Intended for healthcare professionals


Preparing for the next pandemic

BMJ 2013; 346 doi: (Published 23 January 2013) Cite this as: BMJ 2013;346:f364
  1. Nigel Lightfoot, executive director1,
  2. Mark Rweyemamu, professor, transboundary and emerging infectious diseases2,
  3. David L Heymann, head and senior fellow3
  1. 1Connecting Organizations for Regional Disease Surveillance, BP 7000-69342, Lyon Cedex, France
  2. 2Sokoine University of Agriculture, Morogoro, Tanzania
  3. 3Centre for Global Health Security, Chatham House, London, UK
  1. Nigel{at}

Greater cross sector collaboration between health, veterinary, wildlife and environmental experts is needed

There is mounting concern about the rate at which newly identified infectious agents are being detected as they cross the species barrier from animals to humans, causing human illness and death.1. Any of these agents, including new influenza viruses, have the potential to spread rapidly, such is the speed and extent of air travel.2

Seventy per cent of emerging infectious diseases are zoonoses.3 The discovery of a new Lassa fever-like virus—the highly lethal lujovirus4—and a new rhabdovirus with a reservoir in bats potentially adds to the burden of haemorrhagic fever outbreaks caused by Marburg and Ebola viruses. There have been 107 cases of infection with these last two viruses, and 55 deaths, in Uganda and the Democratic Republic of the Congo.5

There is also concern about the recent, sudden, and unheralded appearance of a new severe acute respiratory syndrome (SARS)-like virus—the “novel coronavirus”—in Saudi Arabia, Qatar, and Jordan. Nine laboratory confirmed human infections have been reported to the World Health Organization, five of which have resulted in death.6 The source of infection is not known. However, early research suggests that this virus might have the potential to infect several different animals, including bats and pigs.7 The virus may already be widespread in animals. Person to person transmission has not been ruled out for close contacts in the outbreak in Jordan, and it is difficult to determine the virus’s epidemic potential.

The 2009 H1N1 influenza pandemic virus spread from pigs and became transmissible between humans some time in early 2009 where experts least expected it. One month before the first infections were detected in the southern United States, the Mexican media were reporting unexpected severe cases of respiratory disease at the end of the flu season. However, the attention of flu planning experts was focused on avian influenza in the Far East. This year new variants of influenza viruses transmitted from pigs to humans in the US, especially at agricultural fairs, have resulted in more than 300 human infections with a new variant influenza A virus, H3N2v.8 Onward human to human transmission has not been reported, but vigilance is needed because pig farming is a global food industry.

Intensive farming practices, environmental degradation, and processes related to the mining industry could all increase opportunities for infectious agents to breech the species barrier; some of these infections may have epidemic or pandemic potential in humans. Responding effectively and efficiently to these cross species infections and all other emerging infections is a challenge for the international public health community, the Food and Agriculture Organization, the World Organization for Animal Health, and WHO.

Current surveillance and response systems in many countries are often compartmentalised, and in poorer countries they may be poorly resourced. Better generic disease surveillance may be achieved through the joining up of “vertical” single disease networks that would share molecular technologies for the fingerprinting of infectious agents. An example of joined up surveillance in the United Kingdom through the Human Animal Infections and Risk Surveillance (HAIRS) group has shown how veterinary and human medicine can effectively work together on risk assessment.9

The concept of “one health” has become a central idea in both veterinary science and public health,10 and a global initiative was launched in 2004. The aim is to highlight the links between animal diseases and public health and to champion a multidisciplinary approach to tackle emerging infectious diseases.11 The initiative has been driven by international health, veterinary, wild life, and environmental experts and supported by WHO, the World Organization for Animal Health, and the Food and Agriculture Organization.

Effective surveillance and a rapid response to an emerging epidemic or pandemic depend on good observation at local level and early communication of potential events to those who can assess and support the management of the risk. “One health” practitioners in the field need to be trained, equipped with diagnostic tests, and provided with rapid communication tools. Weak surveillance networks need to be strengthened. In the past few years new networks have been established in Africa, the Middle East, the Far East, and southeastern Europe.

These networks work across borders, sectors, and national boundaries to collaborate on mounting an early response in the event of an infection threat. They have come together in a new non-governmental organisation, Connecting Organizations for Regional Disease Surveillance (CORDS).12 This organisation is funded by the Rockefeller, Skoll, and Bill & Melinda Gates Foundations, which hope to improve the capacity of these networks and to develop the culture of early communication and problem sharing globally.

If in the short term we are unable to prevent the next pandemic, we will still gain by being better prepared, whatever the threat is. Good response plans will have a chance of working only if surveillance and risk assessment are joined up across sectors and a culture of early communication of potential problems is entrenched.

Next week experts in human and animal public health, international global health bodies, and policy makers from a wide range of disciplines will meet to discuss cross sector responses to infectious disease and further debate on the “one health” initiative at the 2013 Prince Mahidol Conference in Bangkok, Thailand (


Cite this as: BMJ 2013;346:f364


  • Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: NL is executive director of CORDS and the other two authors are affiliated to CORDS, although it is not their main affiliation; all authors will be attending the 2013 Prince Mahidol Conference in Thailand.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


View Abstract