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Man gets 6 years for $4.2M COVID relief fraud scheme

FORT LAUDERDALE, Fla. (AP) — A South Florida man was sentenced Wednesday to six years and two months in federal prison for trying to obtain more than $4.2 million in COVID-19 relief funds by filing false loan applications.


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Three years of COVID-19 and it’s still here

It was three years ago this week, when Gov. Ron DeSantis announced on a Sunday evening, March 1, 2020, that “two individuals” in Florida tested “presumptively positive” for a coronavirus called COVID-19.


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Pandemic 3 years later: Has the COVID-19 virus won?

On the third anniversary of the COVID-19 pandemic, the virus is still spreading and the death toll is nearing 7 million worldwide. Yet most people have resumed their normal lives, thanks to a wall of immunity built from infections and vaccines.


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March 12, 2023

Tomasz Woźniakowski

Welcome to The Next Pandemic, a limited-run weekly newsletter from Times Opinion that explores the most pressing ideas and debates on how to prepare for future threats. I’m Alexandra Sifferlin, the health and science editor for New York Times Opinion and your guide for the next several weeks.

As we mark three years of the Covid-19 pandemic, a question looms: How ready are we to face another one?

This is a question we’ve posed to experienced health policymakers, frontline workers and infectious-disease researchers in the United States and around the world. We plan to cover debates over masking, the importance of indoor air quality, the threat that bird flu might pose and much more.

In today’s newsletter, we are featuring Tom Inglesby, the director of the Johns Hopkins Center for Health Security, on specific steps the United States should take to better prepare for pandemic threats. We also asked eight experts to take part in a pandemic simulation. We hope to show that expertise does not ensure conformity of ideas or approaches to pandemics and that many policy questions remain open to debate, exploration and new information.

Think of this newsletter as your go-to place for the most informed and creative ideas on pandemic readiness. We will respond to reader feedback and look forward to hearing from you. Be sure to check out our reader Q. and A. at the bottom of the newsletter. You can reach us at next-pandemic@nytimes.com.

If you’re not interested in receiving The Next Pandemic newsletter, you can manage your email preferences here or unsubscribe using the link at the bottom of this email. — Alexandra Sifferlin


How to Prepare for ‘Disease X’

By Tom Inglesby

Director of the Center for Health Security at Johns Hopkins University

Late last year, I participated in an exercise meant to play out what might happen if the world was presented with a new disease spreading quickly, with no warning.

The exercise revolved around a number of simulated emergency meetings of the World Health Organization advisory board, called in response to a very serious new pandemic — a risk that the W.H.O. refers to as “Disease X.”

Among the exercise participants were highly experienced current and past health ministers and senior public health officials from nine countries. The urgent events required them to make hard policy decisions quickly, with little information. Each decision had huge consequences for society and for the course of the pandemic. This was how it was in the early days of Covid. It’s also how it will be in other pandemics.

Some of the smartest and most experienced international public health leaders had differing, sometimes opposing views on many fundamental questions about the response. Should they shut down travel in the earliest days? Should they close schools in the first affected countries? If a future pandemic has a much higher case fatality rate than Covid or if it severely affected children, should countries take different, stronger, faster measures to contain it? Top experts don’t yet agree.

These will be terribly hard decisions for leaders to make. And that’s why it’s essential to anticipate and be ready for them in advance, reaching broad consensus where it’s achievable.

During the peak of the Omicron wave in January 2022, U.S. congressional leaders across the political spectrum were frustrated by the need to transform the country’s pandemic response. “We can never let this happen again,” was a frequent refrain.

But a year later, and three years after Covid was declared a pandemic, that collective resolve is diminished. The promise to prepare for pandemics in fundamentally new, far more ambitious ways has rapidly faded.

As horrible as Covid has been — it remains one of the leading causes of death in the United States — it is not the worst-case scenario. There are viruses with case fatality rates twice, 10 times or even greater than that of Covid, such as H5N1 influenza (bird flu), Nipah and Ebola. Fortunately, those viruses have not developed the capacity for efficient human-to-human respiratory spread. A concern is whether a new viral strain with higher case fatality will also develop the capacity for rapid spread among people. There is growing global concern over H5N1’s spread in animals — a development that governments must track and prepare for, and which all the more should broadly spur vigorous new pandemic preparedness efforts.

