What are the specific problems?

My name is Dr. John Gerrard. I’m the director of infectious diseases at the Gold Coast University Hospital.

In recent decades, we have seen the emergence of new infectious diseases threats on a regular basis. So there is no reason to suspect that such threats will not continue to emerge on a regular basis in the future. The problem, of course, is we don’t know what the nature of such threats will be. We can, however, classify the possibilities into four broad groups. The first is the emergence of infections demonstrating increasing resistance to the anti-microbial treatments that we have on offer. Such examples would include tuberculosis, HIV, multi-resistant gramme-negative infections. The second group would include known infectious diseases that change their epidemiology, say, for example, through climate change and the redistribution of arthropod vectors like mosquitoes.

The third infectious disease threat would include novel viruses that behave in new and unexpected ways. And we’ve seen that on a number of occasions in the recent decades, for example, HIV, a pandemic that was completely unexpected and has behaved in really quite an unusual and unexpected way. Other infections, like hepatitis C and Zika virus, also fall into this category. And the final category, of course, is the science-fiction apocalypse pandemic of the movies. The closest we have come to seeing something like that is the West African Ebola epidemic of 2014/15. I had first experience of that terrible epidemic. And I would not want to see anything like that ever replicated around the world.

I think what a lot of people, both clinicians and non-clinicians, do not appreciate about antimicrobial resistance is that antimicrobials are central to almost all important things we do in medicine. So whether you’re talking about the treatment of cancer or general surgery, antimicrobials are central. Imagine a world in which we weren’t able to give the effective treatments for cancer, because we didn’t have the antibiotics available to treat infections that might occur. Then those treatments may well become useless. Imagine a situation where an operation on a knee could result in an infection which was untreatable. That might well render routine surgery untenable. The threat is greater and not appreciated as it should be by both clinicians and the public at large.

Another pandemic in the future is inevitable. We’ve seen pandemics on a regular basis in the past. And there is nothing magic about the current year in which we live. So there is no reason to suspect that another pandemic will not occur sometime in the future. The problem is predicting exactly what the nature of that pandemic will be.

It’s difficult to say whether we are truly pandemic ready. We are certainly better prepared now than we were a decade ago as a result of our recent experiences. The problem, of course, is we don’t know what the next pandemic will look like. We don’t know what it will be. We don’t know how it will spread. We don’t know how many people it will affect. So it is difficult to prepare for a specific pandemic. All we can do is prepare in a very general sense for the different types of pandemic that might occur. So, for example, hospitals are being designed and built with an increasing number of single rooms where we can isolate patients.

In the previous hospital in which I worked, it proved impossible to isolate patients during the 2009 influenza pandemic, for example. So we are certainly better prepared now than we were a decade ago, but are we prepared? It’s hard to say.

One thing that the 2014 West African Ebola epidemic taught us was that it is critical that we go straight to the source of a pandemic or of a potential pandemic to prevent its spread, to prevent it before it crosses borders and spreads beyond the initial epidemic. So what will the future of an epidemic response look like? It will look like a rapid response, moving clinicians rapidly to an area of potential infectious threat. We learned from the West African Ebola experience that delaying a response can lead to potential disaster. And I think that was a lesson for the whole world. And we’ve learned it well.