Wednesday, May 16, 2018

CLADE X: Archived Video & Recap


Yesterday Johns Hopkins held a day-long pandemic table top exercise (Clade X), with former and current government officials playing the roles of the President's National Security advisory team, as a pandemic scenario unfolds. 
Divided into 4 sessions, each between 90 and 120 minutes in length, this 7 hour pandemic exercise provides a unique window for the American public into the difficult (and at times,`impossible') political and logistical decisions that must be made during a global health crisis. 
The only ones with the script are the moderator, his team, and those bringing in fresh news reports.  Everyone else at the table is working without a net, and basing their responses on their previous government experience.

Links to the 4 sessions can be found at:

Clade X Livestream (Archived)

Having participated in a couple of these tabletop exercises in the past, I can vouch for the fact that after a while, you really do feel on the hot seat when questioned or asked to justify your position.

Without giving too much away (you'll want to watch the entire exercise), I can tell you that the exercise team threw some interesting curve balls at the panel, illustrating that the next pandemic may not follow the same script as previous outbreaks. 
They presented an `atypical', and (in the beginning) highly asymmetrical pandemic, that seemed very slow to get off the ground.  At least, in the morning sessions.
Despite repeated warnings from the CDC & HHS panelists and the moderator's updates, many on the advisory panel seemed to discount estimates of it taking `at least a year, maybe longer' to get a vaccine.

Unfortunately, this `. . .  and then a small miracle occurs' mindset seems pretty common, particularly in non-medical government circles.
Even the WHO over estimated the amount of H1N1 vaccine that would be available 1 year into the 2009 pandemic by a factor of 5 (see Unforgiving Numbers & Pandemic Vaccines).
Kudos to the Johns Hopkins team for making some bold choices as to the virus, its origins, the manufacturing and ultimate availability of vaccines, and the realistic, but devastating butcher's bill at the end.

Although a one day session can only scratch the surface of the number of thorny issues that officials would face during a pandemic, this exercise does provide plenty of food for thought (and hopefully, discussion).

The biggest take-away is that we are completely and woefully unprepared to deal with a severe pandemic (or any other major regional or global disaster), and that the costs of being caught unprepared are literally unthinkable.
And so we don't think about them.  Well, most people don't.  
Those that do - like the folks at the CDC, HHS, FEMA, CIDRAP, Johns Hopkins Center for Health Security, thousands of EMS and EOC centers around the globe - all know that the next big crisis could come at anytime.
And when it does come, our lack of preparedness will come back to bite us, in ways we can only begin to imagine.  As bad as the Johns Hopkins' pandemic scenario was, it is not the worst case.
If you haven't watched the full 7 hour pandemic exercise, I hope you'll do so at your earliest opportunity.  Ideally, you will watch it with friends, co-workers,  and/or family members, so you can pause the video and discuss and debate each crisis point as it comes up. 
Fair warning, however.  
For many of these issues, there are no `good' or even feasible solutions.  And what may seem `right' to do during the morning session, may very well come back to haunt you later in the day. 
And that's the true reality of a severe pandemic.   Sometimes there will be no good options available.
A little over a decade ago, in Quotable Quotes,we looked at some statements by government officials on what an H5N1 pandemic might look like. While many were excellent, the one that best exemplifies the problem with pandemic preparedness is:
“Everything you say in advance of a pandemic seems alarmist.  Anything you’ve done after it starts is inadequate."- Michael Leavitt,  Former Secretary of HHS
And ten years later, it remains apparent we haven't done near enough to prepare to face the next pandemic.