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World must prepare for next “inevitable” pandemic, flu expert warns

BMJ 2023; 381 doi: (Published 26 April 2023) Cite this as: BMJ 2023;381:p931

Linked Feature

Inside the Worldwide Influenza Centre: monitoring the constant threat of flu and other viruses

  1. Elisabeth Mahase
  1. The BMJ

Concerns over avian influenza viruses this year show that “we can’t drop our guard” and must prepare for the next “inevitable” pandemic, Nicola Lewis, director of the Worldwide Influenza Centre at the Francis Crick Institute, has warned.

In an interview with The BMJ,1 Lewis said that “the threat of influenza hasn’t gone away, and it didn’t go away even when we had the covid-19 pandemic.” She said that her team were working to understand the viruses circulating in animal populations that were changing “despite the fact we were already in the middle of an alternate disease agent pandemic.”

Lewis, who joined the Francis Crick Institute last year from the Royal Veterinary College, heads up the Worldwide Influenza Centre in London, one of the world’s seven major centres responsible for analysing influenza viruses, which reports into the World Health Organization through the Global Influenza Surveillance and Response System.

In the past couple of years the world has seen H5N1 infect and kill huge numbers of wild birds and spread to sea lions and mink. There have been 11 human cases since January 2022, and concerns have been raised over the virus’s ability to spread to previously unreached places and species and to lose seasonality.2

This month China has also reported the first ever death from H3N8 avian influenza. This was the third case of human infection with a H3N8 virus ever reported, after two previous non-fatal cases were reported in April and May last year, also from China.3

Lewis highlighted the possibility that viruses such as H5N1 could “mutate into something that then has the capability to infect an even wider host range or potentially to start to manage to sustain transmission in the mammalian host.” She warned that this threat was only going to grow as the population increased and food production systems expanded. “I certainly think that, I’m afraid to say, future pandemics are likely inevitable,” she said.

However, Lewis does not think that this means countries cannot prepare. “What I would hope we can do is get us to a place where a future pandemic is something we can mitigate the worst effects of—and I think that’s where we need to be aiming for at the moment,” she said, adding that preparedness could not be achieved without international collaboration. This would mean building capacity in countries around the world, she added—both on the animal health side and on the human health side—including diagnostics, policy, communication, and trust across different health sectors.

“One health” approach

As the threat posed by H5 and other avian influenzas has drawn international attention this year, Lewis also wants to see more focus on the risk posed by swine influenza viruses. “Certainly, the threat remains from the swine influenza viruses, and I don’t think it should be downplayed because these viruses are endemic in the mammalian hosts,” she said.

The 2009 swine flu (H1N1) pandemic led to around 18 500 laboratory confirmed deaths,4 although later studies estimated the actual death toll at more than 280 000.

Lewis has called for the international community to act, using “one health” principles—where animal health and public health work in partnership—to tackle the challenges posed by these viruses together, including through continued pandemic funding for research, diagnostics, and vaccines.

She warned, “I’m very concerned that we are missing the opportunity. We cannot not take this opportunity to learn what we can from the covid pandemic to make sure that we are better prepared next time. Because there will be a next time.

“I think we’re at a critical juncture here where we frankly can’t afford to stop the process, because if we do, we will just reach the point where we haven’t learnt the lessons and we aren’t more prepared. And I think that would be an extremely retrograde and damaging step.”


  • Correction: We amended this story on 26 April 2023 to correct the name of the Worldwide Influenza Centre, which we had referred to as the World Influenza Centre.

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