Saturday, December 16, 2017

The Challenge Of Promoting Pandemic Preparedness

Business Not As Usual


A decade ago - before the relatively mild H1N1 pandemic of 2009 - much of the world was making substantial progress towards better pandemic preparedness. Governments, agencies, organizations, and businesses were creating plans, holding drills, and girding themselves against an H5N1 bird flu pandemic that has so far failed to materialize.
While H5N1 is still out there, we've a new generation of avian and novel flu viruses that we are watching today, with the number of threats having grown to include H7N9, H5N6, H5N8, along with a rogue's gallery of second tier threats.
The CDC's Influenza Risk Assessment Tool (IRAT) currently lists 14 novel viruses with the greatest pandemic potential, although there are others in the wings. 
CDC's Influenza Risk Assessment Tool (IRAT) 
While influenza is viewed as having the greatest likelihood of sparking the next pandemic, other respiratory viruses like MERS, SARS, Pneumonic plague, emerging antibiotic resistant pneumonia's, and of course - Virus X - the one we don't know about yet, are all contenders.

Despite a plethora of threats, recent media coverage (see Smithsonian `Next Pandemic' Webinar Now Available Online), new studies showing both H7N9 and H5N6 acquiring worrisome mammalian adaptations, and a renewed push by some governments to update their pandemic plans (see here, here, and here), relatively little planning appears to be going on at the local or state level or in the private sector.
Some of that inaction is understandable.  We were warned of a devastating pandemic 10 years ago - and while what came in 2009 was bad - it was nowhere near that bad. 
Add in a slow recovery after the economic crash of 2008, and the daily barrage of warnings about everything from nuclear war, to a stock market bubble, to the potential health effects of non-ionizing radiation from your cell phone, and well . .  a loosely defined pandemic threat falls pretty far down most people's list of concerns.
Yet we are all but certain another pandemic will come.  We just don't know when, or how bad it will be. 
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."
The threat of another influenza pandemic is consistently ranked higher by most governments than a major cyber/terrorist attack, solar flare, or nuclear/WMD war – and is considered all but inevitable by many experts.
The declassification of a 2009 Northern Command Pandemic Plan in 2013 (see SciAm story Pandemic Flu Plan Predicts 30% of U.S. Could Fall Ill) estimated that during a moderately severe pandemic 30% of the population could fall ill, 3 million could require hospitalization, and 2 million Americans could die.
As horrific a toll as that might be, the impact globally - particularly in low resource countries - could be many times worse. 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
We are rapidly coming up on the 100th anniversary of the deadliest influenza pandemic in history, and while I expect to see a good deal of media coverage next year, for most people today this is ancient history, and hard to imagine ever happening in our modern era.

While I certainly wasn't around then, as a young paramedic (40+ years ago) many of my patients were teenagers or young adults during the 1918 pandemic - and a few were willing to talk to me about their experiences - particularly during the run up to the Swine Flu scare of 1976 (see Deja Flu, All Over Again).
I wish I'd kept notes, but from the grim stories they told I came away with a new-found respect for the power of an influenza pandemic (I'd weathered the 1957 and 1968 pandemics without so much as a sniffle), and a life-long interest in emerging infectious diseases.
A little over decade ago, then Secretary of HHS Michael Leavitt lamented - "Everything you say in advance of a pandemic seems alarmist.  Anything you’ve done after it starts is inadequate."
And that's the problem. Pandemics typically emerge without warning and then move swiftly. 
From the time we know we're facing a pandemic to the time we are fully involved could be as little as a few weeks. Precious little time to prepare, particularly when the whole world will be scrambling for the limited resources available to combat it.

Six months ago, in World Bank: World Ill-Prepared For A Pandemic, we saw the latest in a long line of assessments stating that a severe pandemic would test our modern medical system, society, and economy in ways we can barely comprehend.
Despite seeing such warnings issued on a regular basis, the overall level of pandemic preparedness across the private sector, and at the state and local government levels, seems less robust today than it was a decade ago.
Maybe we get lucky, and another pandemic doesn't arrive for years. A strong possibility.  But there are no guarantees it won't start somewhere in the world tomorrow, and be boarding an international flight the day after.

As we discussed in The New Normal: The Age Of Emerging Disease Threats, the reality of life in this second decade of the 21st century is that we are probably more vulnerable to global disease threats now than we have ever been before.
Yet,  somehow we’ve been lulled into a false sense of security. A belief that it won't happen here, or anytime soon, and if it does . . .  it won't be that bad.
A nice fantasy, but one that leaves us ripe for a very rude awakening. I know if you are reading this, I'm likely preaching to the choir, but hopefully some of next year's coverage of the 100th anniversary of the 1918 pandemic will help reawaken a wider interest in pandemic preparedness once again.

Because being caught flat-footed and unprepared in the next pandemic would almost certainly make a bad situation much, much worse. 

No comments: