While the world is focusing much of its efforts on preventing a new flu pandemic, British epidemiologist Sir John Edmunds, considered to be one of the UK's most influential infectious disease experts, warns that the next major threats could come from very different sources. "Even though respiratory illnesses represent the greatest threat, the problem is that there are many other things that could trigger a pandemic," he says during an interview with EL PAÍS in Madrid. He recently visited the Spanish capital to participate in an event organized by the Ministry of Science. As chief scientific advisor to the British Foreign Office, he's been on the front lines of some of the biggest health crises of recent decades, including the West African Ebola outbreak (2014-2016) — the deadliest on record — and the COVID-19 pandemic, during which he advised the British government. Edmunds recently returned from the Democratic Republic of the Congo (DRC), where he closely followed the latest Ebola outbreak: it has already claimed more than 5,000 lives. He argues that countries must prepare not only for known pathogens, but also for crises that are difficult to anticipate. "One of the lessons from COVID-19 is precisely that we shouldn't just prepare for the threats we know about," he states. Question. You've just returned from the DRC, where there's been an Ebola outbreak. What did you find there?Answer. I went to [the city of] Bunia, which is the epicenter of the outbreak. The response is very different [compared to what happened during] the West African outbreak. [In the case of that outbreak], the big donor countries were a bit colonial in their response. The UK worked closely with Sierra Leone, the U. S. with Liberia, and France with Guinea. Today, the response is largely being led by African institutions, and I think that's a positive thing. We've made great strides scientifically and technologically, but also in terms of organization and procedures: for example, when it comes to sending experts to even the most remote locations. But still, there are things that are much worse. Q. For example?A. The epidemic is occurring in an area that has an ongoing conflict. When I was there, I was told that there were 250 different armed groups active in eastern DRC. Some of these are very organized and some of them much less so: they're much more chaotic. The humanitarian crisis in that part of the world is enormous. And so, with the epidemic on top of all of that, it's a much more challenging situation than what we saw in West Africa. Q. If you had to point to the main pandemic risk today, what would it be?A. The reason why we put so much effort into the flu is that it's probably the most plausible candidate. We do get flu pandemics periodically. We know that influenza will cause another pandemic; it's just a matter of time. But even though respiratory illnesses pose the greatest threat, the problem is that there are many other things that could trigger a pandemic. I think we need to be much more aware that we can be affected by all kinds of infectious diseases, each with very different transmission mechanisms. Q. Which diseases specifically?A. You can think about Mpox (monkeypox). Mpox has been around forever (it was first identified in 1970). It's not a new disease. But it arrived in Europe and North America in 2022 and has spread around the world in a very different way than the flu, [mainly through close and prolonged physical contact between people]. And, if you think about it, the last major pandemic of the 20th century is something that people have forgotten, or they don't think of it in pandemic terms: HIV. We're still in the first wave of the HIV pandemic 40 years later. Q. Pandemic preparedness is often considered an expense that can be postponed. What happens when investment in prevention and response is neglected?A. Well, you can just look at COVID-19 to see the impact. Epidemics have enormous consequences, and not only for health. They also affect the economy, education and children's academic performance, for example. When these kinds of events occur, they influence every aspect of society. Q. The World Health Organization (WHO) often mentions "Disease X" – an unknown pathogen, capable of triggering a major epidemic. How do you prepare for something you know nothing about? A. Do you remember [former U. S. Secretary of Defense] Donald Rumsfeld's classification of "known knowns," "known unknowns" and "unknown unknowns"? The dangerous ones are the ones that we don't really know about… the kind of "unknown unknowns." And again, these are the kind of unusual "black swan" events. They will happen. I think we just need to make sure that we have systems in place that are resilient enough and adaptable enough to deal with weird, hard-to-predict events. One of the lessons from COVID would be that we concentrated too much on just the threats we know about. For years, we focused a lot of our attention on the flu… but in addition to pathogens, there are other risks that can also trigger major crises. Q. You've said that we shouldn't only worry about pathogens. What other threats concern you?A. Natural disasters, like floods or heat waves. These are very likely to increase in frequency and intensity due to climate change. We know this, but we still need to do much more, both to reduce the risk of them occurring — by mitigating climate change — and to improve our response to these types of events. And, finally, there are other issues that we wouldn't classify as natural threats, but rather as "man-made" threats. And they haven't gone away; in fact, these threats have probably increased in the last five or six years. We need to consider them as well. Q. Is artificial intelligence (AI) one of them?A. It's a threat and it's an opportunity. Q. And disinformation?A. Yeah, it's a threat. It's a threat to society as a whole… but it's not easy to decide how to deal with it. We live in democracies. We're open to people having different ideas, and we should be. That's our strength. We shouldn't undermine that strength by trying to combat disinformation in the wrong way. I know this is a pretty boring answer. But we just need to do our job better as scientists in terms of getting the data, being as objective as we possibly can about whatever issue [we're dealing with], being as rigorous as we can, and getting that [information] out to the public and explaining it to the public. We have a responsibility to explain science as clearly as possible and not pretend that things are clear when they aren't. Q. During the COVID-19 pandemic, some scientists who had public advisory roles – yourself included – were subjected to personal attacks. A. During COVID, some people reacted in ways that were less than ideal. But when people used to get in touch with me, I used to respond to them; it didn't matter who they were. Q. Do you still receive those kinds of messages?A. Less so, but occasionally. Sign up for our weekly newsletter to get more English-language news coverage from EL PAÍS USA Edition