For the first time in history, we have an opportunity to stop the next pandemic.
From the earliest thinking of the Greek physician and philosopher Claudius Galen to the 19th-century British “father of epidemiology” John Snow to the years before the Covid-19 pandemic, recurring, widespread, and uncontrollable illness has been beyond the grasp of the most cutting-edge science. For most of our history, humans have experienced plagues and pandemics as acts of unknowable forces.
No longer. In recent decades, scientific and medical advances have made it possible to detect, treat, and stop the pathogens most likely to sweep across continents and cause widespread death. The question now is not whether we can prevent the next pandemic, but whether we will.
• Why another pandemic within the next few decades is likelier than you might think — and why all hope is not lost, despite the US retreat from global health leadership
• Where the next pandemic will likely come from
• The three-part playbook to extinguish pandemic threats, and how the world can collaborate to implement it
• The most urgent, low-hanging steps we can take to blunt pandemic risk from infectious diseases right now
On our current trajectory, we will likely be faced with another pandemic in our lifetimes. By 2050, humanity has a nearly 50 percent chance of facing a pandemic as severe as Covid-19, which killed an estimated 25 million people around the world, and a one in seven chance of a catastrophic pandemic killing 100 million people, according to an analysis published by the World Bank and The Lancet. These odds depend on both what’s called the “spark risk” of a new threat emerging, and the “spread risk” of that threat growing to pandemic scale. Both risks are increasing every year due to more contact between people and wild animals, the proliferation of labs handling high-risk pathogens, and increasing accessibility of biological weapons. So the 50-50 odds are optimistic. Nobody wants to relive the pain and chaos of the last pandemic, but biology doesn’t care.
As the US withdraws from collaborative global leadership, and conflicts simmer and spread around the world, the post-World War II order is under threat. But people around the world still believe that countries should work together, including on global health, as long as international cooperation actually solves tangible problems.
The America First Global Health Strategy, released in September by the Trump administration, includes detection and containment of biological threats as top priorities. In June, the UK announced a billion-pound investment in a new biosecurity center “to protect the British public and the economy from future pandemics.” The African Union has launched a new African Epidemic Fund to support countries in preparing for and responding to outbreaks, and East Asian countries have made political and financial investments to prepare for biological threats from outbreaks and adversaries. Even as countries cut global health funding, stopping the next pandemic is a problem the world wants to solve.
Technological breakthroughs and lessons learned from the Covid pandemic have created an unprecedented opportunity to prevent, detect, and snuff out new threats at the source. With the right leadership and smart investments, we can take the top pandemic threats off the table in the next 10 years.
What will cause the next pandemic?
A couple hundred viruses are already circulating in humans, and hundreds of thousands more are circulating in animals. The risk of these viruses jumping from animals to humans, known as zoonotic transmission, is increasing as people move into areas that were previously inhabited only by animals. In the last 10 years, several of these so-called natural outbreaks, including Zika and bird flu, have had serious health and economic impacts.
For almost all of human history, pandemic threats emerged from nature. But now we have new, human-created risks to worry about. The number of labs handling the two highest-risk biological samples has quadrupled in the last two decades; these labs are now in nearly 150 countries. As more of these labs are built without the necessary safety protocols and oversight, the risk of an accidental spill also grows. And as technology (synthetic biology, automation, and AI) makes it easier for bad actors to turn viruses into weapons, the risk of a country, terrorist group, or even a lone actor deliberately starting a pandemic increases.
In 2024, the World Health Organization brought together scientists from around the world to prioritize a list of viral families — groups of viruses with similar characteristics — that have the potential to cause the next pandemic. Five groups stand out as the most dangerous.
The top two “viral most wanted,” as they are sometimes called, are almost certainly the influenza and coronavirus families — familiar names because they have caused most of history’s pandemics and major epidemics. Both are capable of spreading rapidly, and future strains have the potential to be much deadlier than the versions we have seen previously.
The next three on the most wanted list are viruses that are already wreaking havoc around the world. The paramyxoviridae family includes measles (extremely contagious but less deadly) and Nipah (less contagious but often deadly). This family has a nasty combination of virus characteristics that — if they ever converged into one virus — could make for a pretty bad pandemic, though the chances of it happening naturally are low.
