No one can predict the next pandemic

Anh Đức

As the aftermath of the COVID-19 pandemic still lingers, three years after the first patient was identified, Việt Nam News’ Anh Đức talked with Sir Jonathan Stafford Nguyen Van-Tam, former Deputy Chief Medical Officer for England and consultant to vaccine maker Moderna, for insights into how humankind can prepare against the next unknown transmissive diseases.

How do you feel about this trip, coming back to your roots in Việt Nam? Were you excited?

This is my first time in Việt Nam, and I suppose it’s a very emotional trip because when I was a small child in the UK growing up, my father, who is a teacher, talked about Việt Nam. He talked about his education, and how strict it was, and how the UK was nowhere as strict. And he talked about having to walk miles to get to school.

So I built up this kind of picture in my head of what Việt Nam was like, or at least what it was like in the 1930s, 1940s, and early 1950s.

When I got the chance to come back (to Việt Nam) – I still say, automatically, to ‘come back,’ but I’m not really coming back. I knew Việt Nam would be different.

And I knew from Ambassador Long (Nguyễn Hoàng Long, Việt Nam Ambassador to the UK), it would have progressed so much more than when my dad left it.

It was very emotional to be here for the first time. To feel like I kind of knew the place at one level, and yet to realise, at another level, I didn’t know that place.

It was more like the world I already knew, from Britain. So quite a blend of feelings, but quite emotional because my dad died in 2015. So this is really was about, you know, a journey that I’m making almost on his behalf, as well.

You say you have a picture of Việt Nam in the 1930s and 40s. When you came here, what was for you the most substantial difference between the Việt Nam in your picture and the Việt Nam that you have seen for yourself?

Modernisation, very, very simply, at almost every level. And you can see that there’s a massive amount of construction and development going on. When I landed here, I saw a country that is moving fast to develop. I think that we’ll see the big difference.

You are the first British person of Vietnamese descent to receive knighthood from the Royal Family. Can you tell us more about that?

It was a truly incredible honour. It obviously came on the back of serving the government in the UK, during the pandemic.

You know, when you get pulled into an emergency like that, as a public health doctor, you’re focused on what you can do to solve the problem, not what the consequences might be for yourself.

One of the nice consequences was to be very surprised to have been selected by Her Majesty the Queen (Queen Elizabeth II) at the time, to be awarded knighthood.

It’s just a very special accolade and it’s a very special day to attend your ceremony.

Let us move on to a subject that is perhaps more to your liking, which is about epidemiology and viruses. Professor Tam, in your opinion, how has epidemiology evolved over the years? What do you think are the key advancements that have shaped the field?

I think the basic theoretical aspects of epidemiology are still quite simple. What’s changed is that researchers in other areas of medicine have realised that they need epidemiological methods to do high-quality studies.

But that’s now changed; you know, orthopaedic surgeons, if they want to do big studies, need to understand epidemiological methods quite often. Epidemiology has kind of moved out into other bits of medicine.

The other thing that has changed since I was a boy is the business of statistical analysis, that has really completely changed, and it’s changed partly because of computerisation.

Since the early 1990s, computerisation has changed everything. The kinds of research techniques available, particularly multiple multi-variable regression techniques, and the level of statistics I no longer understand, has really changed everything, I think.

Continuing about the new technologies like AI and new computing power, what role do you think these technologies can play in the design of new vaccines to prepare against new diseases?

That’s a very good question. We already know, for example, that machine learning can teach computers to read fundus photography, that’s the photographs of the back of the eye, better than humans. There are already systems around the world where humans no longer look at the images from the back of the eye, instead, the computer looks and detects subtle abnormalities. Because machine learning learned from looking at millions and millions of films.

There are already areas like that, where AI has changed the world. We’re just getting into this new world now, beyond machine learning of AI, where the machines are creative too. We’re seeing it in the university sector, we first saw it, I think in terms of the idea that students could submit, they could ask ChatGPT, to write an essay for them. And we wouldn’t know the difference. That was the kind of low hanging AI.

What AI can also do, I think, in the future, is identifying new targets for drugs, and for vaccines, in a way that it would take humans much, much longer to do. I think AI is going to eventually – maybe not now, maybe five years from now, maybe ten years from now – but eventually AI is going to drive drug design and vaccine design in a way that is revolutionary.

But I can’t quite tell you how. Because we’re not there yet.

