The COVID-19 pandemic provided a brutal real-world test. Officially, the World Health Organization records nearly 780 million cases and 7.1 million deaths globally. The true toll is almost certainly far higher.
Dr Richard Horton, editor-in-chief of The Lancet, has issued one of the clearest warnings yet: another pandemic is not a question of “if” but “when” – and humanity is actively creating the conditions for it.
In an interview with India Today, Horton declared that the world is “destroying the planet sufficiently to create conditions for another pandemic in the next 20 years.” He added bluntly: “In fact, it is almost inevitable.”
His remarks come almost exactly one year after a major Lancet Commission projected a 48 per cent chance of a catastrophic pandemic killing more than 25 million people in the coming decades, and a 23 per cent likelihood of another COVID-19-scale outbreak within the next ten years.
Horton’s central argument is simple and devastating: the relentless destruction of forests, unchecked urban sprawl, climate change, and unsafe human-animal interfaces are forcing pathogens out of their natural reservoirs and into human populations at an accelerating rate.
“These are exactly the conditions where a mutated virus can move from animal to human,” he said, pointing to unsanitary meat markets and abattoirs that still operate across much of the world. “If such a virus is capable of spreading through the respiratory route, the consequences could be devastating” – even “species-ending trouble,” he warned.
Political Will Missing
Scientists have been documenting this trend for years. Zoonotic viruses are jumping species barriers more frequently, adapting faster under ecological stress. Habitat loss pushes wildlife into closer contact with livestock and people; warmer temperatures expand the range of disease-carrying insects and animals. The ecological safety net that once kept novel pathogens contained is unravelling.
Horton is not alone in using the word “inevitable.” In a 2022 Lancet editorial he wrote: “The elements of a robust public health system to prevent the next (inevitable) pandemic are well understood.” What is missing, he argues, is political will and honest reckoning with past failures.
The COVID-19 pandemic provided a brutal real-world test. Officially, the World Health Organization records nearly 780 million cases and 7.1 million deaths globally. The true toll is almost certainly far higher.
Indian Figure “Fantastical”
Nowhere has the gap between official and estimated mortality been more stark than in India. The government initially reported around 500,000 COVID-19 deaths to the WHO. Independent analyses tell a different story: the WHO’s own modelling estimated 4.7 million excess deaths; a Washington University study put the 2020–21 figure at 4.1 million; a Lancet report cited roughly 4 million; and India’s Civil Registration System data released in 2025 showed 2.1 million excess deaths in 2021 alone – the year of the devastating Delta wave.
Horton did not mince words. He called the official Indian figure “fantastical” and “primarily not true.” He was equally critical of Britain’s early pandemic response – delayed lockdowns, inadequate PPE for frontline workers, and disastrous care-home policies – but noted that the UK at least conducted public inquiries and admitted mistakes.
“Every single country failed,” he said. “We made terrible mistakes… and we admitted them.” The absence of such admission in many nations, including India, is what worries him most.
Without transparent accounting of what really happened, genuine learning cannot occur. “If you can’t even admit the level of mortality and failure,” Horton warned, “you can’t begin to prepare. And when the next five years come, you won’t be ready to save millions of people unnecessarily.”
Acknowledge Scale of the Last Disaster
SARS-CoV-2 itself has not vanished; it continues to circulate and evolve. The next threat, however, may not even belong to the coronavirus family. It could emerge from influenza, Nipah, a novel paramyxovirus, or something entirely unknown – but the underlying drivers remain the same: ecological disruption and fragile food systems.
Horton’s message is not fatalistic. He believes the tools exist: stronger surveillance of animal-human interfaces, investment in early-warning systems, regulation of high-risk markets, rapid vaccine platforms, and – crucially – political honesty about past errors.
Yet he sees little evidence that the world is moving fast enough. The same pressures that made COVID-19 possible are intensifying, not easing.
As forests shrink, cities expand into former wilderness, and climate boundaries shift, the probability of another spillover rises. The Lancet Commission’s 48 per cent estimate for a >25-million-death event in the coming decades is not alarmism; it is a sober actuarial assessment based on historical patterns and current trajectories.
Horton’s final plea is therefore both scientific and moral: acknowledge the scale of the last disaster, confront the uncomfortable truths about how we live on this planet, and act before the next inevitable outbreak becomes the one we cannot contain.
