The Committee expressed its assessment that this outbreak is a wakeup call and that in a highly mobile world, all countries should always be prepared for the unanticipated possibility of outbreaks of this, and other serious infectious diseases. The situation highlights the need to strengthen collaboration between health and other key sectors, such as aviation, and to enhance communication processes. – WHO Statement On MERS June 17th, 2015
While the MERS coronavirus is obviously not yet ready for prime time, it is far from being the only virus out there with the potential to spark a global health crisis. And indeed, the full story of MERS has yet to unfold, as it may yet evolve into a pandemic threat.
Nature’s laboratory is open 24/7, and is constantly tinkering with the evolutionary process. From this come winners and losers, and while it may not seem fair to us humans, nature plays no favorites when it comes to success.
Making things considerably worse than say – a hundred years ago – our ability to rapidly transit the globe makes us all potential (albeit, unintentional) co-conspirators in the dissemination and evolution of new viral and bacterial species. As we’ve seen in Korea, a single traveler can unknowingly become infected while abroad, fall ill after returning home, and spark a local epidemic.
While the WHO is calling MERS a `Wakeup Call’, in truth it is far from the first, we’ve just hit the snooze alarm repeatedly over the past hundred years in hopes of bagging a few extra winks.
The Great pandemic of 1918 was perhaps the first example of how a global outbreak could be spurred on by the unprecedented movement of troops during WWI. Incredibly, even during the age of steamships and relatively limited travel, the virus managed to pretty much circle the globe in a matter of weeks.
The pandemics of 1957 and 1968, while less severe, should have also sounded the alarm. But once over, they were soon forgotten. HIV’s emergence and acceleration in the early 1980s, SARS in 2003, even the introduction of West Nile Virus to NYC in 1999, and the arrival and rapid spread of Chikungunya in the Americas 18 months ago have all been wakeup calls.
But relatively few were listening.
Despite the fact that over the past 18 months we've seen cases of H5N1 and H7N9 exported from China, Ebola and Lassa Fever exported from West Africa, MERS exported from the Middle East – just to name a few - hospitals in Korea were obviously caught unprepared to deal with a new contagion.
And while this time it was the Koreans caught with their masks down, tomorrow it could just as easily be India, or Australia, or the United States scrambling to contain an outbreak.
An Assessment by the Director of National Security last year (see DNI: An Influenza Pandemic As A National Security Threat) found the global spread of infectious diseases – along with cyber attacks, terrorism, extreme weather events, WMDs, food and water insecurity, and global economic concerns.- constitutes a genuine threat to national security.
As we discussed last year, in The New Normal: The Age Of Emerging Disease Threats, the reality of life in this second decade of the 21st century is that disease threats that once were local, can now spread globally in a matter of hours or days.
We’ve been lulled into a false sense of security since the last pandemic was relatively mild, and the feeling is they only come around every 30 or 40 years. But viruses don’t read calendars, or play by `mostly likely worst-case scenario rules’ that are adopted by most planning committees.
Although it isn’t getting near the exposure it should be, Egypt has been battling the largest ever outbreak of human H5N1 since the virus emerged nearly 20 years ago. The Egyptian government has pretty much shut down any reporting on the situation, but as of April 9th the WHO was reporting roughly 170 cases over the previous six months.
Given their history, it is hard to believe that no news is good news.
The third winter wave of H7N9 in China has been similarly cloaked in secrecy. What we don’t know about MERS in Saudi Arabia could fill volumes, and many countries that once reported avian flu cases regularly (i.e. Indonesia, Cambodia, Laos) have been noticeably silent the past few years.
Not all of these lapses in reporting are deliberate, of course. Some are due to a lack of resources, societal barriers, political instability or regional conflicts.
Over the past year we’ve also watched an unprecedented spread of HPAI H5 viruses around the globe, along with the emergence of a half dozen new sub-types of avian flu (H5N1 N/A, H5N2, H5N3, H5N6, H5N8, H10N8).
We are in the summer lull for avian flu, but outbreaks are expected to ramp back up this fall and winter. Hence the release of a CDC HAN:HPAI H5 Exposure, Human Health Investigations & Response just two weeks ago.
Last February, given the number of new flu subtypes, the remarkable and rapid spread of HPAI H5 viruses to Europe and North America, and several months of Egypt dealing with the worst human H5N1 outbreak in history, the World Health Organization released a blunt assessment called:
The current global influenza situation is characterized by a number of trends that must be closely monitored. These include: an increase in the variety of animal influenza viruses co-circulating and exchanging genetic material, giving rise to novel strains; continuing cases of human H7N9 infections in China; and a recent spurt of human H5N1 cases in Egypt. Changes in the H3N2 seasonal influenza viruses, which have affected the protection conferred by the current vaccine, are also of particular concern.
The entire report is well worth reading, but after warning that H5 viruses were currently the most obvious threat to health, they also advised:
Warning: be prepared for surprises
Though the world is better prepared for the next pandemic than ever before, it remains highly vulnerable, especially to a pandemic that causes severe disease. Nothing about influenza is predictable, including where the next pandemic might emerge and which virus might be responsible. The world was fortunate that the 2009 pandemic was relatively mild, but such good fortune is no precedent.
The time has come to take pandemic planning seriously again, not because of one specific threat like MERS or H5N1, but because there’s a growing list of pathogens with pandemic potential queuing up around the globe.
Otherwise, in the post-mortem analysis after the next pandemic, experts will once again be telling us that it should serve as a `wakeup call’ for the next global health crisis.