the times | Saturday November 14 2020 1GM 41
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before it reaches humans at all. Here, you also need to
change public health orthodoxy. You need to
introduce the epidemiologists to the ecologists, the
economists and the agriculturalists.
“Where is it that these spillovers are happening? It’s
animals. We don’t need to have a lab create a
bioweapon, it’s already being created by the way
animals are being held in factory-like conditions. It’s
like an incubation,” Professor Sridhar says. “Then
there’s deforestation, urbanisation, unregulated wet
markets. All this means these spillover events are
increasing.” Despite this, the WHO does not do
agriculture: for that you need the FAO (Food and
Agriculture Organisation). Neither does it do ecology:
there your acronym of choice is UNEP (the United
Nations Environment Programme).
“Everything is in silos,” agrees Kate Jones, professor
of ecology and biodiversity at University College
London (UCL). “These types of diseases are from
animals, and changes to animal communities is the
province of ecology. Public health is public health.
Understanding economies and people is economics.”
All of them, she says, need to be integrated. One
example of how this could be done is her work on
“disease forecasting”. By combining knowledge on
climate, demographics and human behaviour,
she and her colleagues have made a model
that predicts when Lassa fever, a
disease similar to ebola, may spill
over from its rodent hosts into
people.
“It’s not as if we weren’t
warning pandemics would happen,”
she says, but fixing it, preventing those
spillovers, requires fundamental changes in
societies. “We need to think what’s the long-
term cost of doing things in a short-term
way?” And then, the question becomes not just
what needs to be done. It’s what can be done.
In Clémenceau’s office, throughout the austere
winter of 1919, the French prime minister and the US
president went back and forth. Wilson wanted “peace
without victory”. Clémenceau, presiding over a
shattered country, felt differently. “The conduct of
Germany,” he said, “is almost unexampled in human
history... Germany saw fit to gratify her lust for
tyranny.” Now he wanted revenge.
Wilson kept on threatening to leave, but never did.
Clémenceau eventually accused him of being a prima
donna. “He’s like a cook who keeps the trunk ready in
the hallway,” he said. Lloyd George said that it was likegetting together and talking about the post-pandemic
world. As far as Devi Sridhar, who holds the chair of
global public health at the University of Edinburgh, is
concerned, there is a lot to talk about. Viruses are
global; our response has not been. And it needs to be.
“With pandemics there is always a moment where you
think, ‘At what point was this irreversible?’,” she says.
“And, if so, how can you prevent this happening
again?”
The last occasion you can realistically stop a
pandemic is also, for coronavirus, the first time we
realised it was happening: when there is a large cluster.
At some point in mid-January, she thinks, the world
had a very brief window to act, but because of public
health orthodoxy we failed. “The whole expert
consensus in January, February and prior to that was
that border restrictions and travel restrictions make
no sense and are harmful. They are saying, ‘Keep
things open, keep things open.’ ”
Partly this was because that was what their
mathematical modelling told them. Partly, some have
suggested, it was ideological. Global health experts are
not the sort to instinctively approve of shutting down
migration. But it was wrong.
“Having watched this evolve,” says Professor
Sridhar, “my big takeaway has been, actually, if we
were going to redo this you would have said to many
countries, ‘We need to restrict air travel now’.” This
also means, she says, that the WHO itself needs to
gain teeth. At the moment “they have no sticks.
They’re a carrot organisation.”
There is some international law around disease
outbreaks, the International Health Regulations.
These specify, for instance, obligations around
detecting and reporting cases, but even these
requirements are hard to enforce and very limited.
“Are they sufficient?” says Professor Sridhar.
“Obviously, they aren’t for quarantining countries, for
investigations or for sanctioning countries.” The
WHO, she says, “can’t even do shaming, they can’t
even go out and say, ‘You didn’t do a good job’.”
She points to an occasion when David Nabarro,
special envoy for the pandemic to the WHO, was
asked if Sweden’s response was good. “And he said,
‘Yes, I think Sweden’s response was good.’ And then
everyone said, ‘WHO adviser praises Sweden.’
