The next pandemic disease outbreak is already on the way. Only its identity remains a surprise.

Medical science is confident that the conditions for the worldwide spread of a novel, highly infectious pathogen have already been met – and the monster is already incubating in the human compost heap.

There have been seven pandemics since 2000: SARS, swine flu (H1N1), MERS, Ebola, Zika, monkeypox and COVID (which claimed 27 million lives). An eighth pandemic, HIV-AIDS, is still blazing, having killed 44 million so far.

As WHO director-general Tedros Adhanom Ghebreyesus warned recently, the next pandemic the world will face is not a “theoretical risk” but an “epidemiological certainty”.

It is high time people understood that pandemics are not an act of god, nature or an unfortunate accident. They are a direct result of human behaviour and our combined personal decisions about things like family, food, travel and lifestyle. They are an event we wish on ourselves, mostly in wilful ignorance.

Pandemics are also just one of the 10 catastrophic threats that face modern humanity – but one that is deeply interconnected with others and, so, cannot be overcome in isolation from its drivers.

Among the prime candidates for the next planetary plague are Avian flu and Chikungunya.

Avian flu (H5N1) is a serious, highly contagious strain of bird flu that has moved quickly around the world. (Australia is the only continent currently free of it). Unlike previous strains, H5 avian flu has so far been found in more than 560 bird species and 90 mammal species globally – mainly scavengers but also dairy cattle, cats, goats, alpacas and pigs. Migratory wild birds can carry bird flu long distances.

So far there have been 474 reported human cases of avian flu, mainly in Southeast Asia and China, of which 316 resulted in death. Most, so far, have been contracted through exposure to sick birds and animals: human-to-human infections are rare and thought to require further mutation in the virus. However, its very high mortality rate makes it extremely dangerous as a potential pandemic pathogen.

Just to complicate the picture, six other strains of avian flu have also been found to infect humans, though, so far, all appear less deadly than H5N1.

Chikungunya is caused by the chikungunya virus, which is spread to humans by infected mosquitoes. Large outbreaks and sporadic cases are found mainly in the Americas, Asia and Africa, with occasional smaller outbreaks in Europe. The name comes from Tanzania and means “that which bends up”, a vivid depiction of the agonising posture of infected people suffering excruciating joint pain.

The symptoms of chikungunya are similar to those of dengue and Zika, making it hard to diagnose and, thus, to determine the number of people infected. Its victims suffer fever and severe joint pain, which is often debilitating and may be prolonged; other symptoms include joint swelling, muscle pain, headache, nausea, fatigue and rash. It is mainly lethal in young children. The number of cases is thought to run into several millions so far.

No specific antiviral treatment is yet available. Two chikungunya vaccines have received regulatory approval in several countries or been recommended for use in populations at risk, but vaccines are not yet widely available nor in widespread use. However the US has recently suspended one of these over “safety concerns”, while Europe continues to use it.

World approval to develop a pandemic prevention, preparedness and response convention was granted in May 2025 – but that historic decision is still a long way from the world being ready to face the next onslaught.

Key drivers of a pandemic are:

1. Overpopulation: infectious disease spreads most efficiently when the population of the host is high. This decision rests with families worldwide.
2. Overcrowding: infectious disease also travels most swiftly when people or animals are packed together in small spaces, exchanging air, bodily fluids and touch.
3. Travel: infectious diseases spread most effectively when carried by people, mosquitoes, birds and other vectors. Global travel is a major factor, with 1.2 billion travellers moving between countries every year.
4. Decline or collapse of public health measures, eg in a war, natural disaster or through political neglect.
5. Evolution of a new, highly infectious pathogen from an existing, less harmful microbe.
6. Design of new, highly infectious agents by science.
7. Escape of infectious organisms from ruined environments – mostly caused by the industrial food system, bringing humans and wild animals into closer contact.
8. Use of wild animals as food.
9. Unhygienic intensive livestock industries that harbour and may help spread new pathogens
10. An alarming increase in drug resistance among common disease-causing organisms like TB, HIV, malaria, candida, leprosy, gonorrhoea, staphylococcus, klebsiella, shigella etc, as well as livestock diseases than can transfer to humans.

This list makes it clear why pandemics are on the rise – and humanity can expect more of them. The principal causes — overpopulation, overcrowding and world travel — are seldom discussed by global and national health authorities for fear of offending minority opinion in the world or local community. And they are the combined result of countless small personal decisions.

Consequently, current pandemic strategies are not focused on genuine prevention, but rather on limited attempts to blunt the edge of the next outbreak in a way that appeases social outrage by the ignorant.

The fact that humans are now packed into megacities round the planet like battery chickens makes future pandemics unavoidable. The fact that millions cart their diseases round the Earth every day in airliners, trains, buses and cruise ships, makes new outbreaks unavoidable. Our whole society is set up to incubate and disseminate new plagues.

A fresh source of pandemic disease is the spreading anti-mask, anti-vaccine movement, consisting largely of people who would rather risk the lives of their own children, parents or neighbours than suffer the inconvenience of a paper mask or a pinprick of demonstrably low risk. That a country, as affluent, educated and widely-travelled as the US, has knowingly set out to destroy its own healthcare system with anti-science increases the global pandemic risk for everyone.

Vaccines are a front-line defence against pandemics. Since the mid 1970s, they have saved the lives of 146 million children and infants, who would all be dead if the anti-vax movement had its way. This clearly illustrates how selfish behaviour costs lives. New vaccines undoubtedly carry risks, but killing millions because we are too scared to face them is not the answer.

The creation of the modern food system has led to the destruction of half the planet’s land area which, in turn, has released new pathogens like ebola, COVID, zika, nipah, marburg and monkeypox into the burgeoning human population as their host animals and habitats are wiped out. So, the modern diet starts new plagues, by destroying the environments that keep them in check – and we need to change what and how we eat.

The move towards a global Pandemic Convention by WHO is a vital first step – but unless it also addresses issues such as overpopulation, our unsustainable food system and mass travel it will be powerless to do anything other than take the edge off new outbreaks after they have already begun to wreak havoc.

COVID wasn’t the Black Death or the Spanish flu. It was a warning shot. And H. sapiens is still deaf to it.

A pandemic is the worldwide spread of a new disease, such as a new type of influenza virus or COVID-19.

The views expressed in this article may or may not reflect those of Pearls and Irritations.