Flailing in the Waves: How U.S. Neglect and Avian Influenza Threaten Global Pandemic Prevention

I watch the merganser flailing pitifully in the surf as I look out over Long Island Sound from the deck. The distressing sight corroborates the many reports of avian flu outbreaks along the East Coast and what I have known all along: It is only a matter of days until we will see the impacts of avian influenza in our own backyard. The dying merganser serves as a stark reminder of why our work with the Intergovernmental Negotiating Body (INB) on a WHO instrument for pandemic prevention, preparedness, and response is vital as an environment-focused civil society organization.

As I prepare for the upcoming thirteenth meeting in Geneva next week, I ponder the changed landscape in which these negotiations will proceed. Since the INB12 meetings last September, we have seen multiple outbreaks, most notably Marburg virus disease in Rwanda and Tanzania and Ebola Sudan virus disease in Uganda. Ongoing. However, while we tend to look south when it comes to emerging infectious diseases, we absolutely must focus closer to home. After making landfall on the North American continent in 2021, H5N1 avian influenza has developed the ability to circulate in wild birds successfully and has become endemic in the USA. Here, it continues to dramatically impact biodiversity, killing millions of wild birds and tens of thousands of wild mammals while causing economic distress across the poultry industry and anyone who eats eggs.

Additionally, and most importantly, in March 2024, the H5N1 avian influenza virus, to the surprise of many, crossed over between wild birds and cows in Texas and successfully established itself in the nine million-strong U.S. dairy cow herd. Through the unrestricted movement of animals, coupled with inadequate surveillance and mitigation measures, the virus has now infected nearly 1,000 herds across 16 states. This genetically homogenous pool of bovines now constitutes a fantastic evolutionary opportunity for the virus, as continuous cryptic spillover events between dairy herds, humans, domestic cats, and other species drive the evolution of novel viral characteristics.

This evolutionary process is further facilitated by the fact that influenza viruses have a nifty trick up their sleeve, a process called reassortment, which allows them to exchange large chunks of genetic material – and thus traits — when they encounter another influenza virus, like human flu, in their shared host cell.

While the immediate threat to humans remains low, as the virus has not yet acquired the ability to transmit between humans, there is no question amongst experts that this situation is frightening and future developments are highly unpredictable. This unpredictable nature of the ongoing outbreak has been compounded by the fact that the present administration has started the process of withdrawing the United States from the World Health Organization (WHO) and has instructed key federal health agencies, such as the Centers for Disease Control (CDC), ?to pause external communications with the WHO and the public.

There is no need to look south. There is no question that, today, the USA constitutes the greatest global influenza pandemic threat. Both as a source of the next pandemic influenza virus, as H5N1 circulation and evolution continue unabated and poorly observed and communicated across the country, and by withdrawing from its global commitments and responsibilities the US disregard has lethal potential.

Tackling global infectious disease outbreaks, epidemics, and pandemics requires, above all, transparent, trusted collaboration, as the Global Influenza Surveillance and Response System (GISRS), a cornerstone of global health collaboration, exemplifies. ?This crucial and successful collaborative global response platform helps mitigate the effects of pandemics, such as the 1957 H2N2 outbreak, while ensuring the efficacy of current seasonal influenza vaccines. Over seven decades and through three pandemics, the system has expanded to address threats from zoonotic influenza A subtypes and other respiratory diseases. Most recently, GISRS proved essential during the COVID-19 pandemic, with its network facilitating timely virus detection, sharing of reagents, and enhancement of pandemic preparedness. It continues to set the standard for international cooperation in tackling public health crises and remains a model of global cooperation in protecting public health.

Next week, the INB negotiation efforts in Geneva will need to focus on global collaboration by building on the experience, trust, and transparency of successful global efforts such as the GISRS while not letting the short-termism of the U.S. administration derail them. With its decision to leave the WHO, the U.S. diminishes the world’sability to effectively address global health emergencies, such as the next influenza pandemic, posing a significant public health risk to other Member States. With the U.S. facilitating the international spread of disease, some [@ArnoldBosman et al.] have correctly argued that this situation merits recognition as a "Public Health Emergency of International Concern."

It is a simple truth that infectious diseases know no borders. Their spread underscores the critical need for a strong, reliable, and committed network to detect threats early and respond effectively. The escalating avian body count and emerging mammalian mortality spotlights this fact. We do not want to find ourselves ailing and flailing like the hapless merganser. We join ?a multitude of colleagues around the globe in urging national and international political and public health leaders to address this development with the urgency and cooperation such a designation requires by doubling down on collaborative efforts to finalize a comprehensive pandemic agreement. Such a commitment is essential for safeguarding global health and ensuring humanity's collective well-being.