| Covid exposed the vulnerabilities of health systems all over the world, highlighting a need to expand disease surveillance, tackle misinformation and speed up work on vaccines and therapies to fight a slew of both known and unknown pathogens. And while the Oxford-AstraZeneca team, Pfizer and others delivered Covid shots in record time, less affluent regions struggled to gain access as wealthy nations put their own interests first. Production was concentrated in just a handful of countries. Sarah Gilbert is part of a team that's seeking to fill those gaps and make sure countries are better prepared to deal with the next emergencies. Oxford's recently minted Pandemic Sciences Institute joins groups such as the Coalition for Epidemic Preparedness Innovations, the World Health Organization's pandemic intelligence hub and the EU's Health Emergency Preparedness and Response Authority in a bid to stop outbreaks from exploding into global crises. The institute, which hoped to attract more than £500 million ($597 million) in investment when it was unveiled last year, has so far raised about £100 million. The university aims to build on its Covid vaccine with AstraZeneca, one of the first to cross the finish line, and the Recovery trial that helped identify Covid therapies. "Academic institutions such as Oxford have a lot to contribute in the event of a global public health crisis," Gilbert tells me. The plan is to move "as fast as possible, but there's still a way to go to complete our fund-raising," she says. One priority, she says, is widening vaccine manufacturing capacity globally and establishing sites that are ready to ramp up swiftly if needed to respond to a new disease. That would minimize delays and help address inequity. But ensuring investments benefit the regions they're located in and don't lead to "white elephants" will be crucial, she says. HERA, the new EU organization, also plans to maintain a network of "ever-warm" manufacturing facilities. "During a pandemic, when vaccine production is located in some countries and not others and everyone wants a vaccine, that's when we see the problems of nationalism," Gilbert says. "So we have to prepare for that by making sure we have manufacturing on every continent and in every region." Africa, she says, is especially important. Working with partners, Gilbert and her colleagues are analyzing the pipeline and aiming to spur development of vaccines and medicines in all the major groups of viruses that are known to infect humans. One target is Nipah virus, which has a fatality rate estimated at 40% to 75% and has sparked outbreaks almost annually in parts of Asia. There's no vaccine currently available. "The nightmare scenario is a disease with the fatality rate of Nipah virus that is also very highly transmissible," she says. "We need to stop these outbreaks before the virus gets a chance to evolve." — James Paton | 
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