Seven months ago, with the Covid-19 crisis still barely recognised outside China, I wrote sarcastically in this column about the six-year pandemic panic syndrome – suggesting that pandemic panic had erupted over the past two decades in a six-year cycle, that this outbreak of coronavirus (it had not been named then) was unlikely to be “the big one” like the Black Death of the 1300s; that we were terrible at recognising risk; and that the greatest threat from the Wuhan outbreak was likely to be economic rather than medical. Now, seven months on, how wrong was I to be cynical? And what lessons have we learned that will help prepare us for the inevitable next pandemic? Obviously I was wrong if I appeared to play down the threat. As I noted back in January: “The new can be dangerous and it is rash to be dismissive of the outbreak too early.” As we look today at 21 million cases worldwide and 769,000 deaths, with no sign of the pandemic abating, it is clearly inappropriate to make light of the threat. But in a global health crisis, we still need to keep things in proportion. This is not “the big one”. The Black Death killed between 70 million and 200 million people between 1346 and 1353. As we weigh the risks that face us every year, it is important to remember that on average, 1.4 million people die from traffic accidents, 400,000 from malaria, 650,000 from influenza and 1.4 million from diarrhoea. These are terrible mortality numbers, and so are those from the Covid-19 pandemic, but perhaps above all else we need to look at the traumatic past seven months as a dry run for the big one when it eventually strikes. Already there are at least eight clear lessons we need to take away. First and perhaps most important of all, international cooperation and a unified approach within each economy are essential to tackle a threat that knows no borders. It is almost embarrassing to see how dreadfully uncoordinated responses have been, and how poor the international cooperation. The World Health Organisation is clearly the only starting point for international coordination, but is clearly not yet fit for purpose. Out of its annual US$4.84 billion budget, US$3.77 billion is for “base programmes”, and US$863 million for a dedicated attack on polio. Just US$209 million remains for “special programmes”. This is clearly far short of the funds that are needed to manage and overcome a pandemic. Lessons from the Covid-19 pandemic for the next predictable surprise Second, it is essential that science should lead, and that this scientific effort should be internationally coordinated. This should mean constant sharing of data, development of treatments, cooperation on vaccine development and manufacture, and coordination on procurement. We currently have 168 vaccines being developed, with 28 of them already being tested on humans. High-level cooperation to manage this activity ought to be a no-brainer. WHO director general Tedros Adhanom Ghebreyesus is seeking US$31 billion for an Access to Covid-19 Tools (ACT) Accelerator programme to do just this, and should be supported. Third, pre-emptive investment and early action are essential, and again must be globally coordinated. The experience of the past seven months is that once the cat is out of the bag, then the cost of containment soars exponentially. Fourth, a short menu of simple practical actions can, if applied fast and consistently, stall the spread and give our health systems time to put in place the needed medical response: wearing masks, avoiding crowded indoor places, extensive and intelligently targeted testing, and effective contact tracing. This surely explains why containment efforts have been so much more effective in places like South Korea , Taiwan, Hong Kong, Singapore and even mainland China. Fifth, even with massive scientific studies, viruses like Covid-19 are seriously pesky, elusive critters. Seven months into the crisis, scientists and medical experts are still learning new things about how it spreads, how it harms us, and how best to treat it. We are finding the virus on packages of Ecuadorean shrimp and Brazilian chicken. We seem to have millions of silent asymptomatic carriers . Hong Kong prepares to launch mass Covid-19 testing, confirms 46 new cases It is astonishing that New Zealand, after 102 days without a single new case and with effectively sealed borders, can suddenly discover about 30 cases. Did the virus enter via food supplies or packaging? Could it possibly have lain dormant for three months before reappearing? Scientists are still trying to discover with certainty where Covid-19 originated. Sixth, the truly crippling impact of the pandemic is not medical but economic. The International Monetary Fund has estimated that the global cost would likely be about 10 per cent of global gross domestic product – about US$9 trillion – with around US$11 trillion in government stimulus measures already commandeered. At the Australian National University, Warwick McKibbin has suggested the more realistic cost for 2020 will be US$21.8 trillion. Job losses globally will run to hundreds of millions. Insolvencies will soar. Government deficits and debts will rise strongly from already record levels. Many governments will default on international debt repayments. If this is the inevitable minimum economic price of a pandemic, then the question surely arises: why not massively divert funding to pre-emption of future pandemics, and fast, effective response systems? Massive investment – perhaps in the trillions – should be channelled into health care systems, ensuring adequate stockpiles of equipment held in anticipation of future need, and improved salaries for essential workers. Many countries have food stockpiles to bolster food security. Why not the same for health security? The World Bank says total health care spending worldwide in 2017 amounted to US$7.8 trillion. Doubling this sum could be well justified if it could pre-empt the crippling trillions lost economically from lockdowns and international economic dislocation. Seventh, harm from a pandemic may be more dramatic and visible than the harm being inflicted by climate change , but is in principle no different. Our failure to ensure international cooperation and global coordination provides important lessons in our current failure to properly address climate challenges. Failure to invest is a fool’s saving. Finally, it seems we remain as poor as ever at judging the risks we face and how to manage them. Some lessons we seem unable to learn. David Dodwell researches and writes about global, regional and Hong Kong challenges from a Hong Kong point of view