Sunday, February 02, 2014

DNI: An Influenza Pandemic As A National Security Threat

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# 8258

 

While we are constantly exposed to a certain amount of gratuitous pandemic mongering in the media and online – often with the intent of driving web traffic (or ratings) or selling products – this week a pair of high ranking US officials have weighed in on the not-inconsequential risks, and potential impact, of seeing another pandemic.

 

In his 2012 unclassified Worldwide Threat Assessment - just two years after the end of the last influenza pandemic -the nation’s Director of National Intelligence (DNI) James R. Clapper didn’t reference pandemics at all. 

 

Understandable, really, given the historic tendency of pandemics to come around every 10 to 40 years.

 

The following year (2013), however - with the sudden emergence of a novel coronavirus on the Arabian Peninsula - the unclassified report had this to say:

 

(Excerpt)

HEALTH and PANDEMIC THREATS

Scientists continue to discover previously unknown pathogens in humans that made the “jump” from animals—zoonotic diseases. Examples are: a prion disease in cattle that jumped in the 1980s to cause variant Creutzeldt-Jacob disease; a bat henipavirus that in 1999 became known as the human Nipah Virus; a bat corona virus that jumped to humans in 2002 to cause Severe Acute Respiratory Syndrome (SARS); and another SARS-like corona virus recently identified in individuals who have been in Saudi 13 Arabia, which might also have bat origins. Human and livestock population growth and encroachment into jungles increase human exposure to crossovers. No one can predict which pathogen will be the next to spread to humans, or when or where such a development will occur, but humans will continue to be vulnerable to pandemics, most of which will probably originate in animals.

(Continue . . . )

Fast forward nearly a year - now with the H7N9 virus added to the growing public health threat list - and the latest Worldwide Threats Assessment – published January 29th, 2014, carries an even stronger warning regarding the emergence of global health threats.

 

(Excerpt)

HEALTH RISKS


Health security threats arise unpredictably from at least five sources:  the emergence and spread of new or reemerging microbes; the globalization of travel and the food supply; the rise of drug-resistant pathogens; the acceleration of biological science capabilities and the risk that these capabilities might cause inadvertent or intentional release of pathogens; and adversaries’ acquisition, development, and use of weaponized agents.  Infectious diseases, whether naturally caused, intentionally produced, or accidentally released, are still among the foremost health security threats.  A more crowded and interconnected world is increasing the opportunities for human, animal, or zoonotic diseases to emerge and spread globally.  Antibiotic drug resistance is an increasing threat to global health security.  Seventy percent of known bacteria have now acquired resistance to at least one antibiotic, threatening a return to the pre-antibiotic era.

 

In addition to the growing threat from resistant bacteria, previously unknown pathogens in humans are emerging and spreading primarily from animals.  Human and livestock population growth results in increased human and animal intermingling and hastens crossover of diseases from one population to the other. 

No one can predict which pathogen will be the next to spread to humans or when or where this will occur.  However, humans remain vulnerable, especially when a pathogen with the potential to cause a pandemic emerges.  For example, we judge that the H7N9 influenza in China that emerged from birds in early 2013 is not yet easily transmissible from person to person.  However, it bears watching for its extreme severity, high death rates, and potential to mutate and become more transmissible.  Between late March 2013, when the virus was first recognized, and the following May, when it was brought under control, H7N9 influenza killed over 20 percent of those infected and caused severe disease with long-term hospitalization in nearly all other cases. 

If H7N9 influenza or any other novel respiratory pathogen that kills or incapacitates more than 1 percent of its victims were to become easily transmissible, the outcome would be among the most disruptive events possible.  Uncontrolled, such an outbreak would result in a global pandemic with suffering and death spreading globally in fewer than six months and would persist for approximately two years.  

 

This was, admittedly, just one of many threats discussed in this 27 page threat assessment.  Others include cyber attacks, terrorism, extreme weather events, WMDs, food and water insecurity, and global economic concerns.

 

So, if you are feeling safe and smug in middle America, reading this report should quickly disabuse you of that quaint notion.  We live in a complex, interconnected, and increasingly dangerous world.

 

Also last week, the Director of the CDCDr Thomas Frieden – weighed in on the pandemic threat in a special piece he penned for CNN News (see CDC Director Frieden: On Preventing A Pandemic).

 

While it is impossible to know when another pandemic will occur, few scientists doubt that it will happen again.  Pandemics have swept the globe for centuries, and show no signs of abating despite our modern medical advances.  

 

In fact, according to respected anthropologist and researcher George Armelagos of Emory University, we are actually entering an age of re-emerging infectious diseases which he has dubbed The Third Epidemiological Transition.  

 

Dr. Armelagos describes this trend in his 2010 paper The Changing Disease-Scape in the Third Epidemiological Transition.

 

It is characterized by the continued prominence of chronic, non-infectious disease now augmented by the re-emergence of infectious diseases. Many of these infections were once thought to be under control but are now antibiotic resistant, while a number of “new” diseases are also rapidly emerging. The existence of pathogens that are resistant to multiple antibiotics, some of which are virtually untreatable, portends the possibility that we are living in the dusk of the antibiotic era. During our lifetime, it is possible that many pathogens that are resistant to all antibiotics will appear. Finally, the third epidemiological transition is characterized by a transportation system that results in rapid and extensive pathogen transmission.

 

In other words, the emergence of MERS-CoV, H5N1, Nipah, Hendra, Lyme Disease, H7N9, H10N8, NDM-1, CRE, etc. are not temporary aberrations. They are the new norm, and we should get used to seeing more like these appear in the coming years.

 

That said, having now blogged on emerging infectious diseases for more than 8 years, I wouldn’t be surprised if we went another 10 years without seeing a pandemic.  Nor would I be terribly surprised if we found ourselves deep in the heart of one six months from now.  If writing 8000+ blogs has taught me anything, it is the folly of trying to predict what will happen next.  


While we are getting better at observing these pathogenic threats, we are far from being able to predict what they will do next.  

 

Like with earthquakes, tornadoes, terrorist attacks, and the upcoming hurricane season – while we can’t predict when or where a public health emergency will happen– we can be pretty sure that something fairly major will happen somewhere in the next year.

 

And that those who are best prepared, are the most likely to come through it in the best shape.

 

Which is why – even when the source of these threats are nebulous, and the timing far from certain – the smart money is on maintaining an `all hazards’ preparedness plan for your business and your family.  The general preparedness steps you take to prepare for an earthquake or hurricane will also help you during a flood, forest fire, or yes . . . even a pandemic

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For more on what you can do to prepare for the next disaster, visit the FEMA, or Ready.gov website, and feel free to re-visit some of my earlier preparedness blogs (below).

 

Preparing For An Unpredictable New Year
HSPH Video: The Next Pandemic: Are We Ready?
GridEx 2013 Preparedness Drill
Pandemic Preparedness: Taking Our Cue From The Experts

 

And lastly, in NPM13: The Greatest Prep Of All,  I wrote about what I consider to be the most important preparedness step you can take – having, and being,  a disaster buddy.  Cultivating a network of family and friends to whom you can turn for help in a disaster, to who can turn to you for aid,  if they need it.

 

Because no matter where you live, its just a matter of time before the next disaster strikes.

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