Preparation in an age of pandemics

“The harms caused by the pandemic extend beyond the direct and indirect effects on health,” she said. “We are still enumerating the ways in which the virus disrupted society, our political environment and global economy. The multitude of harms is not unique to COVID-19. It is a hallmark of how infectious disease affects society.”

Nuzzo cautions that the biggest mistake we can make now is treating COVID-19 as a once-in-a-century event. Just as so-called 100-year floods are now expected to happen every 1 to 30 years as a result of human activity and environmental changes, disease outbreaks will also become more frequent.

“The climate-linked hazard events that produce floods are increasing,” she said. “I don’t think this is controversial or even surprising to most people. People see this happening with their own eyes. But this very same trend is happening with infectious diseases.”

The flood of new infectious disease outbreaks includes the mpox virus, which the World Health Organization declared a public health emergency of international concern twice last year. Tanzania is currently experiencing an outbreak of the Marburg virus. This follows on the heels of the first-ever Marburg outbreak in Rwanda—one of the largest ever recorded. And Uganda is in the midst of an outbreak of Sudan virus disease, an infection similar to Ebola, for which no licensed vaccine exists. 

In the U.S., rising cases of the H5N1 avian influenza in both animals and people are a cause for grave concern, as the totality of data on the virus ranks it as one of the most deadly. “H5N1 has not gained the ability to easily infect and spread between people,” Nuzzo said. “If it does gain this ability, make no mistake—we will be in another pandemic.”

Nuzzo stressed that, in an age of persistent infectious disease threats, we must prepare for outbreaks as recurring hazards rather than freak occurrences. “This does not mean living in a perpetual state of emergency,” she said. “It means finally doing the work to understand these threats and our vulnerabilities to them.”

Founded by Nuzzo just three years ago, the Pandemic Center is working to take pandemic threats off of the table. Through research, education and outreach, the Center engages policymakers, practitioners and the public to prevent outbreaks from escalating into pandemics—while also working to reduce our vulnerabilities and increase our resilience to biological emergencies.

For instance, Nuzzo and Wilmot James, senior adviser to the Pandemic Center and professor of the practice of health services, policy and practice at Brown, are leading a global effort to build and sustain surveillance systems that not only spot outbreaks early but also analyze environmental and climate conditions that increase the likelihood of disease emergence.

Professor James and other researchers from the Pandemic Center are working with South African policymakers to help South Africa achieve vaccine independence. The overall goal of the program, VacTask, is to decentralize the production of vaccines, making them widely available throughout the world. 

The Pandemic Center has also produced a Testing Playbook for Biological Emergencies that helps executive leaders ensure fair access to accurate testing during an outbreak. 

“Recent infectious disease emergencies told us that decision-making can make or break a response,” Nuzzo said. “We all remember how difficult it was to get tested at the beginning of COVID-19, and frankly at many other times during the pandemic. Failing to deploy and scale testing has been called the original sin of the U.S. response to COVID.”

Among its many educational and outreach initiatives, the Pandemic Center’s Tracking Report delivers weekly updates on outbreaks directly to subscribers’ inboxes. The Report, free and available to the public, can be accessed here.

An epidemiologist by training, Professor Nuzzo’s work focuses on global health security, public health preparedness and response, as well as health systems resilience.

With colleagues from the Nuclear Threat Initiative, she co-leads the first-ever Global Health Security Index, which benchmarks 195 countries’ public health and health care capacities and capabilities. She also co-founded the Outbreak Observatory, which conducts operational research to improve outbreak preparedness and response.

In addition to her scholarly work, Professor Nuzzo regularly advises national governments and for-profit and nonprofit organizations on pandemic preparedness and response, including COVID-19.