The Poxviruses, meanwhile, include smallpox, very deadly but eradicated, and mpox, which has led to two global emergency WHO declarations since 2022.
Last on the list are arboviruses, which are often carried by mosquitoes and ticks. Arboviruses like dengue and malaria (a parasitic infection) are spreading to new countries due to climate change and urbanization. Countries where these viruses have long circulated are seeing record outbreaks, and locally acquired cases are becoming routine in new places, including the US.
All of these top threats have the potential to naturally mutate in a way that poses a novel risk to humans, either by becoming more deadly, spreading more efficiently, or both. But they can also be manipulated by humans in ways that make them more dangerous.
How can we stop these threats?
We have three main lines of defense against pandemics: prevent the spark of a new threat, contain a threat before it spreads, and — if all else fails — rapidly roll out tests, treatments, and vaccines that can slow transmission or protect people who are infected.
The first, and most efficient, way to stop pandemics is to prevent new threats from emerging by lowering the risk that viruses will jump from animals to humans, preventing lab leaks, and deterring bad actors from developing biological weapons. Effective approaches exist to prevent these threats.
Deforestation, driven by agriculture and urbanization, creates more opportunities for natural virus spillover around the world. We know how to mitigate that risk: Brazil, for example, put a set of policies in place between 2005 and 2012, including financial incentives and regulatory changes, that rolled back deforestation in the Amazon by 70 percent while increasing crop production. Wildlife markets and trade are another high-risk opportunity for spillover. Similarly, low-cost but effective interventions could mitigate these risks, including bans on the trade of high-risk wildlife species.
These solutions face real economic and political headwinds, in part due to the dependence of many countries’ economies on these practices. Solutions will not only require buy-in from those countries’ political leadership, but will also require alternatives, including new approaches to meet the ever-increasing demand for food production.
To make a biological weapon, bad actors need to either use an existing virus sample, or purchase synthetic DNA or RNA to create something new. Sellers of these materials can put simple screening processes in place to make sure the materials purchased are used by legitimate researchers. To prevent lab leaks, governments can put in place clear rules to make sure high-risk research is conducted with the strongest safety standards. In most countries, including the United States, where many high-risk labs are located, existing guardrails are largely voluntary.
In cases where we cannot prevent pandemic threats from emerging, the second line of defense is to quickly detect and stop them from spreading. Early warning and disease surveillance systems that regularly collect data on illnesses can quickly identify when something goes awry. Evolving technologies — from artificial intelligence to wastewater surveillance — make this vision more achievable than ever.
Most countries already participate in the global influenza surveillance network, sharing data and samples for the annual flu season and quickly detecting new virus strains with outbreak potential. Countries could expand the influenza network or build out newer models, like the Biothreats Emergence, Analysis and Communications Network (BEACON), to detect a wider range of other emerging biothreats before they spread. Much like weather reports, these systems have the potential to move beyond describing current events to predicting the likely evolution of threats and informing prevention efforts.
Any effective surveillance system requires an easy, affordable, and accurate way to test for a virus. Rapid tests for COVID and seasonal flu now exist for use at home and in healthcare settings. Developing similar tests for the top pandemic threats would help to quickly identify and contain new threats.
The third line of defense, following prevention and surveillance, is a robust system to rapidly develop, manufacture, and deliver safe and effective treatments and vaccines.
Infectious disease experts have converged around the goal of getting safe and effective tests, treatments, and vaccines ready for distribution within 100 days of identifying a new pandemic threat. The process to develop a vaccine took about 300 days during Covid-19, a record at the time, but if it had been done in 100 days, more than 8 million additional lives might have been saved.
AI can accelerate every step of this process — from surveillance to early-stage vaccine and treatment development and faster manufacturing. The US Defense Department’s Generative Unconstrained Intelligent Design Engineering (GUIDE) program is using advanced simulation and machine learning to cut the timeline for developing effective treatment candidates from 10 years to 100 days. The Coalition for Epidemic Preparedness Innovations (CEPI) is using AI to identify the right targets for vaccines, with the goal of cutting the timeline for this critical step from months to days or even hours.