The world needs to be prepared for the next Disease X, something capable of causing global catastrophic risks. Here’s what it would take to collect all we learned from Covid and to transform our preparedness.

We need to get vaccines in arms much faster.
A number of countries call this commitment the 100-day mission — referring to the number of days it should take to develop a safe, effective vaccine after the sequencing of a novel pandemic virus. This would require serious investment from governments and close partnership with private sector vaccine manufacturing companies to establish much faster processes in research and development, clinical trials, regulatory review and more. It would require more investment in technologies such as mRNA that could be used for a range of Disease X threats. Right now, a large majority of government funding to help develop vaccines and medicines for pandemics is for existing, known pathogens, as opposed to preparing for future unknowns.

We need to make it much easier to develop and distribute tests.
Until diagnostic tests are widely available, leaders and the public will be flying in the dark in a future pandemic. We now know that we need contracts to exist between the federal government and the diagnostic industry that can be enacted quickly, because we don’t have time to start complex negotiations in a crisis. ‌

The Food and Drug Administration‌ needs a‌ clear and established path for rapidly reviewing new tests‌ during a crisis‌. The Centers for Disease Control and Prevention must be ready to provide immediate diagnostic clinical guidance‌‌, and health insurers and the Centers for Medicare and Medicaid Services need to be ready to provide quick and full coverage ‌for testing. Pharmacies, doctors’ offices and community centers should be positioned to dispense tests swiftly.

Imagine if in the first weeks of Covid ‌‌everyone could have easily gotten a free test at one of thousands of locations‌‌. ‌‌That should be the expectation for the future.

We need a stronger stockpile of high-quality protective gear.
Our national supply of personal protective equipment, or P.P.E., was far too small ‌in the first months of Covid, especially when it came to masks. We need a far stronger and more resilient approach‌‌. ‌The U.S. supply chain is still quite vulnerable to disruption because we rely on so many single-use products that have components from around the world, which many countries will be seeking at the same time in a‌‌ pandemic. ‌

We ‌must be in a position in which health care workers and all essential workers can obtain very high-quality masks quickly. This means shifting at least a substantial portion of our national high-filtration-mask supply away from disposable single-use ones to reusable respirators that can be worn repeatedly‌‌ and safely.

We need to seriously change our approach to indoor air quality.
Just as we ‌expect‌‌ clean water from our spigots, we should have cleaner air moving through our buildings. Better filters, more outdoor air intake and new technologies to diminish pathogen burden should all be part of the plan — these things are key for future pandemics and for ‌lessening the toll of viruses overall. The Biden administration made substantial funding available for schools to increase ventilation, but many schools have not made these investments. The administration also began an effort to improve indoor air in buildings across the country, but most of the implementation of that plan ‌depends on local decision makers‌‌, building owners and operators, and better building codes.

We need stronger research oversight and lab safety.
It is still not clear what caused the Covid pandemic, and resolving that uncertainty would require new information and data. But even without knowing‌‌ what the proximal cause of Covid was, we should resolve nationally — and internationally ‌‌ — to operate labs with lethal and contagious viruses in the safest possible ways.

We need strong government oversight of that kind of work, with a framework that balances proposed benefits with major risks. A White House and National Institutes of Health review of these policies is underway now, and there are many important changes that if adopted would make U.S. policy and practice much safer and more effective on these issues.

These efforts are part of the larger set of actions and programs needed to prevent accidental or deliberate events from starting major epidemics and pandemics. That work should include requirements for monitoring or preventing the laboratory synthesis of deadly or extinct viruses; a strong national capacity to attribute a novel pathogen to its origin; commitment to support the Biological Weapons Convention, the international treaty that bans biological and toxin weapons; and vigorous scrutiny and oversight of the practice of extracting from remote ecosystems viruses ‌‌that may have pandemic potential‌‌ and have never been introduced to people or studied in a lab.

