Infection and pandemics

Three questions sit under this heading, at different stages. The seasonal burden is well established. Influenza kills several times more in a bad winter than in a mild one. RSV's toll in older adults was under-recognised until routine testing. It is now measured, and vaccinated against. First-season effectiveness is high; durability is the open question. Antimicrobial resistance is building towards a measured burden. Global estimates put deaths directly attributable to resistance at over a million a year, rising fastest among the old. That said, the data are thin exactly where the burden is greatest, and inferred rather than counted almost everywhere else. Pandemic preparedness is the least settled of the three. The pandemic left better surveillance: wastewater, genomic sequencing at scale, and linked vaccination registers. It also left an unresolved argument over how much of that capacity has been kept, how the next respiratory pandemic would be detected, and whether the excess-mortality machinery built in 2020 would tell us in time. The evidence on each question is different in kind. They share a page because they draw on the same surveillance systems and are counted by the same methods.

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