Once safe and effective vaccines are developed, billions of doses may be needed, and manufacturers must be ready to rapidly scale up production. Innovations in the approaches to making vaccines — called platform technologies — can speed up that timeline. For example, the most common method for making seasonal flu vaccines uses chicken eggs to grow the virus, a slow process that requires a lot of (sterile, pathogen-free) eggs. Newer approaches to vaccine manufacturing, sometimes called “plug and play” platforms, are more akin to a printer and an ink cartridge. The printer itself is developed in advance and tested for safety and efficacy; then scientists can quickly plug in the new ink cartridge, or information about a new pathogen, when an outbreak occurs. These “plug and play” vaccine platforms, including mRNA vaccine technology, can shorten the timeline for manufacturing billions of safe and effective vaccine doses from years to months.
In an emergency, we need an existing “warm base” of global manufacturing that can quickly be repurposed to make emergency tests, treatments, and vaccines. That requires making sure enough manufacturers are able to use existing vaccine platforms, and that we have enough diversity in vaccine platforms globally to be prepared for a range of needs. One of the best ways to ensure a warm base of manufacturing capacity around the world is to build and use a variety of plug-and-play platforms now, to make vaccines against existing threats like Ebola, HIV, and seasonal influenza. Repurposing an existing manufacturing plant is much easier than building a new one in an emergency.
What would it take to do this?
What would it cost to prevent pandemic threats from emerging, quickly detect threats when they do emerge, and respond effectively when they spread? And who could make this happen?
In early 2021, the World Bank and WHO estimated that $31 billion would be needed annually to pay for pandemic prevention, preparedness, and response globally. A review by the International Monetary Fund estimated that investments of $60 billion up front and $5 billion annually could ensure enough manufacturing capacity to vaccinate 70 percent of the world’s population against a new virus within six months.
Conservatively, then, $30 billion annually for 10 years, with a larger down payment, would be sufficient to take the top pandemic threats off the table, with many second-order benefits. For comparison, Covid-19 cost the US economy about $14 trillion through the end of 2023. The global economic losses from an influenza pandemic could be double that. The bottom line on cost is that preparing for and preventing a pandemic is vastly less expensive than living through one. Given the odds of another pandemic in our lifetimes, the world should make this investment.
But this is a big goal with many components. So where is the most urgent place to start?
A catastrophic pandemic, killing as many or more people than Covid, would likely come from one of the top two threats — a coronavirus or an influenza virus. Most urgently, we need safe and effective vaccines and treatments against these two viral families. Researchers at CEPI estimated in 2018, before recent breakthroughs in technology, that the total cost of developing a vaccine, including the cost of failed vaccine candidates and regulatory approval, is about $300 to $500 million. Assuming some added complexity for developing broadly protective vaccines, and adding the cost of developing effective treatments and tests, an investment of $10 billion over 10 years would likely be sufficient to develop the tests, treatments, and vaccines needed to blunt those two top threats to humanity.
Numerous governments, institutions, and philanthropies are already investing in breakthrough solutions, but those efforts are ad hoc, uncoordinated, and lack a clear set of top priorities and a timeline. The next United Nations High-Level Meeting on Pandemic Prevention, Preparedness, and Response will take place in September 2026; between now and then, one of the institutions leading the way — whether CEPI, the UK government, the African Union, or others — should bring together the current major investors in vaccines, treatments, and tests to align.
They should agree on: Who is driving investments against coronaviruses? Influenzas? Other viral most wanted families? What do scientists need to make faster progress toward breakthroughs? When will we see results, and how will we share our progress transparently with the public? They should tell the world what is needed to take these threats off the table so we never again face a devastating pandemic.
Five years out, we are still living in the shadow of Covid-19 and all the fear, frustration, anger, and loss it created. It’s natural to want to ignore the threat of pandemics, to simply hope that we can avoid another “act of God” in our lifetimes. But we can stop this threat. Not with luck or divine intervention, but with acts of human ingenuity, commitment, and belief. Let’s do this.