In light of the recent global pandemic, what lessons have we as humans learned about pandemic preparedness? How can the healthcare systems of countries such as the UK or Việt Nam learn and better themselves to prepare for this?

We just faced a very severe pandemic. We would probably say it was the most severe pandemic since the influenza pandemic of 1918.

This tells us that although we have societies that are much more modern than society was in 1918, we could still have a virus that causes enormous public health problems and enormous damage.

It also tells us that pandemics keep on happening. And if you go back 100 years, there have been five respiratory pandemics: four of them have been due to influenza: 1918, 1957, 1968 and 2009, and one of them has been a coronavirus in 2020.

We’ve had five pandemics, respiratory pandemics, in 100 years. That’s why I say to young scientists in my lectures, the chances of another pandemic in your working lifetime are almost 100 per cent.

They’re much higher than the chances of a pandemic in my lifetime, when I was your age: I’ve actually had two pandemics in my working life: 2009 and 2020.

What I would say is that it’s easy, in a kind of political sense, to say, “Wow, you know, this was a once in a lifetime experience,” you know, they can forget about this.

Now, for the next however many years, I don’t think you can forget about these things, I think there’s ever precedent threats. And you can’t predict, if you could predict the next pandemic, if you could just predict the timing of it, you’d be very, very, very rich indeed — because everybody would want your knowledge.

But nobody can predict pandemics. The more you try to predict them, especially in public, the more often you’re wrong. But I can say it’s almost certain that there will be more. And we need to make sure that we learn from what happened this time.

We need a whole cohort of health professionals, but also government professionals, who understand the need to keep pandemic planning alive, and to keep systems ready to respond.

In your opinion, what are some of the most significant, immediate emerging threats to public health? How can we proactively address them?

I’m going to surprise you here. But the thing I see, when comparing the UK, for example, to Việt Nam, is I see in the UK, we have a population that is ageing, there are already more old people than there are young people, there are already people living a very long time with chronic diseases.

Now, in Việt Nam, the age population pyramid is different. There are many more young people. But it’s going to be really important to think about what happens 30 years from now, what happens 40 years from now, in Việt Nam, when I predict that your population would change in its demography to become older, with more chronic illnesses.

Your health system in the future will need to deal with other kinds of things we’re trying to deal with now, in the UK.

My encouragement is, don’t take a two- or three-year view of things. Only take a 10-, 20-, or 30-year view, try to think almost beyond your own working lifetime.

Think for the next generation. What’s it going to look like, and what do we do now to try and make that better.

That probably wasn’t the answer you were expecting, you’re probably expecting me to name a particular virus I’m worried about or something. I’m always worried about a flu pandemic, but actually with my kind of broader public health hat on, I’m worried about ageing populations, and they’re changing healthcare demands.

On top of that, we live in a world where we just have to accept that climate change started. Global warming is going to change the ecosystem and these rare pathogens that depend upon, for example, insect vectors, they’re going to penetrate more and more areas of the world and become more and more problematic, rather than less problematic, if climate change continues, but I’m not a climate change expert.

You are a leader in the field. Do you have any advice you would like to give us younger individuals who are aspiring to pursue a career in science and research?

The first piece of advice is that if you’re going to find something in science that you want to pursue, and become the very best at it, you’ve got to choose something that really, really interests you. Something that really burns you up at night, something that you have a passion for. Choosing the right subject that suits you, and suits your kind of aspirations, your motivation, is critically important.

The first thing I always say to young scientists and your doctors is; don’t be in a rush. You’ve got many, many years of work ahead of you, you have got time to experiment with and see different bits of science, see different bits of medicine, and decide which bit is the bit for you.

For me it was respiratory viruses. I just found them absolutely fascinating. They felt like a moving target and because of that I felt it was something that could kind of keep me interested for years and years to come.

I’ve been looking at researching respiratory viruses since 1991 and I’ve never found a reason to move away from that field.

The second thing, and I don’t apologise for saying this, is that you are only held back in life or limited by your own drive and your own ambition. It really is up to you how hard you want to pursue that career. But if you are going to make it in science and research in particular, you end up at some point having to be really dedicated.

You end up at some point having to give very large amounts of your time, not just your professional time, but your personal time as well, to study and to learning. And you have to keep on learning.

So I can kind of give a warning to – without apology – to young scientists, that you’re going to have to work really hard and you’re going to have to be very motivated. VNS