Nipah virus and the lessons of COVID-19: are we prepared for the next pandemic threat?

The coronavirus disease 2019 (COVID-19) pandemic has exposed profound and persistent weaknesses in global preparedness, including fragmented surveillance systems, governance failures, inequitable access to countermeasures, and erosion of public trust. Although SARS-CoV-2 has dominated global attention, other high-consequence zoonotic pathogens with pandemic potential have remained comparatively neglected. Among these, the Nipah virus (NiV) represents a particularly serious threat, characterized by high case-fatality rates, zoonotic spillover from wildlife reservoirs, documented human-to-human transmission, and the absence of licensed vaccines or specific antiviral therapies. This narrative review synthesizes and contextualizes existing evidence on the NiV through the lens of lessons learned during the COVID-19 pandemic. Drawing on epidemiological data, outbreak experience, and global health policy literature, this review examines the key dimensions of preparedness, including surveillance and diagnostics, laboratory and health-system capacity, vaccine and therapeutic development, emergency governance, ethical decision-making, and the operationalization of One Health approaches, with particular attention to low- and middle-income and fragile settings. The review highlights that despite scientific advances achieved during COVID-19, preparedness for the NiV remains limited and uneven. Persistent gaps in integrated surveillance at human-animal-environment interfaces, constrained laboratory capacity, insufficient investment in countermeasures, fragmented governance, and enduring global inequities threaten timely detection and containment. The NiV should therefore be understood not as an isolated regional concern, but as a warning signal for future "Disease X" scenarios, underscoring the urgent need to translate COVID-19 lessons into sustained, equitable, and multisectoral pandemic preparedness.