The C.D.C. needs a reset.
The C.D.C. has essential national pandemic preparedness and response responsibilities ‌‌as the nation’s top national public health agency. ‌‌But the pandemic revealed many of its challenges, including early testing mishaps, complicated public guidance and an inability to collect some key data that national leaders and the public needed. The agency needs new authorities to gather data quickly, new abilities to contract, retain and recruit talent, and new capacity to deploy people and funding to state and local public health organizations around the country that will need that assistance. ‌

The C.D.C. needs to operate rapidly in crisis, both in ‌the United States and internationally. Currently, its budget is broken into about 160 programs that aren’t allowed to be changed during pandemics ‌‌ — this must change. Some ‌changes are in the C.D.C.’s control; others will require legislative solutions (‌like giving it more authority and funding‌).

These are not the only efforts needed — we also need stronger local public health capacity, stronger support to community organizations doing on-the-ground response work and more — but they are a critical start. And there are upcoming opportunities to act on them.

The Biden administration’s budget request asks for funding for pandemic preparedness, and Congress should embrace it. Congress also has the opportunity to reauthorize the Pandemic and All-Hazards Preparedness Act this year, and it could bolster, among many key capacities, the Administration for Strategic Preparedness and Response in its work to develop and distribute vaccines and to strengthen the supply chain.

Covid brought out incredible resolve, scientific ingenuity, individual and community perseverance and innovation. But even with that, millions of people died, many millions more were sickened, and societies were terribly set back in the United States and around the world. We are likely to face similar or worse pandemic threats in the future. We need to use the time we have now to make big preparedness changes to protect us from challenges that could arise again without warning.


A Pandemic Simulation

We asked a group of experts to take part in a scaled-down Disease X simulation — responding to scenarios quickly, with little detail, as they would likely have to in a real-world situation.

Here are the parameters they are working with: A respiratory virus starts spreading tomorrow in the United States. It appears more transmissible and more deadly than SARS-CoV-2, the virus that causes Covid-19, and it is equally risky for children and adults, based on the rapid spread and number of deaths in another country. There’s no available vaccine, though one is under investigation. There are only 10 reported cases in the United States, but five are in the jurisdiction you are advising. This is all the information available.

Click below to see how they responded.


You Ask, Experts Answer

Dr. Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security, responded to reader questions about coordinating response efforts and protecting the vulnerable.

Since public health is mostly funded and carried out by the states, how do we improve preparedness across America and how do we educate people about the importance of having a coordinated common response? — Rich Scott, Sunnyvale, Calif.

Caitlin Rivers: I’m glad you asked, because this is a topic that I’m passionate about in my work at Johns Hopkins. Many people do not realize that the U.S. public health system is federated. Most legal authorities and budgetary controls reside at the state, and sometimes county, levels. The Centers for Disease Control and Prevention and public health associations like the Council of State and Territorial Epidemiologists provide technical support and coordination when needed. This system is flexible enough to tailor outbreak responses to the needs of local communities, which is helpful, but performance from one jurisdiction to the next can be uneven. I would like to see more standards, common operating procedures and other process improvement measures for outbreak response. There should be an engine of progress to ensure we are constantly evolving and improving.

America has always failed to protect the most vulnerable Americans (people with disabilities, the elderly, people with chronic conditions). What can be done to protect vulnerable folks going forward? What sensible steps can we take to ensure the health and safety of those who live in large nursing homes and care facilities in particular? — Ann E. Green, Bala Cynwyd, Pa.

Rivers: It’s such an important question. I hope that the pandemic has expanded awareness that older adults and people with medical conditions are more vulnerable to severe illness — not only from Covid-19 but other common infections as well.

I have a few ideas: First, certain health care facilities (like those that treat people with immunocompromising conditions) should continue to require masks. Facilities should also ensure adequate indoor air quality with proper ventilation and filtration. In nursing homes and long-term-care facilities, more stringent staffing and training standards should be implemented to better protect residents. Finally, disease outbreaks in long-term-care facilities should continue to be reportable to public health authorities. That was a pandemic-era policy that should become permanent.

