By Umar Sheraz
Dr. Peter Black is a foresight practitioner and veterinary epidemiologist with extensive experience in addressing emerging infectious disease threats. His experience has included working as the Deputy Regional Manager of the Emergency Centre for Transboundary Animal Diseases (ECTAD) based in Bangkok with the United Nations Food and Agriculture Organization (FAO) and as Director of One Health and Director of Emergency Animal Disease Preparedness for the Australian Government Department of Agriculture. In these roles, he has managed the implementation of the Emerging Pandemic Threats (EPT) Programme with a wide range of government and non-government partners across ten countries in South and Southeast Asia. Peter has worked to introduce more strategic foresight focused approaches in both FAO and the Australian Government Department of Agriculture over a number of years. He graciously agreed to give time for an interview and help in its editing.
Umar: Thank you for giving us this opportunity to talk to you, I’ll start with something which I learned from macro history, that “the only lesson that we have learned from history is that we have learned no lesson from history”. Any comments on that in regard to the coronavirus.
Peter: I think there are partial truths there, but I don’t think it’s entirely true. I think we probably haven’t learned some of the things we could have learnt from previous pandemics or plagues going back in history, but we do understand the value of quarantine for example as a fundamental approach. But I do think that the difference now compared to the 16th century or even more recently in the early 2000s, is that the level of connection and travel and the way the globalized world is functioning now has changed, and is changing very rapidly. And I know that’s quite a cliché in some senses. What we would have learned previously about social disruption, for example, is relevant, but it depends on scale. There are also some challenges now which are quite different. And the lessons that we learned before may not be totally applicable.
Umar: Your field of epidemiology seems so data and statistics intensive while foresight is about fantasizing and dreaming. So how does foresight have a role in your particular field?
Peter: Actually, it relates very closely, in a sense, because I am an epidemiologist, whose specific area of interest is emerging infectious diseases. So there is this whole issue of emergence and what brings that forth. And if you look at what I’m trying to achieve, a lot of our work is to improve some anticipation. But it’s not necessarily as deep and holistic as it could be. For example, much of the epidemiologists work on emerging infectious diseases (in the Flatland view of Wilber), I would say is trying to be predictive. Foresight brings with it the capacity to go way beyond and understand that prediction is not the issue. It’s actually much more around the anticipation and understanding the assumptions behind why we think things might emerge as they do. On a personal level, foresight has expanded my perception of what the real drivers are in terms of emerging infectious disease and the way society thinks about them. There are a lot of technical parts to it, but the socio-economic and cultural aspects are so much more important and these help to explain why we end up with the sorts of challenges that we have. For me, foresight opened those doors up in a way that hadn’t been opened by studying epidemiology more formally. Although a lot of those social factors are definitely included and mentioned, they are often at a different level from what foresight offers.
So even if you look at the history of an issue for an emerging infectious disease, there are lots of examples in historical times and there are lots of general principles about why things happen. But we can improve on what the future possibilities are, by bringing some of the foresight frameworks to bear on the issue from a whole range of perspectives.
Umar: Ok, your field is a bit tricky and you also have to sensitize the policymakers and the bureaucrats on the need for being prepared. So how do you sensitize your audience and how does foresight come in handy when you’re talking to a decision-maker before an epidemic? Could you share some of your prior experiences?
Peter: I actually think that the health community is pretty sensitized in any case because of some of the threats that we have experienced previously. You know, even if you go back to the Spanish flu pandemic from 1918, there’s a lot of history and understanding there. And earlier this century, there was a lot of interest about the potential for another pandemic flu emerging when the influenza strain, H5N1, emerged in China. It was zoonotic and was being spread from poultry to people. People were dying and there was deep concern. So they were already sensitized, in a sense, to emerging infectious diseases. And as a result of that, there have been lots of preparations and exercises. It is interesting, though, that the virus, H5N1 caused a lot of concern, but did not end up being the virus that mutated to cause the pandemic in 2009, which was H1N1. And it didn’t come from China; it came from Mexico. So even though we were sensitized, it came from another direction. But there was a lot of planning which had gone on, in response to the emergence of H5N1 and it did help.
