From One Pandemic to the Next—What's Next on the Horizon for Infection Prevention and Control?

Not to be alarmist but the next pandemic could just be around the corner. And while we have no way to know which pathogen will emerge, the truth is the question is not if there will be another pandemic, but when. After more than 4 years battling the impact of COVID-19, we should be ready, right? With so many lessons learned, and great clarity of the issues our health system faced, what do we need to worry about? Many of us—nurses, doctors, administrators, healthcare workers, the list goes on—had been preparing for pandemics for many years. From pandemic plan development to tabletop exercises to risk management frameworks to early warning systems, we believed we were ready. And yet, the COVID-19 pandemic found us vulnerable and unprepared (McKenna et al. 2023). There had been warning signs that the pandemic might not be an influenza pandemic. The SARS epidemic in 2003 (Hung 2003) and the ongoing MERS epidemic in various countries showed us that Coronaviruses had the potential to cause a pandemic (Zumla et al. 2024). Yet, we continued preparing for something different, with the assumption that, as with the H1N1 pandemic in 2009 (Rossouw and Greyling 2024), the next pandemic would be caused by influenza. Sadly, this turned out to be quite far from reality, and SARS-CoV2 spread across the world. In Australia, we took a tough approach to controlling the spread of COVID-19. Borders were slammed closed, and citizens and permanent residents needed a permit to enter or exit the country. States and Territories implemented widespread mandatory hotel quarantine for international arrivals, with less than 72 h of notice to operationalize these programs. These programs were set up on top of countrywide lockdowns and local restrictions, causing further challenges for hospitals and quarantine workers. So, if we are to really be prepared for what might be round the corner, the next pandemic, we need to consider the key aspects of the COVID-19 pandemic response and what we (still) must learn. In clinical practice, mitigation of risks comes from designing good plans and exercising these plans (Birnbach et al. 2010). A key aspect of many countries COVID-19 response was wide-ranging lockdowns and quarantine of individuals. In Australia and New Zealand, mandatory hotel quarantine was used as a key population risk reduction measure (Bush et al. 2023). Mandatory hotel quarantine was operationalized in less than 48 h but was barely mentioned in pandemic preparedness plans and exercises (Bush et al. 2023). The scale of the mandatory hotel quarantine was such in Australia that 22 pathways into hotel quarantine were used (Bush et al. 2024) and over 50 quarantine facilities across the country. With credit to the Infection Prevention and Control teams that successfully managed the day-to-day operation, only 27 viral escapes were documented. In the clinical and community settings, the challenges were immense. Teams managed severe Personal Protective Equipment (PPE) shortages, unprecedented activity, system overwhelm, healthcare worker burnout, as well as the very real risk of acquiring COVID-19 in the workplace, and the effect of this on their health, their families, and their community (Edward et al. 2024). There was also widespread loss of life reported in the media constantly, further contributing to mental health burden, alongside the physical exhaustion (Isch 2025). Although there was a lot of expertise featured in the media, everyone became an infection prevention and control (IPC) professional. Mask usage was mandated and widespread even without mandates; hand hygiene behaviors became second nature with everyone using alcohol gel hand rubs. Evidence of the role of indoor air quality on virus transmission also became clearer. The airborne nature of many respiratory infections prompted the WHO to call for abandoning the droplet spread/airborne dichotomy in favor of airborne/inhalation (World Health Organization 2024). And whilst the storm raged, we failed to capitalize on the IPC expertise that already existed in the system. A small team of expert advisors was established to provide guidance at the height of the pandemic but was rapidly dissolved with no role for IPC in the newly established Australian Centre for Disease Control (ACDC). Lack of system integration across states and jurisdictions as well as poor linkages between acute care, residential care, and the community (challenges that were already well known) created huge challenges in disease control. There was also a wasted opportunity for public health messaging to support sustained change in infection prevention behaviors that were developed at the height of the pandemic, but a rush to return to “business as usual” made many keen to forget what we had learnt and implemented. Although behavioral sciences, show it is difficult to sustain healthy or disease avoiding behaviors (Albarracín et al. 2024) proper messaging to counteract misinformation can help (Bragazzi and Garbarino 2024). Policy makers, public health advocates and healthcare workers should be at the frontline of fighting mis and disinformation—so why were we in such a hurry to say it was all behind us? System wide improvement in IPC has made a difference in some settings, with implementation of key policy pieces a direct learning from the destruction of COVID-19 outbreaks. In Australia and Ontario (Canada) for example, IPC lead nurses are now mandated in residential aged care, affirming that we can reduce negative infection outcomes through specialist training and staffing to support outbreak management. Vaccination is another positive story; there is no doubt the pandemic toll would have been much worse had a vaccine not been rapidly made available and widely administered. There have been many government enquiries into the pandemic (Bardosh et al. 2024): in Australia alone 19 so far have taken place (Bush et al. 2024). But we need to make sure the outcomes of these inquiries are implemented and exercised. In the healthcare settings, there is a need to be realistic about what happened during the pandemic and how underprepared we really were. There was a huge increase in acuity with increased attendances while trying to continue the “business as usual” activity, thresholds for system capacity and surge planning are key lessons from this situation. Another aspect to consider is the supply chain issues with procuring PPE, the potential reuse and/or use of makeshift PPE and the burden of these issues on the workforce and hospital decision makers. Long period of PPE usage not factored in the workday and workers breaks, the shortage of healthcare workers placing an undue burden on the workforce and the role of indoor air quality on infectious disease transmission should have a much higher profile now, yet it would be interesting to know how many hospitals would have adequate air handling systems if another pandemic were to hit tomorrow. We must acknowledge that another pandemic will come. We need to make planning—real planning—a routine activity, embedded into daily activities. We need to be realistic about our challenges and the lessons we learned. It may look like an uphill battle, but we have many of the tools needed to prepare. Although acknowledging that 5 years in the COVID-19 pandemic we all might want to think about something else, let's embed infection prevention and control behaviors in our daily lives; let's focus on the hierarchy of controls and what can be done today to have safe indoor environments. Let us unite to prevent mis and disinformation as well as vaccine hesitancy, and let us continue to advocate for those who are most vulnerable to the impact of infectious disease. We can do all of this right now, and it will mean we will be much better prepared for what is coming next. Stéphane L. Bouchoucha: conceptualization, writing – original draft. Sally. M. Havers: conceptualization, writing – original draft. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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