Individuals can take steps to help protect people who are vulnerable, too. Stay home if you feel unwell, and I recommend wearing a mask while in public if you have been exposed to someone who is sick. Also, be respectful of people’s preferences — nobody should be made to feel uncomfortable for wearing a mask in public.

Have a question? Reach us at next-pandemic@nytimes.com.

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New COVID origins data suggests pandemic linked to animals

International scientists who examined previously unavailable genetic data from samples collected at a market close to where the first human cases of COVID-19 were detected in China said they found suggestions the pandemic originated from animals, not a lab.


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Ladapo defends COVID stance against criticism from federal health authorities

Florida Surgeon General Joseph Ladapo is standing by his controversial opinions about COVID-19 vaccines and precautions even in the face of a rebuke by federal public health officials.


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New COVID origins data point to raccoon dogs in China market

BEIJING (AP) — Genetic material collected at a Chinese market near where the first human cases of COVID-19 were identified show raccoon dog DNA comingled with the virus, adding evidence to the theory that the virus originated from animals, not from a lab, international experts say.


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March 19, 2023

Tomasz Woźniakowski

When it comes to global health, Bill Gates is one of the most influential forces — including for pandemic preparedness. The Bill and Melinda Gates Foundation committed more than $2 billion for the global Covid-19 response alone. Knowing what one of the most powerful individuals in philanthropy views as a priority is important for understanding how that might shape the trajectory of future preparedness. Today, Gates argues for an idea he’s been pushing for: A system of pandemic responders who are ready in case there’s a crisis.

What do you think of this idea? Let us know at next-pandemic@nytimes.com. Alexandra Sifferlin


The World Needs Pandemic Firefighters

By Bill Gates




Imagine there’s a small fire in your kitchen. Your fire alarm goes off, warning everyone nearby about the danger. Someone calls 911. You try to put the fire out yourself — maybe you even have a fire extinguisher under the sink. If that doesn’t work, you know how to safely evacuate. By the time you get outside, the fire truck is already pulling up. Firefighters use the hydrant in front of your house to extinguish the flames before any of your neighbors’ homes are ever at risk of catching fire.

‌We need to prepare to fight disease outbreaks just as we prepare to fight fires. If it is left to burn out of control, a fire poses a threat not only to one home, but to an entire community. The same is true for infectious diseases, except on a much bigger scale. As we know all too well from Covid, an outbreak in one town can quickly spread across an entire country and then around the world.

When the World Health Organization first described Covid-19 as a pandemic just over three years ago, it marked the culmination of a collective failure to prepare for pandemics despite many warnings. And I worry that we’re making ‌‌those same mistakes again. The world hasn’t done as much to get ready for the next pandemic as I’d hoped. But ‌‌it’s not too late to stop history from repeating itself. The world needs a well-funded system that is ready to spring into action at a moment’s notice when danger emerges. ‌We need a fire department for pandemics.

I’m optimistic about a network that the W.H.O. and its partners are building called the Global Health Emergency Corps. This network of the world’s top health emergency leaders will work together to get ready for the next ‌‌pandemic. Just as firefighters run drills to practice responding to a fire, the Emergency Corps plans to run drills to practice for outbreaks. The exercises will make sure that everyone — governments, health care providers, emergency health workers — knows what to do when a potential outbreak emerges.




One of the corps’ most important jobs will be to ‌‌take quick action to stop the spread of a pathogen. The speed of action requires countries to have large-scale testing capabilities that identify potential threats early. Environmental surveillance like sewage testing is key, since many pathogens show up in human waste. If a sewage sample comes back positive, a rapid response team would deploy to the affected area to find people who might be infected, implement a response plan‌‌ and kick off the necessary community education about what to look for and how to stay protected.

As C‌ovid-19 demonstrated, a pandemic is a trillion-dollar problem, and mitigating this challenge should not depend on volunteers. We need a corps of professionals from every country and region, and the world needs to find a way to compensate them for the time they spend preparing for and responding to transnational threats. They must be able to deploy teams of professionals on standby to help control outbreaks where they start.