In my experience, foresight has helped to change the conversations around epidemics, because the responses tend to be at a very technical level. So, there is a lot of emphasis on preparedness plans, communications during a pandemic, and a full dress rehearsal of what the activities will be. But quite often there’s not much thought about, what’s actually driving this emergence in the first place. It’s as if we have almost accepted that we live on a planet and we will have diseases. While this is true, not much thought goes into whether we can actually do something in a much more primary preventive sense rather than what happens in most of the health systems on the planet, which are reactionary.
For example, there’s been a lot of effort put into improved surveillance. Surveillance is actually a secondary preventive measure. It doesn’t prevent anything from emerging. Surveillance is designed to actually detect something very early and it is very useful. But it actually doesn’t address the primary driver about why some of these things are emerging. And that’s where I think foresight really adds a lot of value. I have used a lot of frameworks to look at the way the world is functioning and why some of the emerging diseases have emerged as they have. And foresight has definitely given me a different perspective on some of those, because it’s not about the fact for example, that we’ve got a new virus which has come from a bat and that’s led to a disease. The thinking for me is much more upstream than that.
Umar: Now you have been witness to a lot of epidemics. Post-outbreak, do you think there is some sort of a change/flexibility in the perception of policymakers, politicians or bureaucrats?
Peter: History, from my perspective, would argue that in most cases it doesn’t get easier over time because the response tends to be at the level of improving surveillance, improving preparedness and actually having plans. The issues that I’m talking about are more fundamental drivers that take a much bigger mindset change, which are up against some of the more potent interests in society. Because if I look at why some of these pandemics have emerged, they very much hinge on the economic structures and the way that we have chosen or constructed our systems, especially economically. I will quote an example of the Nipah virus in Malaysia. The reason that the Nipah virus emerged was not just because there are bats with the virus there. Investigations revealed that the virus emerged in a very big piggery where flying foxes were visiting because the owners actually planted mango trees right next to the pig pens. Growing mangoes and raising pigs was a profitable business, and to actually maximize efficiency, they put them together. So they actually had a system which attracted flying foxes right above the pens where there were pigs – and that facilitated the transmission of the virus from bats into pigs and from pigs into humans, leading to deaths of both pigs and people. Retrospective modeling and research also showed that for the Nipah virus to establish, it had to be a big piggery with multiple introductions of the virus into a population with lots of young susceptible pigs. Nipah virus would not have established in a small back yard pig operation.
If you look at even the emergence of the H5N1 influenza virus in China in the early 2000s, again, the driver for that was actually increased efficiency or production of poultry, including ducks. The duck numbers in China and Vietnam rose drastically, between 1993 and 2003, and farmers were moving into ducks as they were a quick way of generating cash. At the same time, chicken production was also intensifying. So we actually had a milieu in the background for encouraging certain human behaviors which lead to conditions that are conducive to the evolution of certain viruses, and some of them will be transmissible to humans. So if I come back to the question about talking to policymakers, do they want to hear this sort of discussion? Many of them don’t. This is not the area where they would claim that their interest is. Although now with Coronavirus, I would say that we have got more interest in future planning and policy around the way that certain industries might develop and even how certain land-use change could happen in the future. But it is quite early days in that change process. There are not many examples where this thought process is really being taken on board to a great degree.
Umar: Okay, great. From your conversation, it seems that the future of such epidemics is still going to be reactionary. I don’t think the anticipation is going to be built into decision making because there is so much information and so many possibilities. How then do you think we should use foresight to actually prevent the next big epidemic?
Peter: Yeah, and I think this is one of the problems because actually if you look at what I’m fundamentally talking about, the issues which are driving the emergence are actually very much more fundamental. It comes back to things about consumption, globalization, economic growth and the way economic growth has been set up in a sense that people believe it’s infinite on a finite planet. So they are driving the issues which are overloading the planet.
In fact, the planet cannot sustain what we’re doing and we’re pushing things to the edge. The emerging infectious disease like these in more recent years are really a symptom of a planet under pressure. Now, the way to address those sorts of issues is not just necessarily around the next pandemic; you could be addressing some of these same issues to address factors contributing to climate change. For example, land-use change, the sorts of agriculture that we’re using on the planet which contribute to climate change, are also contributing to the milieu, which is going to promote the emergence of the disease. So we need much broader fundamental changes in the way we choose to live on this earth, to address this at a more fundamental level. Now is that likely to happen? COVID-19 has provided us with a big pause as well as all the pain that we’re going through. There is definitely a chance for a reset, but it will depend very much on how long this goes for and what choices we choose to make. And I believe one of the silver linings that has emerged, is an opportunity to look at and imagine new futures and to have a lot more people interested in that conversation.