Whereas if you’d asked Nabarro, ‘Is New Zealand’s
response good?’ or ‘Is China’s response good?’ he’d say,
‘Yes, yes.’ They work through praise.”
Travel bans are the last resort in stopping a
pandemic. The first, and best, time to prevent it is
being between “Jesus Christ and Napoleon Bonaparte”.
For Sir David King this is, diplomatically speaking,
pretty mild. He is, today, the chairman of Independent
Sage, the group of scientists set up in parallel to the
government’s advisory committee. In his life, though,
he has been many other things: chemistry professor,
scientific adviser and, with his work trying to keep the
climate change negotiations moving, diplomat.
He would love to be in the situation where there are
merely three politicians disagreeing furiously in a
room. At climate conferences, he says, there could be
6,000. “I just find that pretty difficult,” he says. “That
multilateral negotiating process is cumbersome in the
extreme.” It is more difficult still when there are
perceptions that one nation is judging another.
“It is clear that infectious diseases begin with certain
malpractices.” So, surely, we should ban live animal
markets? “If you accept people need to eat meat, how
do they do that without a refrigerator? They take
animals home in cages. You need to acknowledge the
situation people are in.” There is, he says, the very real
danger that “you are the colonial in the room, telling
them what to do”.T
hese concerns are one reason why some are
bypassing countries entirely. Dame Sally
Davies, the former chief medical officer for
England, thinks that to beat the next
pandemic the last thing to do is get bogged
down in a “system that is so fractured”. She has
announced the Trinity Challenge, a prize fund for
academics and private-sector groups to find new data
and use existing data to prevent that next pandemic.
“Wouldn’t it be great if we had an always-on
surveillance system? Could we start monitoring sewage
routinely for odd genomes?” she asks.
“What we’re effectively doing is setting up a
network of academics and private-sector organisations
that’s global. How do we prepare better so that the
next time we handle it better? We pick it up earlier
and snuff it out, we respond better, we recover better.”
Yet there is a paradox in all of this, in our hope that
we can find solutions to a pandemic. The story of
human technology and advancement is, in general,
one of improvement in our lives. It has made us
happier, healthier, richer and stronger. Except, that is,
in one area. The roads that brought trade to Europe
from the East also brought disease — the Plague of
Justinian, the Black Death. The cities that allowed
humans to exchange ideas and live alongside one
another did the same for pathogens such as cholera
and influenza. The aeroplanes that created a global
community created a viral community too.
Viruses are designed to adapt with us and against us.
“In human history we have never been able to stop
pandemics,” says Dame Anne Johnson, from UCL and
a fellow of the Academy of Medical Sciences. “Can we
do that now? With all the armaments of science?”
In one sense, in her role on Sage, her job
is to do just that. In another sense,
she knows what she is up against.
“We are working against the
extraordinary forces of biology and
evolution of viruses which thrive
when they interact with human
societies in ways that allow them to
spread. You are always up against that force,
and the idea there will be no pandemics in the
future is very difficult to believe.” A virus, like
the IRA, needs only to be lucky once.
Wilson got his League of Nations, but he never
got his “peace without victory”. As winter
became spring, the talks stalled. Then, in April,
Wilson became ill with a fever and violent fits of
coughing. When, after a week’s convalescence, he
returned to Clémenceau’s study, his aides said he was a
changed man. His fight had gone and he gave in. The
Treaty of Versailles, and its reparation payments, was
the result.
There is, unfortunately, a lesson here for those
planning a post-pandemic world. It is possible to make
the case that the Second World War happened because
Wilson failed in his goal. It is possible to make the case
that the reason he failed was because he got sick.
If so, we know the likely cause. At some point,
perhaps in 1917, a single cluster of atoms in a single
virus changed. That virus then moved from human to
human, spreading throughout the world as men
returned from the trenches. Eventually, Spanish flu
infected the most powerful man in the world, and his
utopia never came to be. History, once again, laughed
at human attempts to control it.Tom Whipple is science editorThere may need to be
difficult conversations
about cultural practices,
for example about
regulating meat markets,
to prevent pandemics like
the present one, which is
believed to have
originated with viral
mutations in a batISAAC LAWRENCE/AFP VIA GETTY IMAGESiWil