Sunday, August 17, 2014

UK: Updated Pandemic Response Plan & Exercise Cygnus


Credit ECDC – 125 years of  Pandemic  History


# 8963


Although it is not often front and center in the news, or in the daily threats messaging from most governments, an influenza pandemic is considered among the most likely high-impact global threats that we could face in the foreseeable future. 


Earlier this year, in Influenza Pandemic As A National Security Threat,  we looked at a threats assessment by the Director Of National Intelligence that included:


Worldwide Threats Assessment – published January 29th, 2014,


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. 


In December of 2012 the U.S. National Intelligence Council released a report called  "Global Trends 2030: Alternative Worlds" that tries to anticipate the global shifts that will likely occur over the next two decades (see Black Swan Events).  Number one on their hit parade?


Global Trends 2030's potential Black Swans

1. Severe Pandemic

"No one can predict which pathogen will be the next to start spreading to humans, or when or where such a development will occur," the report says. "Such an outbreak could result in millions of people suffering and dying in every corner of the world in less than six months."


Similarly, last year the UK’s National Risk Registry of Civil Emergencies listed Influenza at their nation’s #1 threat.

The highest priority risks

2.2 The following are considered by the Government to be the highest priority risks of emergency, taking both likelihood and impact into account:

Pandemic influenza – This remains the most significant civil emergency risk. The outbreak of H1N1 influenza in 2009 (‘swine flu’) did not match the severity of the scenario that we plan for and is not necessarily indicative of future pandemic influenzas; the three influenza pandemics of the 20th century (1918–19, 1957–58 and 1968–69) all had differing levels of severity. The 2009 H1N1 pandemic does not change the risk of another pandemic emerging (such as an H5N1 (‘avian flu’) pandemic) or mean that the severity of any future pandemics will be the same as the 2009 H1N1 outbreak.


The threat of another influenza pandemic consistently ranks higher than that of a major cyber/terrorist attack, solar flare, or nuclear/WMD war – and is considered all but inevitable by many experts (although the timing & severity are unknown).


Yet for the public it remains a distant and rarely considered threat.


In the middle part of the last decade there was a big push to prepare for a pandemic, by both the public and private sector.  The fear back then was the H5N1 `bird flu’, but instead we were blindsided by a much milder H1N1 pandemic in 2009.


While not a walk in the park, the 2009 pandemic failed to live up to the early hype, and given these tough economic times - and the false perception that modern pandemics are unlikely to be severe - many businesses have now put pandemic planning on the back burner.


Ironically, the risk of a severe influenza pandemic today is arguably much greater than it was in 2006. 


Back then, we were essentially worried about the H5N1 avian flu virus, that had infected (at that time) only about 300 people, killing roughly 60% of them.  Over the past two or three years we’ve seen an explosion of novel flu & respiratory viruses jumping to humans including: 

  • H7N9
  • MERS-CoV
  • H10N8
  • H5N6
  • H6N1
  • H9N2
  • Swine Variant H3N2v, H1N1v, H1N2v


And, as we discussed in the past (see H2N2: What Went Around, Could Come Around Again), close relatives of older pandemic strains still circulate in the wild as well,  and could return someday.


And of course, there’s always VIRUS X . . the one we don’t know about, yet.


On Friday Public Health England released an updated  Pandemic influenza response plan, which can be downloaded in the two PDF files below.


This PHE plan describes the staff roles for all directorates during the 5 pandemic phases: detection, assessment, treatment, escalation and recovery (DATER).


Pandemic influenza response plan

PDF, 1.01MB, 88 pages

Pandemic influenza strategic framework

PDF, 299KB, 19 pages


This plan and the learning from the national multiagency pandemic influenza Exercise Cygnus in late 2014, will inform the further development of comprehensive and integrated plans in delivering an effective and sustainable response across the organisation.

This system of cross-organisational working will deliver the resources, science and leadership required during the pandemic in order to support the staff and organisational response from local and national centres, and laboratories.



Mentioned above is Exercise Cygnus, which in October will test over three days the readiness of the UK to respond to a serious pandemic threat.  Some excerpts from an overview of the exercise follow:







Interestingly, they have chosen to revive the H2N2 virus which last emerged in 1957 as a pandemic, and disappeared (in humans) in 1968 when it was supplanted by the H3N2 virus.  Anyone born after 1968 would have little or no immunity to this virus.  


As we’ve discussed previously (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?) – while we worry about the H5 & H7 avian flu strains – only H1, H2, and H3 viruses have been known to cause pandemics in the past 125 years.


In 2006 and 2007 a lot of businesses and organizations invested considerable time and money into creating comprehensive pandemic plans.  Most of those have probably not been updated – or even looked at – since the 2009 pandemic, and many are woefully in need of updating.  


Businesses change, people move on, supplies are used up and not replaced. That dust covered plan buried in your bottom drawer may not be as relevant or useful today as it was when it was first created. 


And of course, there are many new companies and entities that weren’t around 8 years ago, and plenty more that never created a plan in the first place.


While no one can predict when, how severe, or what virus will spark the next pandemic -  the risks of seeing a severe pandemic have not diminished.  Which is why everyone – not just government agencies, and healthcare facilities – should give some thought as to how they would deal with a large scale epidemic or even a pandemic.


Credit CDC 

Last October, in Pandemic Preparedness: Taking Our Cue From The Experts, I wrote about personal and business pandemic preparedness, which included numerous links to governmental guidance documents, and an excellent 20 minute video produced by Public Health - Seattle & King County -  called Business Not As Usual .

If you’ve not seen this movie, or haven’t seen it recently, it is well worth taking the time to watch it.


You’ll also find a long list of preparedness resources available on this page as well:

Another good resource comes from the Trust for America’s Health.


Credit TFAH It's Not Flu As Usual Brochure

Having a good pandemic/disaster plan could easily spell the difference between a business weathering a pandemic or going out of business.  Making this a good time to drag your plan out, and make sure that it is adequate to the task.


For more information on pandemic planning, you may want to revisit:


Pandemic Planning For Business
NPM13: Pandemic Planning Assumptions
The Pandemic Preparedness Messaging Dilemma

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