Governments must strengthen their ability to respond to unpredictable global emergencies rather than concentrating almost exclusively on familiar infectious diseases, according to British epidemiologist Sir John Edmunds, who has warned that future pandemics could emerge from threats that health authorities have not yet anticipated.
In an interview with the Spanish newspaper EL PAÍS during a visit to Madrid, Edmunds said that although respiratory infections, particularly influenza, remained the most likely source of another pandemic, a much wider range of infectious diseases could trigger major outbreaks through different transmission mechanisms. He also identified natural disasters, human-made threats and misinformation as risks requiring greater attention.
“The most dangerous are the last ones: things we do not even know that we do not know,” Edmunds said, referring to the classification of known and unknown risks associated with former US Defence Secretary Donald Rumsfeld. He described such unpredictable events as potential “black swans” and argued that governments needed resilient and adaptable systems capable of responding to emergencies that could not be anticipated.
Edmunds, chief scientific adviser to the British Foreign Office, has been involved in responses to major health emergencies, including the 2014–2016 West African Ebola outbreak, the deadliest recorded, and the Covid-19 pandemic, during which he advised the British government. He recently returned from the Democratic Republic of the Congo (DRC), where he followed the latest Ebola outbreak, which has reportedly caused more than 5,000 deaths.
During his visit, he travelled to Bunia, the outbreak’s epicentre, and observed a response that differed significantly from the international intervention during the West African epidemic. The current response is being led more extensively by African institutions, which he described as a positive development.
Scientific and technological capabilities, as well as organisational arrangements for deploying specialists to remote locations, have improved, he said. However, the outbreak is unfolding in an area affected by armed conflict, creating additional obstacles. Edmunds said he had been told that approximately 250 armed groups were operating in eastern DRC, some highly organised and others considerably more chaotic. The humanitarian crisis in the region has further complicated efforts to contain the disease.
Edmunds said influenza remained the most likely candidate for another pandemic because such outbreaks occur periodically. “We know that influenza will cause another pandemic and that it is only a matter of time,” he said. However, he cautioned against allowing preparations for influenza to dominate pandemic planning.
He cited mpox, previously known as monkeypox, as an example of how infectious diseases could spread through mechanisms different from those associated with respiratory viruses. Although first identified in 1970, the disease reached Europe and North America in 2022 and subsequently spread internationally through close and prolonged physical contact.
He also pointed to HIV as a major pandemic whose continuing impact is often overlooked. “The last great pandemic of the 20th century is something people have forgotten or do not usually consider in pandemic terms: HIV. We are still in the first wave 40 years later,” he said.
The consequences of inadequate pandemic preparedness extend beyond public health, affecting economies, education and children’s academic performance, Edmunds said, citing the Covid-19 experience.
Natural disasters, particularly floods and heatwaves, were another growing concern. Edmunds said climate change was likely to increase their frequency and intensity, requiring stronger efforts to mitigate climate change and improve emergency response arrangements. He also warned that human-created threats had not disappeared and were likely to have increased over the previous five or six years.
Artificial intelligence represented both a threat and an opportunity, he said, while misinformation posed a wider challenge to society. However, he cautioned against addressing misinformation in ways that could undermine democratic freedoms and the acceptance of differing opinions.
Scientists and public institutions should instead improve the quality of their evidence, maintain objectivity and communicate findings clearly, including acknowledging uncertainty rather than presenting unresolved issues as settled facts.
“We have a responsibility to explain science as clearly as possible and not pretend that things are clear when they are not,” he told EL PAÍS.
