While the next pathogen with pandemic potential may be lurking in a faraway creature, human behaviour will drive it to become a pandemic, according to the Global Preparedness Monitoring Board (GPMB), which issued its first comprehensive pandemic risk report on Monday.

The four riskiest human behaviours involve our global mobility, agricultural and farming practices, mis- and disinformation and a lack of trust – in science, in governments and between countries – according to the GPMB.

In 2024, there have already been 17 outbreaks of dangerous diseases, including H5N1 that has spilt over from cattle to humans and a new strain of mpox in East Africa. 

“The high likelihood that they will spread further should be a wake-up call for the global community,” said the board.

“Pandemics are not random events,” GPMB co-chair Joy Phumaphi told a media briefing before the launch. “The factors contributing to pandemics are deeply intertwined with how humans interact with the environment, animals and trade.

“Human and animal interconnections, including the trade and proximity of animal products, play a significant role in the transmissions of pathogens,” noted Phumaphi, Botswana’s former health minister.

“The increasingly rapid movement of people across countries and continents accelerates the spread of disease,” she noted. So too does the spread of misinformation and disinformation as it “undermines public trust and hampers collective efforts”. 

“Trust is a cornerstone [that is] central to pandemic response. Distrust can contribute to the emergence of new viruses and exacerbate outbreaks whereas trust between stakeholders and nations strengthens international collaboration and response efforts,” said Phumaphi.

The report also identifies “climate change, individualism, economic inequality, and conflict and instability” as key drivers of  pandemics.

We are ‘always at risk’

“We are always at risk. Pandemic drivers evolve rapidly, and if we don’t stay ahead, we’ll be unprepared for what comes next,” said Kolinda Grabar-Kitarović, the other co-chair and former President of Croatia.

“We need to focus on preparing for the next crisis, not just reacting to the last one. While we cannot predict exactly which pathogen will emerge, we can assess our risks and vulnerabilities and develop strategies to address them. Pandemics bring fear and uncertainty, and being unprepared only highlights that fear,” Grabar-Kitarović told a discussion on the report at the World Health Summit in Berlin on Monday.

Phumaphi stressed that collaboration and equity mitigate pandemic risks – and are also the best way to rebuild trust between countries that was broken during the COVID-19 pandemic.

However, cooperation and collaboration are “most difficult” to develop during a crisis – which is why frameworks like the WHO’s International Health Regulations and the pandemic agreement, currently being negotiated, are important, she stressed.

Weak pandemic agreement poses threat

Phumaphi told the media briefing that the release of the report had been timed to coincide with what might be the last meeting of the International Negotiating Body (INB) drafting the pandemic agreement, set for the first two weeks of November.

“We are aware of the direction that the negotiations are taking, and what we are concerned about is that this direction is actually going to fuel the spread of the next pandemic,” said Phumaphi. 

She described reports that the agreement’s commitment to equity had been watered down, as “a serious threat to our readiness”. 

WHO Director-General Dr Tedros Adhanom Ghebreyusus told the summit that the board’s report “highlights many of the key components that the pandemic agreement is designed to address: a One Health approach, equitable access to medical countermeasures, research and development, and most importantly, and most relevant for this world summit, trust”. 

Tedros added: “The global response to the COVID-19 pandemic was undermined by the lack of a coherent and coordinated approach, based on equity and solidarity. We can only face shared threats with a shared response.”

‘Adapt, protect, connect’

The report advocates three measures to counter pandemic threats: “adapt, protect and connect”.

GPMB member Prof Ilona Kickbusch told the summit that, with adapt, the board wants countries  to assess their pandemic risk drivers, involving all sectors of society.

The key to protection is strong primary health care, equity, social protection for the most vulnerable, and boosting international cooperation, added Kickbusch, who is chair of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva.

“Connect” relates to international cooperation and intersectoral cooperation, supported by dedicated funding. But it also relates to digital connection – which has helped with the spread of information but also fueled disinformation.

Without trust, innovation is ‘useless’

Board member Victor Dzau said that while science has great progress with, for example, the rapid development of mRNA vaccines during COVID, “we’re foolish to think that science  alone will protect us”.

Scientific innovations are “useless if people don’t trust them”, said Dzau, who is also President of the US National Academy of Medicine and vice-chair of the US National Research Council.

“Whatever we do, we must address issue of trust. That means that we need to understand the root cause, including social inequity as social inequity fosters mistrust.”

Dzau said trust needs to be build “way before pandemic begins” to ensure that there is a “reservoir of goodwill, of trust, that can be relied upon when the crisis take place”. 

“During a pandemic, we need much better communication to listen more to people’s fears and fears and questions real time.”

Better ‘One Health’ tools

Board member Sir Mark Lowcock, former head of United Nations Office for the Coordination of Humanitarian Affairs (OCHA),   addressed the need for a One Health approach “linking human, animal and environmental health”.

“Those risk areas are particularly found where we have new hotspots, where there’s high levels of interaction between humans, animals and environmental stresses. We need better tools to identify those hot spots and understand the risks involved. The entry point for many countries actually is improvements to their animal health system and their food safety services,” said Lowcock, who is a former UK Permanent Secretary of the Department of International Development.

Climate change is “an amplifier of all these risks”, he added, and this needs to be addressed by “early detection, strong primary health care and overcoming the barriers to access to medical countermeasures” – and “underpinned by strong international cooperation”.

Mobility of people – and pathogens

“Human mobility today through trade, travel, immigration, or refugees who are fleeing conflict or climate disasters, plays in a very important role in spreading diseases, because when people move, the pathogens move with them, and that can bring novel or reemerging diseases into populations that don’t have any prior immunity,” said board member Dr Chris Elias.

“Take the example of the Omicron variant, which was initially identified in South Africa and reported promptly in late November of 2021. Within three weeks, by the middle of December, it had spread to over 70 countries, and that was in the middle of a pandemic where we were reducing the amount of movement,” said Elias, who is president of Global Development at the Bill and Melinda Gates Foundation.

Urbanisation has “skyrocketed” since the 1960, with two-thirds of people projected to live in cities by 2050, he added.

“Cities have higher population density, they have frequent commuting, and they create ideal conditions for the rapid spread of disease,” he noted.

“We have to build trust so that we can objectively assess those risks and take steps to mitigate without overreacting and causing harm to individual economies or the supply chains and creating the kind of inequity that we saw during the COVID pandemic.”

Elias concluded by noting that “one of the best ways for us to repair that trust is to have the kind of agreement we reached as a global community last year with the [amended] International Health Regulations, and to do that with the pandemic treaty, and to continue to build that sense of science driving preparedness and response.”