To be successful, the Emergency Corps must build on existing networks of experts and be led by people like the heads of national public health agencies and their leads for epidemic response. ‌It’s difficult ‌‌for any one country to stop a disease from spreading on its own — many of the most meaningful actions require‌‌ coordination from the highest levels of government. The world needs to prepare for a multiple-alarm fire — the type of fire response that requires different units and departments. These kinds of blazes are rare, but when they happen, there’s no time to waste. Local responders need to know they can count on a surge of well-trained firefighters who will work seamlessly together. They can’t arrive on the scene only to discover that their hoses don’t fit on the closest hydrant or that they have a completely different approach from the other units. The Emergency Corps will make sure countries and health systems are coordinated in advance of an emergency, so that everything runs smoothly during times of crisis.

This is where practice makes perfect. By running drills and simulations, the corps will uncover the areas where ‌countries and leaders are not ready and help us fix them now. ‌It’s important to practice for lots of different types of pathogens, too. Human respiratory diseases are a huge concern, because they can go global so quickly. (Just look at how fast Covid spread.) But they are far from the only threat. What if the next pandemic-potential pathogen spreads through surface droplets? Or if it is sexually transmitted like H.I.V.? What if it’s the result of bioterrorism? Each scenario requires a different response, and the Emergency Corps can help the world get ready for all of them.




We can’t afford to get caught flat-footed again. The world must take action now to make sure Covid-19 becomes the last pandemic, and one of the biggest moves we can make is to support the world’s principal health experts — the W.H.O. — and invest in the Global Health Emergency Corps so it can live up to its full potential.

‌‌This will require two things: First, public health leaders from all countries need to participate. The next ‌pandemic could emerge anywhere, and so the Emergency Corps must have expertise from every corner of the globe, including from national disease and research agencies like the C.D.C. and the N.I.H. in the United States. Second, we need wealthier countries to step up and provide funding to make this a reality.

‌‌I believe the W.H.O. remains our best tool for helping countries stop disease outbreaks, and the Global Health Emergency Corps will represent massive progress toward a pandemic-free future. The ‌question ‌‌is whether we have the foresight to invest in that future now before it’s too late.

Bill Gates, a co-founder of Microsoft, is a co-chair of the Bill and Melinda Gates Foundation and the founder of Breakthrough Energy. He is the author of “How to Prevent the Next Pandemic.”

You Ask, Experts Answer

Dr. Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security, responded to reader questions about coordinating response efforts and protecting the vulnerable.

What can I personally do in my life to help prevent the next pandemic? — Andrew M. Nearbin, Fredonia, N.Y.

Caitlin Rivers: During the Covid-19 pandemic, many felt a sense of uncertainty and loss of control, so it makes sense to wonder what we can do to help prevent “a next time.” Fortunately, the odds that any one of us will be a catalyst for the next pandemic are tiny, but a few general principles are important to abide by: limit contact with sick or wild animals, prevent mosquito and tick bites, and stay home when sick to avoid becoming a link in the transmission chain, for example.

What might be more important is encouraging your elected representatives — at the federal, state and local levels — to make public health a priority. Recently, some state legislatures have been rolling back century-old public health powers and slashing funding as part of a backlash to unpopular pandemic-era measures. Those degradations make me concerned for our ability to respond to future public health threats.

What is the time frame for the next pandemic? It was 100 years or so between the 1918 flu and Covid-19. Will it happen again sooner than that? — Michelle Plaisance, Massachusetts

Rivers: Michelle, I wish I knew. Epidemiologists have gotten better at forecasting the trajectory of active outbreaks, but we can’t yet predict outbreaks before they begin.

While it’s true that the 1918 influenza pandemic and the Covid-19 pandemic were almost exactly 100 years apart, there were plenty of significant events in between. In the past 25 years, we have weathered the anthrax attacks in 2001, the SARS epidemic in 2003, the H1N1 influenza pandemic in 2009 and an Ebola epidemic in 2014, to name a few. Right now, I have my eye on avian influenza A (H5N1). Currently, avian flu is mostly an animal health issue, but we must monitor the virus closely in case it begins to spread among humans.

