Saturday, April 29, 2017

Are We Prepared to Help Low-Resource Populations Mitigate a Severe Pandemic?


The 2014 West African Ebola epidemic showed us just how horrific a severe epidemic can be - and how quickly one can grow out of control - particularly in `low resource' settings.
As bad as it was, the toll of death and suffering in West Africa would pale compared to what a severe influenza pandemic would produce globally, particularly across the developing world.
More than a decade ago we looked at a Lancet study that predicted, based on a 1918-like pandemic scenario, could claim as many 62 million lives, and that 96% of those deaths would occur in developing countries. 

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918—20 pandemic: a quantitative analysis

Prof Christopher JL Murray DPhil , Prof Alan D Lopez PhD, Brian Chin ScB, Dennis Feehan AB , Prof Kenneth H Hill PhD

The authors cited as much as a 30-fold difference in mortality rates around the world in 1918. Countries in Asia, Latin America, and Sub-Saharan African were particularly hard hit. That disparity today, with better access to antivirals, antibiotics, and eventually vaccines for the developed world might even be greater.

In 2012, a  Paper: Are We Prepared For A Pandemic In Low Resource Communities? by Eric Starbuck DrPH, MPH et al., looked at the challenges (and provided some solutions) for helping low resource communities deal with an influenza pandemic.

Those solutions were largely based on NPIs - or Nonpharmaceutical Interventions, such as hand washing, covering coughs, social distancing, and even school closureswhich would be the first line of defense against a severe pandemic everywhere, including in developed nations.

Last weekend, in Community Pandemic Mitigation's Primary Goal : Flattening The Curve, we looked at the freshly minted 2017 Community pandemic mitigation plan by the HHS/CDC, which envision NPIs as our first, and perhaps most effective, response to a pandemic.

While the developed world has an infrastructure, and an (admittedly finite) supply of antivirals, antibiotics, ventilators, and hospital beds to deal with a pandemic, for many low resource populations NPIs may be all they have to rely on.

This week, Eric Starbuck returns with an essay on the NO MORE EPIDEMICS website, which reviews the history of pandemics, the efficacy of NPIs, and how they could be used in low resource settings to mitigate the effects of a severe pandemic.

I've only included the abstract, so you'll want to follow the link to read it in its entirety.  When you return, I'll have a bit more.

Are We Prepared to Help Low-Resource Populations Mitigate a Severe Pandemic?

April 27, 2017

By: Eric S. Starbuck, DrPH, MPH 

Abstract: Although the risk of onset in the next year, or in the next decade, cannot be quantified, a severe pandemic involving person-to-person transmission of a novel respiratory virus is considered by leading organizations to be a substantial global threat. The ongoing threat posed by the H5N1 and H7N9 avian influenza viruses, and by the MERS coronavirus, should serve to remind us of the continuing importance of pandemic preparedness.
In a severe pandemic from a rapidly spreading novel respiratory virus, when all countries and all responding organizations will themselves be struck, most low-resource populations will fail to receive adequate medical supplies, and their health services will be more stressed than they are today.
However, these populations could, by employing well-planned, evidence-based measures, reduce disease transmission and care for those not severely ill, without substantial outside resources. Authoritative guidance must be developed, and support provided for country adaptation, planning for rapid roll-out, and testing of these plans.
         (Continue . . . )

The NO MORE EPIDEMICS website describes themselves as:

No More Epidemics is a five year global campaign to encourage governments and key stakeholders to better prevent, prepare and respond to infectious disease epidemics. Established in 2015 by Management Sciences for Health (MSH), International Medical Corps (IMC), Save the Children (SC), and the African Field Epidemiology Network (AFENET) the Campaign was officially launched in November, 2015 in South Africa.
Our 26 current partners include civil society organisations, community-based organisations, private sector companies and academic institutions all working together to hold governments accountable to prioritize epidemic prevention, preparedness and response planning. No More Epidemics goals are to:
  • Ensure the development of national preparedness plans that include community protection and mitigation.
  • Ensure all States comply with the International Health Regulations (IHR).
  • Increase international and national funding levels for epidemic preparedness, prevention and response.

While you are visiting (and perhaps becoming a partner), you'll want to look at some of the other essays available on their Thought Leadership Page.

Given nearly 10 years of recession and slow economic growth, growing budget deficits, and competing `crisis' issues like nuclear proliferation, climate change, antibiotic resistance, famine, war, and access to clean water - pandemic preparedness can be a tough sell. 

But another pandemic is not just a possibility, it is all but certain. The only real questions are when, and how bad it will be. 
A reality that governments, agencies, businesses, and individuals must all consider carefully as they plan (and hopefully, prepare) for their future.