The next biothreat is inevitable, and the absence of policies to combat it will lead to disaster.

The COVID-19 pandemic has revolutionized public health infrastructure in the United States. Health care expenditures have grown at a record-high rate, the development of vaccinations has been streamlined, and the federal government has enacted several policies aimed to support pandemic preparedness through disease surveillance and medical education. This strengthened infrastructure has enabled our nation to combat COVID-19, maintaining low levels of spread and reducing mortality rates considerably. Our success in this battle has prompted public health experts to announce the approaching end of the COVID-19 pandemic. Combined with public exhaustion of pandemic life, however, such announcements may lead to a diminishing of the significant health infrastructure and pandemic preparedness improvements made in the past several years.

This comes at a particularly dangerous time. WHO public health officials have recently hypothesized that a novel adenovirus may have caused over 450 worldwide cases of acute severe hepatitis of unknown origin. Pediatric populations have been especially vulnerable, and infected individuals have presented with severe gastrointestinal symptoms and acute hepatitis. The possible emergence of this novel adenovirus must signal to our nation that we must not just maintain our strengthened health infrastructure but in fact improve it further. The next biothreat is inevitable, and the absence of policies to combat it will lead to disaster.

As such, we write to urge public health systems to continue funding for the development of diagnostics, therapeutics, and vaccines. Health facilities must be prepared to rapidly roll out diagnostic devices to the public in preparation for the spread of an adenovirus. Additionally, no approved antiviral therapies specific to adenovirus infection exist, and there is no existing adenovirus vaccine available to the general public. Given the possible emergence of this novel biothreat, funding for vaccine research and development must be enhanced to enable a streamlined development of therapeutics and vaccines.

Furthermore, we argue for enhanced data infrastructure for disease surveillance. Throughout the COVID-19 pandemic, US states have used different approaches to track new cases and deaths, complicating efforts to monitor the virus. These errors demonstrate the need for integrated, real-time data on infections, hospitalizations, deaths, and immunizations in preparation for future biothreats.

Additionally, our nation must implement domestic pandemic-response workforces. With hospitals reaching full capacity and health care workers being exhausted through the COVID-19 pandemic, the need for out-of-hospital health professionals trained in pandemic response is clear. We argue that EMTs and paramedics must be trained in adenovirus-response protocols and be enabled to provide more extensive treatments to patients outside the hospital.

Finally, we must combat misinformation and maintain consistent messaging across public health agencies. The COVID-19 pandemic has shown us that political leaders are significant drivers of public attitudes toward pandemics. These leaders must be advised by health care experts and be held accountable for presenting only accurate, consistent health information to the American public.

About the Authors

Faraan Rahim, BSc, is a fourth-year undergraduate student studying chemistry at Duke University. Faraan is a certified Advanced-EMT and has received emergency response training from the  Allegheny Health Network and UPMC hospital systems. He also serves as a training officer with Duke University EMS. Faraan is passionate about optimizing health care delivery, especially in the context of emergency medical services. In the future, Faraan would like to attend medical school and pursue a career as an emergency medicine physician.

Bhav Jain, BS, is a recent graduate of the Massachusetts Institute of Technology (‘22), where he pursued a Bachelor of Science in Computer Science and Brain & Cognitive Sciences. As the 2022 Truman Scholar from Pennsylvania, he is interested in global health care delivery and transforming clinical care as a future physician-policymaker. His research spans oncology delivery, health disparities, and health systems transformation, and has been published in outlets such as Nature Medicine, JAMA Oncology, and American Journal of Public Health. Additionally, he engages with undergraduate students and physicians across 20 states through his nonprofit organization, The Connected Foundation, which partners with health care systems to support seniors transitioning from inpatient or clinical to home-based care.

Sandeep Palakodeti, MD, MPH, is a physician leader, entrepreneur, researcher, and innovator who has spent most of his career building and practicing in value-based models of care. He has continued to research on a wide variety of topics including innovative care models, the transition to value, and clinical outcomes. Dr. Palakodeti currently serves as co-founder and chief medical officer of Hopscotch Health, an advanced primary care provider serving rural communities. Previously, he has held senior leadership roles at University Hospitals health system, CareMore, and the Mayo Clinic. Dr. Palakodeti is a practicing primary care physician and trained at Kaiser Permanente and Harvard Medical School. He currently lives in Ohio with his family.

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