It would also be true that post large-outbreaks-of-disease, the interest in foresight in countries does increase. Post-SARS, Singapore got very interested in foresight. Post foot-and-mouth disease in the UK, there was a lot of effort put in by the government there, into increasing their foresight capacity. So quite often post big-disruptions, interest in foresight increases; but it hasn’t yet led to the fundamental sorts of changes which I think are going to be required to try and address the drivers for current emerging Infectious Diseases (EID) more particularly.
With respect to COVID-19, it’s not looking too good, at the moment. But I can say that in some countries the pain may be contained a little bit and it will be less of a disruption in some countries than others. It’s more likely that if it drags out for much longer, that there’ll be more interest in actually reimagining different futures. I think the earlier that this COVID-19 is overcome, the more likely it is that we’ll snap back to maybe not business as usual, but something which is closer to something we’ve been more familiar with in recent times.
Umar: Ok. Before Coronavirus became top news, there were the SDGs (Sustainable Development Goals) in the spotlight? How do you think this particular issue will influence the SDGs?
Peter: Well, the SDGs have been set up and they satisfy so many different interest groups in a way. The problem I have had with the SDGs is I think that there is no clear hierarchy. And the reality is that if you satisfy some of the SDGs, they are in competition with each other. In my view, they are not actually all headed in the same direction. I think that there could be increased interest in explaining or focusing on some SDGs which are more relevant to the issues around this pandemic. But they would not be owned by the whole of society.
For example, the World Economic Forum, which is hardly the most leading-edge think tank, has identified pandemics as part of their list of risks for some time. Over the last number of years, the WEF has also recognized that the importance of environmental issues has increased. But how is that going to get translated into which SDGs get prominence? You know, the economy is a wholly-owned subsidiary of the environment and not the other way round. And yet within the SDGs, there’s all this balancing, trying to make sure that things actually happen and to keep so many stakeholders happy. The true meaning of sustainability would be a pretty good place to start a dialogue. And I don’t see that the SDGs actually address that very much at all. Sustainable development does not equal sustainability, in my view.
Umar: There is a lot of chaos and insecurity in the developing world and concern for the people who are the least disadvantaged. So do you think there could have been a different approach to address this virus; the developed world versus the developing world?
Peter: Actually, I don’t think there could have been much of a very different approach. The actual tools that you have at your disposal when a new virus emerges like this are very limited and they are the tools that are being currently used. You do not have a vaccine or treatment. You are back to the same measures which were available in medieval periods, basically. You’re talking about separating people who are infected. The countries which have been successful without very draconian measures have had very good tracing and tracking of the contacts with those people; testing them and then isolating them. In countries that are either too late or did not have the capacity to do that, they had to put in measures to stop movement, for people to quarantine themselves or isolate themselves or limit contact to prevent transmission.
What we are seeing is that even with countries with very good health systems, if you did not act early; even if you have instituted these measures, it is going to take a number of weeks to see the results. So some countries have gone much harder, much earlier and their economies have taken a bigger initial hit. Most countries have now realized that there is not much option. They need to stop transmission, which means using those very limited tools to the best of their capacity. There is no magic bullet here that is why everybody has to use a similar approach. Unfortunately, countries with low development and with limited economic resources, are feeling the pinch much more.
Umar: Okay, so six months or a year from now, how do you see this evolving. Will there ever be closure?
Peter: It would end in that it will not be as it is now, but it is very likely this virus is going to be around for the long term. I envision a scenario where It might mutate and become less virulent and we will be seeing less severe cases of disease over time. But this virus is well seeded in the global population and even with a vaccine in about 12 to 18 months, I cannot see it being removed from the list of various respiratory viruses that are floating around the planet.
Another thing that should not be discounted is that the COVID-19 virus is part of the coronavirus family and closely related to the SARS coronavirus, but it continues to mutate. Unless there is a vaccine that covers this class of coronaviruses more generally, it is quite possible that another pathogenic coronavirus could emerge in the future.