To be ready for the next pandemic, we must commit to developing and maintaining robust infrastructure to ensure that new outbreaks are detected quickly and that public health officials are equipped to respond effectively.

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March 26, 2023

Nash Weerasekera

The Covid-19 vaccines were developed, tested and put into arms at stunning speed — all of that took just under a year. The success of the mRNA technology and the logistics of Operation Warp Speed have made many hopeful that in future pandemics, a vaccine solution will always be close at hand.

But one of the scientists behind the Covid-19 vaccines, Barney Graham, isn’t so sure. He told me that he’s optimistic about the research side of this new era of vaccine technology — there are trials for viruses like H.I.V. and RSV underway. But, as Graham explains below, he was dispirited by the Covid-19 vaccine rollout.

Also, don’t miss a quick Q. and A. about the role that intellectual property laws play in vaccine access with Priti Krishtel and Tahir Amin, lawyers focused on patent reform.

Alexandra Sifferlin

I Helped Make the Covid Vaccine. Here’s What I Learned.

By Barney Graham

Dr. Graham helped develop the Covid-19 vaccines while at the National Institutes of Health.

As a physician-scientist who has spent nearly 40 years studying viruses and immunity, I can speak to the scientific advances that made rapid Covid-19 vaccine development possible. I oversaw the work at the National Institutes of Health’s Vaccine Research Center that provided the basis for designing and evaluating the initial Covid-19 vaccines and antibodies.




If anything about the pandemic is remembered as positive, it will be how science ‌was applied to rapidly produce medical countermeasures‌. ‌

But despite the scientific successes, I have doubts about our ability to deal with the next pandemic threat as readily as we dealt with Covid-19 — even if it is a better-known virus like influenza. Case in point, we had a monkeypox vaccine and antiviral drug before that recent outbreak, but by the time they were deployed, thousands of people were infected.

We have entered a new era of ‌‌vaccine science, but can we ‌apply our extraordinary technical capabilities toward the goal of improving public health?

My time as a researcher has encompassed both the long history of vaccine research and the race to develop a vaccine for Covid-19. Some people expressed concern that the Covid-19 vaccine development process was too fast, but the story can be told as either a one-year sprint or a 40‌-year story of scientific advances.




The scientific process is, after all, incremental, and new advances build on many prior discoveries. Ultimately, the process is intended to achieve a better approximation of the truth. In biology, I think of it as looking through a dark glass and peeling back layer after layer, gradually revealing the underlying reality. In that sense, science is a faith exercise because it is searching for evidence of things unseen. Scientists imagine what could be true and then invent approaches to show whether what we envisioned is right.

Over the past 15 years, technologies have emerged that have taken us through several more of these layers of understanding in biology, vaccines and immunity. The precision with which we can see structures of proteins — the building blocks that allow cells and viruses to function — and measure immune responses is stunning.

The time from when the SARS-CoV-2 genome sequences were available to when the first vaccines were authorized and injected into humans was about 11 months. Typically, vaccine development is measured in decades.

‌‌Forty years of research ‌‌into how to to make an H.I.V. vaccine ‌‌helped make rapid Covid-19 vaccine development feasible. These tools and others led to breakthroughs ‌that directly informed Covid-19 vaccine development in 2020.




‌Still, I am concerned that our social order and national and global governance systems are not keeping pace. Having next-generation vaccine technology without adequate systems for implementation and distribution to all people is a waste.

We can be much more prepared to predict or potentially avoid future pandemics, but we must be more intentional. This includes building better systems for local and global pandemic response coordination and making long-term investment in basic research to generate the information ‌needed to develop ‌‌vaccines, antivirals and diagnostics. There should be a much more comprehensive global surveillance program in areas with high biodiversity to identify emerging threats earlier.

