Pandemic origins and a One Health approach to preparedness and prevention: Solutions based on SARS-CoV-2 and other RNA viruses

Abstract

COVID-19 is the latest zoonotic RNA virus epidemic of concern. Learning how it began and spread will help to determine how to reduce the risk of future events. We review major RNA virus outbreaks since 1967 to identify common features and opportunities to prevent emergence, including ancestral viral origins in birds, bats, and other mammals; animal reservoirs and intermediate hosts; and pathways for zoonotic spillover and community spread, leading to local, regional, or international outbreaks. The increasing scientific evidence concerning the origins of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is most consistent with a zoonotic origin and a spillover pathway from wildlife to people via wildlife farming and the wildlife trade. We apply what we know about these outbreaks to identify relevant, feasible, and implementable interventions. We identify three primary targets for pandemic prevention and preparedness: first, smart surveillance coupled with epidemiological risk assessment across wildlife-livestock-human (One Health) spillover interfaces; second, research to enhance pandemic preparedness and expedite development of vaccines and therapeutics; and third, strategies to reduce underlying drivers of spillover risk and spread and reduce the influence of misinformation. For all three, continued efforts to improve and integrate biosafety and biosecurity with the implementation of a One Health approach are essential. We discuss new models to address the challenges of creating an inclusive and effective governance structure, with the necessary stable funding for cross-disciplinary collaborative research. Finally, we offer recommendations for feasible actions to close the knowledge gaps across the One Health continuum and improve preparedness and response in the future.

Keywords: COVID-19 origins and spread; Drivers of emerging infectious diseases; One Health solutions; pandemic preparedness; spillover and spillback.

Fig. 1.

Time line of the emergence and repeat spillovers to humans for a sample of RNA viruses and Monkeypox virus from 1997 to present. Repeat spillovers are indicated in red (the countries involved are in parentheses). The large font identifies the three recent emerging epidemic/pandemic CoVs. EBLV-2, European Bat Lyssavirus Type 2; DRC, Democratic Republic of Congo; HKU-1, HKU-1 coronavirus; HTLV3, Human T-lymphotropic virus Type 3; HTLV4, Human T-lymphotropic virus Type 4; SFTS, Severe Fever with Thrombocytopenia Syndrome virus; CCHF, Crimean-Congo Hemorrhagic Fever virus.

Fig. 2.

Time line of the emergence of CoVs in people or livestock over the past millennium. Evidence supports the origin and emergence of many of these viruses in wildlife, including bats, other mammals, and avian species, often involving an intermediate animal host. The time of the initial spillover as determined by molecular clock analysis or the discovery of the virus by epidemiologic or virologic methods, presumed reservoir host, and the major intermediate hosts for human and swine CoVs are depicted. Black animal silhouettes indicate the likely reservoir (above) or intermediate host (below). PDCoV, porcine delta-coronavirus; SADS-CoV, swine acute diarrhea syndrome coronavirus. HCoV, Human coronavirus; PHEV, Porcine Hemagglutinating Encephalomyelitis virus; HKU-1, HKU-1 coronavirus; Hu-PDCoV, Human-Porcine Delta coronavirus; Hu-CCoV, Human-Canine coronavirus.