Rethinking pandemic preparedness in the Anthropocene.

The social and ecological changes accompanying the Anthropocene require changes in how pandemics are anticipated, conceived, and managed. Pandemics need to be reframed from infections we can predict to inevitable infectious and non-communicable surprises with which we need to cope. A hazard-by-hazard approach to planning and response is insufficient when the next pandemic cannot be predicted. Decision-making will benefit from scoping the problem broadly to generate deeper insights into potential threats. The origins of pandemics come from our relationships with the world around us. Health leaders, therefore, need to be aware of primordial determinants of risk arising from these changing relationships. Cross-sectoral co-learning to anticipate surprise will require bridging agents embedded within a health agency to facilitate transdisciplinary intelligence gathering. A unified set of guidelines is needed to promote pandemic resilience by collaboratively tending to the determinants of health for each other, our communities, and the natural environment.