5
Preparing for Future Pandemics
All six speakers at the forum drew important lessons from the covid-19 pandemic, both for the ongoing response and for future responses. Another pandemic “is not a matter of if but when,” said Walt. “We as individuals, our nation, and the entire global community need to be prepared.”
THE IMPORTANCE OF ENGINEERING
Engineers have been critical in addressing all aspects of the pandemic, Walt observed. For example, as the needs generated by the pandemic became apparent, “researchers embraced the expertise of clinicians to help identify problems that they were facing in the clinic,” and both groups “partnered with engineers to help find scalable solutions.”
The speed with which engineers have been able to solve problems has been remarkable, said Cheng. “Things that would have taken two weeks to do are now getting done in a day or two.” Engineers have been working with suppliers to speed up manufacturing. Governments have stepped in to provide needed support. Administrators have reduced bureaucracy and “system noise.” People have been working in shifts around the clock and using temporary staff. As an example, Cheng cited a project in which 100 parts of a vial washer and filler had to be retrofitted. “Our engineers took it upon themselves to design it, fabricate it, assemble it, and test it. It’s not normally their job, but they did it because we didn’t have the time to go out to a shop or a supplier to try to find the parts.”
This kind of passion and creativity will continue to be essential as the response to the pandemic broadens. For example, Cheng mentioned the obligation to design products not just for wealthy countries and patients but for those with fewer resources. Glass vials are expensive, which means that other options must be developed for the worldwide distribution of therapeutics. “How do we make sure we’re not just designing a lifesaving drug or vaccine for the United States and Western Europe, but we’re designing it for the other countries as well?”
“It’s our responsibility as engineers,” Walt added, “not to be complicit and create technologies and run projects that benefit only those who are willing to pay. We need to make sure that the entire profession looks at this as a community responsibility to ensure that we’re not simply driven by making products and by the profit motive but making sure that we’re helping address the problem in an equitable way.”
THE IMPORTANCE OF COLLABORATION
A rapid response to the pandemic has required deep collaboration between engineers and other professionals. Medical devices, diagnostics, and therapeutics were rapidly tested and deployed. The distribution of products has required extensive collaboration across industries.
Collaboration also extends to groups not necessarily considered in the past. For example, Walt emphasized the importance of treating community members not as research subjects but as research participants. Their needs have to be recognized and met as part of their participation, he said.
Similarly, less obvious forms of collaboration have become apparent. As one example, writing product inserts for pharmaceuticals and having them translated into multiple languages can be very time consuming, McKenzie pointed out. By working with regulatory agencies to make that information available online rather than on paper, the speed of development can be significantly improved.
THE IMPORTANCE OF BOTH SPEED AND SCALE
Collaboration is the only way to achieve the twin demands of speed and scale in responding to the pandemic. For example, “it’s going to take
more than one company and one vaccine to truly make a difference,” said Cheng. No one company can make a vaccine that will meet the needs of all countries and populations. Temperature requirements will make some vaccines better suited to some places than others. For many countries, especially low- and medium-income countries, some vaccines will pose serious challenges of affordability. In that respect, the development of multiple vaccines has been an advantage in that the ones best suited to local circumstances can meet specific needs.
Speed and scale are needed in all aspects of the response, including the production of medical devices, diagnostic tests, and therapeutics. Supplies need to be prepared in advance of developments that will require them. Mobile health needs to be implemented at a large scale to administer health care and prevent further disease transmission. For therapeutics, controlled blinded studies are needed to ensure that safety and efficacy are not compromised.
Such responses can bring multiple benefits. Alkire pointed out that the fastest country to reduce multidimensional poverty in recent years has been Sierra Leone, “and it did so during the Ebola pandemic.” To address that earlier pandemic (2014–16), Sierra Leone reformed health systems, delivered nutritional supplies to schools, mobilized communities, and took other key steps that had “a lasting impact in a positive way,” Alkire said. In responding to an epidemic, countries can use the crisis “to look at broader issues.”
THE IMPORTANCE OF DATA AND ANALYTICS
The response to the pandemic has generated huge amounts of data, Walt observed, and the amounts will continue to grow as the response proceeds. As an example, he explained that continued data collection will be critical for tracking the long-term health effects of contracting covid-19. Similarly, tracking antibody levels over time will shed light on how many people get reinfected and what levels of antibodies protect them. “It’s about getting the right real-world evidence with not tens or twenties but thousands and hundreds of thousands of people,” he said.
Innovative forms of data gathering could make the response to the pandemic more effective and efficient. For example, noninvasive monitors could collect data for use in categorizing individuals into groups depending on their likelihood of infection, with those in higher-risk groups getting tested and quarantined if necessary. Similarly, wearable sensors could enable monitoring of physiological changes potentially
associated with covid-19, such as an increase in resting heart rate, poor sleep quality, or a decrease in oxygen saturation. Smartphone apps using patient-reported information could gather data from multiple users and identify hot spots of infection. Digital contact tracing—for example, using the Bluetooth signal on cellphones—could determine whether someone has been in the proximity of others who have tested positive for covid-19.
The data may not be perfect or comprehensive, and privacy concerns are critical, but modeling can improve and anonymize information derived from the data. “In this way, at-risk individuals…get tested and they are isolated from the population before they can transmit the virus,” said Walt.
Such opportunities exist in all countries, not just high-income countries, Alkire noted. Colombia, for example, was able to combine data about poverty with health records to develop a “very powerful response to the covid pandemic that was very targeted at different people, given the information that they had,” she said. Countries with older or less detailed data might be able to do microsimulations or rapid impact surveys to identify vulnerable people.
