Preparedness for the next pandemic: Lessons from COVID-19

Five years ago, the COVID-19 pandemic swept through the United States, overwhelming healthcare systems, upending lives, and exposing critical gaps in our preparedness for public health crises. New York City — home to the largest public healthcare delivery system in the country — became the epicenter of the epicenter, facing an influx of critically ill patients unlike anything seen before. Since January 2020, the US has recorded over 1.2 million opens in new tab/window deaths from COVID-19, with millions more hospitalizations.

As we mark this solemn anniversary, we must turn our attention to the future, ensuring that we are better prepared for the next pandemic — which may be closer than we think.

Today, the growing threat of H5N1 bird flu looms large. While it’s not yet a human pandemic, and hopefully will never be, the virus’s evolving nature and its ongoing sporadic spillover from animals into humans underscore the need for swift action. If H5N1 were to gain efficient human-to-human transmission, the speed at which we source, assess and disseminate quality public health information would determine our ability to respond effectively. The COVID-19 pandemic provided a stark lesson in the dangers of mis- and disinformation and evolving public health guidance — a challenge that must be addressed before the next crisis unfolds.

The challenge of rapidly evolving guidance

During the COVID-19 pandemic, healthcare professionals struggled to keep pace with the constant evolution of clinical and public health recommendations. Variants such as Alpha, Delta, and Omicron fundamentally altered the trajectory of the pandemic, forcing continuous updates to treatment protocols (e.g., resistance to monoclonal antibodies), infection control measures (i.e., changes in isolation and quarantine guidelines) and testing guidelines (e.g., PCR test sensitivity to previous infections and shorter incubation periods for certain variants). The Omicron variant, which emerged in late 2021 opens in new tab/window, has since given rise to an ongoing “Omicron dynasty” with numerous subvariants. The rapid evolution of the virus meant that healthcare professionals were constantly adjusting strategies based on emerging data, sometimes with little time or advanced notice.

Vaccine recommendations, for example, had to be updated multiple times to better match the circulating variant or offer an additional booster dose to those who are immunocompromised. Since the first COVID-19 vaccines were introduced in December 2020, mRNA vaccines have undergone at least three updates opens in new tab/window to improve efficacy against new variants. While these advancements have saved lives, they have also introduced significant challenges in communicating changing recommendations to the public.

In addition, providing guidance with humility is a crucial lesson learned. Healthcare leaders and public health officials must communicate clearly that recommendations are based on the best available evidence at the time and may evolve as new data emerge. For example, during the COVID-19 pandemic, early guidance on masking led to public skepticism when recommendations changed. Presenting guidance as absolute fact, rather than as the best current understanding, can undermine trust when updates become necessary. Leaders can build public confidence by acknowledging uncertainty and emphasizing the evolving nature of science.

The experience of navigating the pandemic highlighted an urgent need — a robust system for quickly synthesizing and disseminating reliable, evidence-based information to frontline workers.

Investing in information infrastructure

Recognizing this need, NYC Health + Hospitals opens in new tab/window has developed a homegrown tool — the Policy + Resource Hub — to support the rapid creation, updating, sharing and dissemination of critical information. This centralized platform provides real-time access to public health guidance, clinical protocols, resource updates and policy changes, ensuring that healthcare professionals can quickly find trustworthy information during a crisis. By investing in such infrastructure, the health system is addressing one of the major pain points of the COVID-19 response: the struggle to stay ahead of evolving guidance amid an information deluge.

The Policy + Resource Hub exemplifies how healthcare institutions can improve real-time decision-making. When the next pandemic strikes, health professionals will need immediate, vetted information to inform patient care and public health strategies. The alternative, fragmented and sometimes contradictory sources will only exacerbate confusion and delay life-saving interventions.

A roadmap for future preparedness

In our new book, The COVID-19 Response in New York City: Crisis Management in the Epicenter of the Epicenter opens in new tab/window, we provide an inside look at how the largest public healthcare delivery system in the US navigated the worst public health crisis in modern history. Through firsthand accounts, we offer lessons learned from surge staffing, patient load-balancing, ICU management, supply chain constraints and the emotional toll on healthcare workers. This book can serve as a blueprint for healthcare systems worldwide, offering strategies for future pandemic preparedness and response.

One critical lesson from COVID-19 is the need for clear, coordinated and science-based communication. Throughout the pandemic, misinformation proliferated, leading to vaccine hesitancy, resistance to public health measures and preventable deaths. The rapid spread of false information on social media and other platforms remains a persistent challenge, one that could severely undermine efforts to control future outbreaks.

The impact of misinformation on the COVID-19 pandemic has been extensively documented. As outlined by a study opens in new tab/window by Ferreira Caceres et al (2022), misinformation has played a pivotal role in shaping public attitudes and behaviors, influencing vaccine hesitancy, mask refusal and even the use of ineffective treatments. The study highlights the critical role media and communication platforms have in either disseminating accurate health information or amplifying misleading narratives. The authors emphasize that misinformation not only undermines individual health but also burdens health systems, exacerbating the challenges of outbreak response and disease containment.

NYC Health + Hospitals led one of the most successful public health communication initiatives in the US: the Be a COVID Vaccine Champion series opens in new tab/window. This nationally recognized program trained both healthcare professionals and community members on how to effectively discuss COVID-19 vaccines, encourage vaccination and build a cadre of trusted messengers within communities. Thousands opens in new tab/window of New Yorkers participated, learning key principles of health communication, including starting from a place of empathy, being an active listener, tailoring information to the audience, giving a strong recommendation and keeping the conversation going. Equipping healthcare professionals and community members with these essential communication skills strengthened vaccine confidence and uptake, demonstrating how trust, empathy and clear messaging are vital components of pandemic response. This model serves as a crucial lesson for future public health crises, ensuring that science-based information reaches communities in ways that are accessible, relatable and actionable.

As the study by Ferreira Caceres et al. underscores, preventing the spread of misinformation is essential for effective public health interventions. Efforts must be strengthened through collaborative strategies that incorporate government agencies, healthcare systems and media platforms. The COVID-19 pandemic has underscored the urgency of combating misinformation with evidence-based science, clear communication and trust-building efforts within communities.

The ongoing threat of emerging infectious diseases

While the world is no longer in the acute phase of the COVID-19 pandemic, we are far from free of its consequences or the threats posed by emerging infectious diseases. The US has recorded over 7 million COVID-19 hospitalizations opens in new tab/window since January 2020, underscoring the virus’s ongoing burden on healthcare systems. We must remain vigilant as new variants emerge and other pathogens, like H5N1, pose an ever-present risk.

As we reflect on five years of COVID-19, we must ask ourselves: Are we ready for what comes next? The answer depends on the actions we take today. By strengthening information infrastructure, investing in workforce resilience, and prioritizing science-based communication, we can ensure that the lessons of COVID-19 translate into tangible improvements in pandemic preparedness.

History will judge us not only by how we responded to COVID-19 but by how we prepared for the crises to come.