And ‌‌leaders of high-income countries ‌‌must understand that it’s in their best interest to facilitate and build the capacity for vaccine research and manufacturing in low- and middle-income countries. There is an opportunity, with the advent of mRNA, to establish the capability for local ‌‌scientists to find solutions for regional diseases before they become global threats‌‌. This would also provide much-needed surge capacity during public health emergencies of international concern. ‌

The global community needs to build the capacity to immunize everyone around the world in six months during a pandemic. Failure to do so in the Covid pandemic is part of the reason we suffered through successive waves of new variants. This will require cooperative effort on the part of governments, philanthropists, academic institutions, nonprofit organizations and privately held companies.

I retired from the federal government in 2021 after more than two decades of service. While my career has been focused on the biology of viruses and immunity, the pandemic revealed disabling problems related to vaccine access and trust. Therefore, I decided to join the faculty at Morehouse School of Medicine in Atlanta to be a senior adviser for global health equity. I chose Morehouse School of Medicine, one of the United States’ historically Black medical colleges, because health equity is an integral part of its mission. It’s well positioned to influence vaccine access through advocacy, policy reform and the creation of a new generation of global health experts. It’s also an ideal place to work on building trust in science by involving more diverse investigators in discovery and achieving a deeper public understanding of biology.

We just lived through the deadliest pandemic in a century. It’s prudent to consider what has happened, learn from it and ‌‌decide how the world — and our part in it — should operate going forward.

Millions of lives and trillions of dollars were lost. Health and wealth disparities widened. Biology became politicized. We are left with ‌the burdens of long Covid and a mental health crisis. I was inspired by the effort and sacrifices made by health care providers and essential workers to keep us going, and I am hopeful because amid the despair and uncertainty I saw many acts of caring and generosity.

In 1896, William Osler, a founder of Johns Hopkins Hospital, wrote: “Humanity has but three great enemies: Fever, famine and war; of these by far the greatest, by far the most terrible, is fever.” We now have technologies that give us a chance to better prepare, manage‌ and possibly avoid future pandemic threats. ‌

In today’s world, infectious diseases can spread around the globe in a matter of hours. A problem anywhere is a potential problem everywhere, and it is in everyone’s best interest ‌to recognize and solve regional problems ‌‌before they become global ones. It will take all of us, using all the talent and resources we have, working together to avert the tragedy of future pandemics.

Barney Graham helped develop the Covid-19 vaccines while at the National Institutes of Health. He’s now a professor of medicine and microbiology, biochemistry and immunology and senior adviser for global health equity at Morehouse School of Medicine.

Q. and A.: How to Improve Global Vaccine Access

Wealthy countries like the United States had access to Covid-19 vaccines substantially earlier, and much greater supply, than low-income countries did. Priti Krishtel, a health justice lawyer, and Tahir Amin, a former corporate intellectual property lawyer, are co-founders of the Initiative for Medicines, Access and Knowledge. They shared their views on how intellectual property policy and patent systems must change to provide more equitable access.

Alexandra Sifferlin: Vaccine distribution was inequitable during the Covid pandemic. How can that be avoided through better policy?

Priti Krishtel: At a basic level, intellectual property rights exist to motivate people to invent by offering them a time-limited monopoly. During pandemics, these monopolies restrict rather than ensure equitable access. Companies instead use intellectual property to hoard knowledge, block competition and maximize revenue. To get vaccines into the hands of people, we are stuck relying on the benevolence of individual companies. It simply doesn’t work.

A good place to start is with public funding. Moderna, whose vaccine was largely publicly funded through Operation Warp Speed, has brought in a whopping $36 billion to date. It has sole control over the “recipe” that American taxpayers funded. The government didn’t retain enough rights to its investment. If it had, Moderna could have still made a handsome profit, but the United States as a global leader could have also shared knowledge and transferred technology to help save lives around the world. I think doing this differently would have bipartisan support. A really basic step that could be taken immediately by any administration is to ensure that there are always strings attached to public funding.

