Preparation for the Next Pandemic: Challenges in Strengthening Global Health Systems and Surveillance.

The devastating course of the Coronavirus Disease 2019 (COVID-19) pandemic indicates that early detection of candidates with pandemic potential is vital. However, comprehensive metagenomic sequencing for the detection and characterization of total microbiomes is not a practical solution due to the astronomical and rapidly evolving numbers and species of micro-organisms. Analysis of previous pandemics shows that an increase in human-animal interactions, changes in animal and arthropod distribution due to climate change and deforestation, continuous mutations and interspecies jumping of RNA viruses, and frequent travels are important factors driving pandemic emergence. Besides general measures targeting the above factors, surveillance at human-animal interfaces targeting sick workers and animals with unusual tolerance to viral infections, and sick workers at high biosafety level laboratories is crucial. Surveillance of sick travellers is important when alerted by an early warning system or soft intelligence of a suspected outbreak due to unknown agents. These targets of surveillance should initially be screened by multiplex nucleic acid amplification and subsequent unbiased next-generation sequencing to discover future pandemic agents. Novel virus should be cultured in animal and human organoids, and then be tested in animal models such as non-human primates to check for interspecies transmission potential. These agents are candidates for the design of rapid diagnostics, therapeutics, and vaccines. For early detection of outbreaks, there are advantages in using event-based surveillance and artificial intelligence (AI), but high background noise and censorship are potential drawbacks. These systems are likely to be useful if they channel reliable information from frontline healthcare or veterinary workers and large international gatherings. Furthermore, sufficient regulation of high biosafety level laboratories, and stockpiling of broad spectrum antiviral drugs, vaccines, and personal protective equipment are indicated for pandemic preparedness.