Infectious disease and pandemics: what they now cost in deaths, and how well we are defended

Three questions sit under this heading, at different stages. The seasonal burden is well established: influenza kills more in a bad winter than in a mild one by a factor of several, and RSV's toll in older adults, under-recognised until routine testing, is now measured and vaccinated against, with first-season effectiveness high and durability the open question. Antimicrobial resistance is building towards a measured burden: the global estimates put deaths directly attributable to resistance at over a million a year, rising fastest among the old, on data that 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, linked vaccination registers — and an argument, unresolved, about 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 is different in kind; the reason they share a page is that they draw on the same surveillance and are counted by the same methods.

Status

established

Direction

steady

Would change our view

Multi-season data on RSV vaccine durability; a national death series that records resistance directly; or a documented case of a novel pathogen detected — or missed — by the post-pandemic surveillance.

Trackers

Gaps

Adult RSV surveillance outside a handful of countries; linkage of laboratory results to deaths anywhere in Europe; any systematic account of which pandemic-era surveillance has been kept, country by country.