The Next Pandemic
Some have described COVID and the economic and social chaos it engendered as a Black Swan. That’s finance jargon for an unforeseen, unpredictable event with severe consequences. But if pandemics have a spirit-animal it isn’t a swarthy swan. No, pandemics are better described as Gray Rhinos: big, dangerous and entirely obvious.
They’re obvious not in their particulars; the precise timing or severity. But they’re obvious in the sense of being nearly inevitable, and also in the sense that modern science and disease surveillance often shows us what’s coming years in advance. And so it is with one of the next possible-pandemics: bird flu (H5N1 and its variants).
H5N1 has been around for a very long time. It was known as fowl plague at least as far back as the late 1800s. At that time, it was mostly a concern for wild birds and the unlucky poultry farmers whose flocks were decimated.
It received more mainstream attention when it made the jump from birds to humans in Hong Kong in the late 90s. 18 humans were infected and 6 died. Since then, bird to human transmission has happened sporadically in countries around the world. However, crucially - all of those historical infections were animal-to-human. The virus is nearly incapable of human-to-human transmission.
Unfortunately, there is a good probability of that changing in the foreseeable future. That’s because we’re seeing increasingly large and frequent outbreaks of the virus in a wide range of mammals. Everything from wild sea lions, to farmed minks and (ominously) dairy cows. It’s not clear if mammals are frequently transmitting the virus to and from one another. But at the very least, we know that the more time it spends in mammals, the more likely it is to develop that ability. Once achieved, it may also have the ability to spread amongst (rather than simply to) humans.
As recently as 2019, this might have sounded like science fiction. Now it just sounds like science. Most pestilence in human history can be traced ultimately to zoonotic transmission of viruses; exactly what we’re seeing with H5N1. And so, it seems to simply be a matter of time. How much time is anyone’s guess. The fact that the Department of Agriculture has recently announced hundreds of millions in emergency aid to test, study and develop vaccines against this virus tells us that at least the farmers are worried. The lead scientist of the WHO has said he believes that human-to-human transmission is “of grave concern.” Though, of course being concerned is part of his job description.
How bad would H5N1 be if it started circulating within human populations?
Official mortality rates for humans infected with the virus have been over 50% historically. However, this is probably a significant exaggeration of reality and what we would experience today if H5N1 began spreading in the developed world. It’s also possible that future variants that infect humans are simply less deadly.
Treatment options for H5N1 will probably be better than they were for COVID. In fact, we already have some treatments that are at least moderately effective for H5N1. Likewise, vaccines are likely to come online quickly if needed. In fact, researchers are already working on them.
Government and private sector reaction to a rerun of COVID is a little bit of a wild card, but it seems reasonable to believe that both would perform at least slightly better than they did in 2020. Policy makers now have a better understanding of the pros and cons of lockdowns and may better balance the costs and benefits. Supply chains are now more diversified than they were and rely less on “just in time” processes that keep inventories extremely lean. Even investors are likely to be calmer a second time around. Through 2020-2021 they saw that although the costs were high, the world did not end.
Considering all of this it seems right to be concerned, if only mildly so. We know future pandemics are inevitable. H5N1 is a near term contender, but not the only one. But the upshot is that there is every chance that by the time the next pandemic arrives, we’ll be ready and able to respond.