I think they’ll be some very big lessons learned from this pandemic. But how those lessons are applied in countries that do not have advanced health systems to deal with such threats, will also be a huge challenge.
Umar: There is now talk of a second wave of infections in China? Do you think that could be an issue, later on?
Peter: This is a novel virus, so there is not much history to fall back on. I think what we will see is that even after we’ve got it under control and the number of new cases in a country starts to stabilize, it seems that the only way to move forward would be to take the pressure off the brake to see how cases evolve. If there is a quick increase in cases again, above a certain level, it’s likely the brake will go back on. And that could happen a number of times before a vaccine or a good treatment is available. So I don’t think it’s just going be a second wave. I think it’s more likely to be a number of waves over time, depending on how successful and how hard the pressure is put on to keep the transmission at a low level.
Umar: Okay. So any time estimates, we think that the lockdowns will be over and things get back to usual. Any guesstimates?
Peter: Currently I am reading from a whole range of people who are running different models around the planet. I can’t see things getting back to normal in most senses for quite a long time, in most countries. I think that there are going to be forms of physical distancing and behaviors which are going to be quite different until there is a vaccine and/or there is a good level of immunity across the whole planet. And that would be in terms of years. In the next six to twelve months, I would be very optimistic and hopeful that most countries come through this with enough capacity to start to very slowly recover. But I do not think it’s going to be back to business-as-usual at all. And I think some countries are going to find it very difficult to deal with a whole range of socio-economic issues as a result of this pandemic. I don’t discount the fact that there will be some countries which are going to have quite large death tolls because there’s just not the capacity to put in measures which are going to achieve the sorts of social distancing and quarantining which is required. And they certainly don’t have health systems which can offer the sort of care that’s going to be required for very acute cases.
Umar: Dr. Peter, is there anything you want to say to the JFS audience?
Peter: I think there is some tension that I’m picking up, globally as well as in the foresight community, whether this is going to be the big opportunity for the reset that some people are hoping for. Our relationship with the planet is being highlighted to such a degree that for many people they will question and assess what their preferred future is, and that’s a very good thing. But while planning preferred futures for societies, I would still ask, who benefits from this practice. That’s going to be a very important issue to be addressed at the broadest level. Inequity and inequality need to be central in that argument. Reestablishing, transforming and reconfiguring the whole social structures and economics would be fantastic. But it will take some real imagination and drive for people to achieve that. I’m living in hope that, that can happen.
I am also picking up on discussions about whether what we learn from COVID-19 could be applied in some way to help address the climate change challenge. Especially now that the attention of politicians is so focused on the consequences of COVID-19 in terms of mortalities – and economics -and the numerous models and scenarios that are being debated. Climate change seemed to some politicians to be more of a slowly evolving issue that could be kicked down the road or ignored, but I can now see how it might be possible to leverage the learnings here from COVID-19 – which has been fast-paced – to alert more to this even bigger threat to human civilization. And the need to act big and act fast.
Umar: Beautiful. I observed you used metaphors at the Asia Pacific Futurists Network (APFN) conference in Bangkok last year. How important do you think is the role of metaphors in thinking about the future?
Peter: Actually, I think metaphors are absolutely central to any preferred future post-COVID-19. For example one of the metaphors that is being used frequently is the “war” metaphor for fighting this virus and I think it is very unhelpful. The current chain of events is a co-evolutionary process in terms of the human population and a virus and we are not trying to win a war. This virus does not have a strategy to beat the human race. The usage of the war metaphor discounts or limits the number of options that become available to address the challenge. There are other metaphors that are much more useful for us to think about our preferred future, which is very different from anything to do with war.
I would also like to see that the metaphors that we use around the future of the planet have a very positive, hopeful and caring basis for people. The drive towards that becomes much more humanitarian – rather than technical – and much more nuanced and sophisticated rather than just addressing a health threat.
Umar: Dr. Peter, Thank you very much for your wonderful insights and for your time.
Umar Sheraz is the blog editor of the Journal of Futures Studies and can be reached at umar_sheraz@yahoo.com. He works at the Centre for Policy Studies at COMSATS University Islamabad, Pakistan.