To prevent future pandemics, Walt cited the importance of having an interconnected global monitoring and surveillance system that transcends both local and national governments. The global community could then be mobilized to ensure that an infectious agent does not spread beyond a local area before a response can be mounted. “We cannot leave it up to individual countries to close their borders or decide whether they’re going to allow international travel,” Walt said.
THE FUTURE OF WORK
During the forum, William Rouse, research professor in the McCourt School of Public Policy at Georgetown University, examined a highly consequential way in which the pandemic will influence the future: its effects on work.
The pandemic contributed greatly to concerns about a loss of jobs and whether the jobs lost during the pandemic are coming back. But these are not new concerns, observed Rouse. Projections of job loss over
the next 15 years due to automation and artificial intelligence range from 3 million to 80 million, which is half the jobs in the United States.
Given such projections, Rouse has been investigating new jobs that could take the place of those that will be lost. In ten broad categories—including mitigating the effects of climate change, maintaining driver-less vehicles, supervising cognitive aids for older adults, and providing health coaching for people with chronic illnesses—he has identified at least 23 million jobs that could be created in the near-term future.
As automation and artificial intelligence advance, for example, a major occupation for people will be trying to understand and correct flaws in systems that rely on those technologies. “Why are things not operating the way they should, and what went wrong?” Being able to answer such questions requires “sophisticated technical skills,” Rouse said. People will need to learn more fundamentals, not about thermodynamics or quantum physics but about how systems work. For example, the fastest-growing technical jobs listed by the Bureau of Labor Statistics are installing solar panels and maintaining wind turbines, both of which require technical knowledge and skill.
Rouse pointed out that the United States has 100 million disabled and older adults, representing nearly one-third of the country’s population. People could be trained to help them, even if it were from a remote location, especially now that so many people are used to interacting through devices. “You don’t have to be in their house. But you have to be trained to do it.” Telehealth took off during the pandemic, he observed, and further expansion could bring first-class, remotely delivered health care into millions of people’s homes.
Many of the jobs that Rouse has identified do not require a bachelor’s degree. But they do require both an understanding of technology and astute people skills. Rouse made the case that these skills could be gained at community colleges—which are not nearly as expensive as other institutions of higher education—and augmented with employer-based training. Enrollment in US community college is currently about 10 million, so capacity would need to expand to train the people needed for 23 million jobs.
The pandemic has forced a rethinking of many things, including higher education, Rouse observed. For example, “if you’re going to have your education be online, why not have everybody take physics from Richard Feynman, or economics from Paul Samuelson? That would change enormously the 4 million jobs that exist in higher education right now.”
Some colleges and universities with fewer resources will go out of business or be absorbed by other institutions, Rouse predicted. At the same time, educational opportunities will need to expand for the many students who face precarious job prospects, such as those who do not finish high school or immigrants with limited proficiency in English. “We have to prepare people so they can perform the jobs” that will be available in the future, he said. “As a blue-collar worker without a high school education and no technical skills, you’re not going to suddenly do these jobs.”
Preparing all students for the future also calls for a major expansion of the K–12 teaching force to ensure that everyone is prepared to undertake further education and skills training.
Some of the jobs Rouse has identified, such as teaching and health care for the elderly, would seem to require greater governmental expenditures. But he countered that supporting these jobs would save governments money because they will spend less for other services. Furthermore, the people graduating from such programs could make a living wage while paying taxes. “That’s how we get to the point where we are making money by making sure that people are healthy, educated, and productive. These are not costs. They’re investments.”
“It’s not a question of money,” Rouse concluded. “It’s really a question of will. Do we have the will to try to pursue these ends?”
Other speakers at the forum agreed with Rouse that life will be very different after the pandemic. As Cheng pointed out, people will travel less and be more flexible in where, when, and how they work. Virtual communications are here to stay. Digital network resilience, remote connectivity, and cybersecurity are essential. “Innovation and resilience will be absolutely key moving forward,” said Cheng.
CONCLUDING REMARKS
When invited to provide parting remarks for the forum, Rouse said that the world needs to become much better at anticipating challenges rather than letting them happen and then dealing with them. “There’s going to be no vaccine for sea level rise.”
Cheng agreed that sustainability will be a huge issue. “The world is going to look at sustainability differently after the pandemic,” she said.
Work, health care, education, and other basic features of society will all change, which will require that people be open-minded and flexible. “If we become more focused, science based, and data driven, we’ll get through this together.”
Alkire reemphasized the need for equity in delivering vaccines, which requires that leaders be proactive. Examples exist of benefits that emerged from crises, but achieving such benefits requires intention, energy, and making voices heard.
Work pointed to the difficulties of decoupling access from mobility. People need access to jobs, food, supplies, and so on. But when people move, the virus can move along with them. “We need to be able to see what’s going on, use the data now becoming available on transportation systems to see what’s happening, and track this before it gets too far.”
McKenzie thanked all the essential workers not only in manufacturing plants and hospitals but in schools and other institutions. If the pandemic were to reinvigorate STEM education from elementary school through college, “that would be a great outcome of what’s been a very difficult year.”
Walt cited the new collaboration of scientists, engineers, and clinicians that has created “an amazing array of capability and capacity.” The pandemic is a global crisis and requires a global solution, he said. “We cannot solve these problems city by city, town by town, state by state. We need to come together, both as a nation and as a global community, because…the problem is one that affects everyone.”
The pandemic has been a “global call to action” for engineers, Bell concluded. “We all have expertise. It’s our time to innovate and to help make this world a better place.”
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