# 2034
The CDC's Journal of Emerging Infectious Diseases (EID) June issue has an article on the need for greater international preparation for a global influenza pandemic.
First the abstract, then some discussion.
Oshitani H, Kamigaki T, Suzuki A. Major issues and challenges of influenza pandemic preparedness in developing countries.
Emerg Infect Dis [serial on the Internet]. 2008 Jun [date cited]. Available from http://www.cdc.gov/EID/content/14/6/875.htm
Volume 14, Number 6–June 2008
Perspective
Major Issues and Challenges of Influenza Pandemic Preparedness in Developing Countries
Hitoshi Oshitani,*
Taro Kamigaki,* and Akira Suzuki*
*Tohoku University Graduate School of Medicine, Sendai, JapanAbstract
Better preparedness for an influenza pandemic mitigates its impact. Many countries have started developing and implementing national influenza pandemic preparedness plans.
However, the level of preparedness varies among countries. Developing countries encounter unique and difficult issues and challenges in preparing for a pandemic. Deaths attributable to an influenza pandemic could be substantially higher in developing countries than in industrialized countries.
Pharmaceutical interventions such as vaccines and antiviral agents are less likely to be available in developing countries. The public health and clinical infrastructure of developing countries are often inadequate to deal with a widespread health crisis such as an influenza pandemic.
Such an event will inevitably have a global effect. Therefore, improving pandemic preparedness in every country, particularly developing ones, is urgently needed.
While the 1918 pandemic was considered horrific even in developed countries, the death rate was much higher in poorer nations. Exact numbers are not known, but anecdotal reports put the CFR (case fatality ratio) several times higher in Asia, Latin America, and Sub-Saharan African than was seen in the United States and Europe.
As to why some nations fared worse during the Spanish flu than others? Well, some of the theories mentioned in this article include:
- lack of access to adequate medical care
- weak public health infrastructures,
- housing conditions and population density
- nutritional status and
- co-existing medical conditions.
Giving the aging (and likely less susceptible) population of developed nations, and the higher prevalence of AIDS in many poorer countries - along with the factors listed above - It is entirely predictable that the next influenza pandemic will have a similarly larger impact on the developing world, as well.
The authors cite three major issues that developing nations must face during the next pandemic.
- Availability of Vaccines and Antiviral Agents in Developing Countries
- Limitations of Pharmaceutical Interventions
- Lack of Medical and Public Health Infrastructure to Cope with an Influenza Pandemic
In other words, the same problems and limitations that kill millions of people each year for lack of decent medical care will exacerbate the death toll in a pandemic.
Obvious, perhaps. But worth repeating.
The authors go on to list those areas where improvements must be made, including:
- Improving Planning Process
- Increasing Availability of Antiviral Agents and Vaccines
- Providing Better Medical Care
- Developing Feasible Mitigation Strategies
- Strengthening International Collaboration
- Strengthening Core Capacities
Again, no startling revelations here.
But then, the problem has never been in identifying our problems or even coming up with solutions. The difficulty has always been in finding the political will and the financial resources to implement them.
As a species, we obviously failed to learn the lessons from the last great pandemic.
A pity that we may someday be forced to learn them all over again.
The hard way.
