we ask what lessons should have been learned from the recent COVID-19 pandemic and these past coronavirus outbreaks and pandemics.

SARS

SARS stands for severe acute respiratory syndrome. From late 2002 to 2003, illness caused by the coronavirus SARS-CoV-1 caused more than 700 deaths (World Health Organization [WHO], 2006) during the first outbreak. Emerging in China, it then spread to several other countries. Currently, no cure is available, and researchers continue to study and develop vaccines for it.

The virus spread quickly internationally due to its high transmission rate. The WHO coordinated an international investigation and provided support to bring the virus under control (WHO, 2020). There were arguments made at the time for the development of novel surveillance techniques and cooperation between public health and academic institutions, to ensure there were enough scientists with the time and interest to improve tests to apply in an emergency (Weiss, 2004).

Without a vaccine or cure, timely identification and isolation of individuals with SARS over several days was vital, and it was recommended that the public should take personal measures such as good hygiene and workers in high-risk roles provided with sufficient personal protection equipment (PPE).

And, yet, 2020 saw global healthcare systems overwhelmed with COVID-19, and healthcare workers disproportionally exposed to the virus with lives lost due to insufficient PPE (Davis, 2021). SARS-CoV-2 (the virus that causes COVID-19) and SARS-CoV-1 (the virus that causes SARS) have highly similar gene sequences and behaviour patterns (Liu et al., 2020 ). Similar suffering will be experienced if we do not learn from past experiences.

MERS

MERS, the Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in Saudi Arabia. Records show more than 2,600 lab-confirmed cases of MERS and more than 900 deaths (WHO, 2024). As with SARS, scientists are still looking to develop a vaccine to prevent the virus.

MERS is classed as a "zoonotic" virus, reflecting its spread between animals and people. It has been identified in dromedary camels in several countries in the Middle East, Africa, and South Asia, spreading to 27 countries since 2012 (WHO, 2022). Human-to-human transition is possible but rare and is found particularly in care settings, again highlighting the need for good hygiene.

The social and economic impact of MERS put stress on healthcare systems resulting in high levels of mortality and morbidity. From this loss, lessons could and perhaps should have been learned. This included the importance of quick case identification and reporting, efficient infection prevention and control, community-based interventions, and clear, consistent risk communication to the public (Salomon, 2024).

A global, cooperative approach to fighting these diseases is needed more than ever, particularly where vaccines are not yet available.

The importance of this was shown with the COVID-19 vaccine. Highly contagious diseases like MERS, SARS, and COVID-19 significantly impact those with underlying health conditions or in high-risk age groups (Liu et al., 2020), making vaccines even more critical.

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COVID-19: Did History Repeat Itself?

Had we invested more into understanding past coronaviruses and how they could have been better managed, we arguably would have been better prepared to respond to and manage COVID-19.

Source: CDC / Pexels

COVID-19 is caused by the coronavirus SARS-COV-2. Most people experienced mild to moderate respiratory symptoms, but, for others, it was devastating, especially in older people or those with pre-existing conditions, although anyone was at risk of serious illness or death (WHO, 2023).

Initial national and global advice centred around good hygiene, staying at home, and, if you needed to go outside, wearing masks and distancing yourself from others. Advice later focused on receiving the COVID-19 vaccine.

More unique to COVID-19 was the accessibility of television and social media. Instant reports from individuals with potentially no clinical or scientific expertise could rapidly "go viral." WHO labeled it an "infodemic" that paralleled the pandemic (Gwendolyn 2020). This increased the prevalence of misinformation; however, government agencies and public health authorities also took advantage of social media to share helpful advice (Pergolizzi 2021).

Despite the huge achievement in the development of the COVID-19 vaccine, significant barriers remain to achieving worldwide delivery of these vaccines to all countries and all age groups. Nevertheless, the COVID-19 vaccine approach needs to be employed alongside active surveillance of emerging variants and pathogens (Buchy et al., 2021). Relative to other infections such as influenza, little is known about the origin and cross-species transmission of COVID-19. Although healthcare services, drug availability, and lab testing have improved significantly since the 20th century, our experience with COVID-19 has flagged gaps (Buchy et al., 2021).

COVID-19 has surpassed previous coronavirus outbreaks in terms of total deaths and the number of affected individuals (Pandey et al., 2020) with more than 700 million cases and 7 million deaths worldwide. COVID-19 has raised calls for humans to interact differently with each other and the environment. Issues such as climate change, urbanisation, our proximity to animals, vaccine hesitancy, and so much more all play their part (Peeri et al., 2020; Buchy et al., 2021).

Conclusion: Pandemics Are Inevitable, and Lessons Must Be Learned

Future pandemics are inevitable, so we need to be better prepared. The ultimate goal is to pre-empt and prevent future pandemics. History has shown this requires a wide range of interventions and government support of public and private research on an international scale (Coccia 2023). Financial and healthcare support also must be prioritised in low-to-middle-income countries, which will undoubtedly be at a higher risk, suffer a greater burden of disease, and experience less vaccine equity and access.