Recent reports of a cruise ship carrying patients with the hantavirus pulmonary syndrome have sent ripples across global public health systems. With passengers dispersing to countries/regions across the world — from Australia to Europe and the US — the possibility of silent transmission has once again brought the world to a familiar edge of uncertainty. Contact tracing, isolation and surveillance efforts are underway, but the episode underscores a sobering truth: the next pandemic threat may already be in motion, quietly and unpredictably.
Hantavirus is not new. It has long been known to circulate among rodents — creatures that live in close proximity to human settlements worldwide. What is new, and concerning, is the possibility — still under scientific scrutiny — that certain strains may be evolving towards limited human-to-human transmission. If such a shift becomes epidemiologically significant, what are today sporadic outbreaks could transform into tomorrow’s global crisis.
Hantavirus is only one among several looming threats. The world has already witnessed Nipah and Ebola virus outbreaks, both with high fatality rates and limited therapeutic options. India, in particular, has experienced repeated Nipah outbreaks in states like Kerala and West Bengal, demonstrating how zoonotic viruses can emerge abruptly and challenge even well-prepared health systems.
What is striking, in hindsight, is that the global scientific community had anticipated such threats. In 2018, the World Health Organisation (WHO) identified a list of pathogens with pandemic potential. Interestingly, it did not name the virus that would soon bring the world to a standstill — the SARS-CoV-2 virus responsible for Covid-19. Instead, it referred to a hypothetical “Disease X,” representing an unknown pathogen capable of causing a serious international epidemic. Covid-19 was, in essence, Disease X realised.
The lesson is clear: the next pandemic may not come from a known virus but from one that currently exists in wildlife reservoirs, largely undetected. Thousands of coronaviruses, for example, circulate among bats and other species. Only a handful (only seven at the last count) have so far crossed the species barrier to infect humans. The rest remain latent threats, awaiting ecological or behavioural triggers — deforestation, climate change, urbanisation or intensification of livestock farming — to spill directly into human populations or through livestock and omnipresent bats.
This is where the concept of “One Health” becomes indispensable. The One Health approach recognises the interconnectedness of human health, animal health, and the environment. It is not merely a theoretical framework but a practical necessity in a world where zoonotic spillovers are becoming more frequent. Surveillance systems must therefore extend beyond hospitals and laboratories into forests, farms and wildlife ecosystems. Veterinary sciences, environmental monitoring and human medicine must converge into a coordinated, real-time intelligence network.
Encouragingly, the global community has begun to respond. The WHO Pandemic Agreement, adopted in 2025, represents a landmark effort to institutionalise preparedness. Designed as a legally binding pandemic treaty, it seeks to strengthen global surveillance, ensure equitable access to vaccines and treatments, and improve coordinated responses during health emergencies. While negotiations on certain aspects — particularly pathogen-sharing mechanisms — are ongoing, the intent signals a shift toward collective responsibility.
However, global agreements alone cannot substitute for national readiness. India, with its vast population, ecological diversity, and varying health infrastructure across states, must prioritise pandemic preparedness as a continuous, not episodic, effort. The next pandemic will not announce itself politely; it will emerge unexpectedly, compressing response timelines and testing systemic resilience.
Covid-19 offered invaluable lessons, some of which remain insufficiently internalised. First, the pandemic response cannot focus solely on the disease at hand. Essential health services must continue. During the Covid pandemic, disruptions in maternal care, tuberculosis treatment, cancer management and immunisation programmes resulted in collateral damage that will take years to fully quantify. A resilient system must be able to “walk and chew gum at the same time” — to fight the pandemic while sustaining routine healthcare.
Second, infrastructure and capacity cannot be built overnight. Intensive care units, trained manpower, diagnostic networks and supply chains require sustained investment and periodic stress-testing. Simulation exercises, akin to military drills, should become standard practice for health systems. These drills not only identify gaps but also build institutional confidence.
Third, mental health must be recognised as an integral component of pandemic response. The psychological toll of prolonged uncertainty, isolation and economic disruption is profound, particularly among vulnerable populations. Integrating mental health services into primary healthcare and emergency preparedness plans is no longer optional.
Finally, preparedness demands resources — and political will. In an era marked by geopolitical tensions and competing priorities, there is always a temptation to defer investments in public health infrastructure. Yet the cost of inaction far exceeds the cost of preparedness. The economic and social devastation wrought by the Covid pandemic stands as a stark reminder. Investing in pandemic readiness is not an expenditure; it is an insurance policy for national stability.
The world today stands better equipped than it did in 2019 — but not yet adequately prepared. Surveillance gaps persist. Health inequities remain stark. Coordination, both within and between countries, is still evolving. The next pandemic threat — whether from hantavirus, Nipah, an unknown coronavirus or an entirely new pathogen — will test not just our scientific capabilities but our collective resolve guided by One Health approach.
Preparedness is not a destination but a discipline. It requires vigilance without panic, investment without delay and cooperation without reservation. The viruses are evolving. The question is: are we?
The writer is former Director, Communicable Diseases, WHO Region for South-East Asia