Tahir Amin: Credit should be given to the Biden administration for coming out in May 2021 saying it supported waiving intellectual property protections for Covid-19 vaccines. But any change in the World Trade Organization’s rules came too late, in June 2022, and did not reflect what was needed. Member states of the World Trade Organization hold the power to shape intellectual property laws and that’s where reform really needs to happen. It doesn’t work to have a handful of rich countries, which dominate the intellectual property system, determining for the rest of the globe what they can and cannot do in a pandemic. This is where we fail miserably as a global society.

What happened in the Covid pandemic was there wasn’t enough supply to meet demand. We didn’t diversify manufacturing in order to scale up supply fast enough to reach all corners of the globe. People will say there wasn’t the capability out there to do so, but I don’t think that’s true. There were companies out there with the potential to manufacture mRNA vaccines. Now these mRNA vaccine manufacturers are embroiled in litigation with each other over patent infringement and rights to the technology. The way I see it, these companies gave themselves a waiver to get ahead.

Sifferlin: What power does the United States have specifically?

Krishtel: What the Biden administration did coming out in support of waiving intellectual property protections was pretty historic. As a global leader and rule maker, this action has huge signaling effects.

At the time that President Biden made the announcement, over 1.2 billion doses had been administered worldwide, and less than 0.3 percent of vaccines had been given to low-income countries. A lot of lives had been lost. India and Brazil were surging, and there are a lot of Americans with family in India and Brazil. Many of us lost family. So the pressure was definitely on. But I think the administration met the moment and announced their support for the waiver.

But looking forward, we need to fundamentally rethink the global I.P. system. Because when the next pandemic hits, we can’t leave it fully in the hands of private companies to decide what they want to do on a voluntary basis. Sharing knowledge would save time and save lives: We need a system that incentivizes that kind of collaboration. This is the piece of the puzzle that we haven’t solved, and the United States has a significant leadership role to play.

Amin: There needs to be a level playing field. If we’re going to decentralize production and make vaccine production happen around the world when it’s urgently needed, then you actually have to transfer that capability or suspend intellectual property. It could be a pooling, for example, by country governments. They could all pool together funds and say, instead of a COVAX purchasing pooling system, there’s a research and development pooling system. That way everyone chips in, and the companies that are leading the race get their fair share. Or they can have the bigger markets, but then they allow these other countries to have access to the knowledge and technology to serve themselves.

But we don’t do that. We live with a pharmaceutical system where it’s basically winner takes all, even if they didn’t invent all of it because there was public funding.

Sifferlin: Given how entrenched these systems are, what hope is there for the changes you’re calling for?

Krishtel: The rhetoric used to be that intellectual property only exists to drive innovation, but also that I.P. has nothing to do with pricing or access. And because of the pandemic, I think people understand that’s not true. This administration made the link between I.P. and access to medicines clear, and I think public opinion has shifted as well.

We’ve heard from many people, including people who work for the pharmaceutical industry, that they see it now. People really understand the problem. And for us, understanding the problem is always the first step toward redesigning the system.


You Ask, Experts Answer

Dr. Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security, responded to a reader question about vaccine boosters.

Is there any consensus in the scientific or medical communities as to the efficacy of continuing to receive Covid boosters? I am 75 and have had four shots to date. Should I continue to get the boosters every three or four months? — Thomas A. Giles, Shreveport, La.

Rivers: A quick recap: Adults have had access to two rounds of booster doses in addition to the original two-dose series. The latest shot, an updated formulation, hit pharmacies in September.

Boosters are meant to address two problems: waning immunity, where protection from the vaccine fades, and the evolution of the virus away from what the vaccine is designed to protect against. There is good evidence that these boosters reduce serious illness — particularly in older adults, who are more vulnerable to severe illness.

It is not clear when the next round of shots will become available. Britain and Canada are offering a booster to high-risk adults this spring, but there has been no word yet from the Food and Drug Administration on whether we can expect the same in the United States. The F.D.A. has said that new doses will be annual like the flu shot, so it may be the next dose won’t hit pharmacies until fall. If a spring dose is authorized, I expect it will be for people who are high-risk.

Have a question? Reach us at next-pandemic@nytimes.com.

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