Credit WHO
#18,792
While we are thankfully now in an interpandemic period there are plenty of obvious (and not so obvious) zoonotic threats in the wild that could - with little or no warning - kick off the next pandemic.
Twenty years ago - with the rise of H5N1 in Asia and then Europe - there was a huge push for every nation, every state, and most federal and state agencies to create (and test) their pandemic plan.For decades the assumption had been that only influenza A viruses were capable of sparking a modern pandemic. But three brushes with coronaviruses (SARS, MERS-CoV, and COVID) over the past 2 decades have proved that pandemics can come in many flavors.
While most of these plans optimistically envisioned a repeat of the relatively mild 1968 or 1957 influenza pandemics, they at least got leaders thinking about the threat, and inspired many drills.
As a result, the world was caught flat-footed and unprepared for the COVID pandemic of 2020. More than five years later, however, we are starting to see a wave of new pandemic plans (and pandemic vaccine purchases) unveiled around the globe:
In February of 2007, the CDC & HHS unveiled their Community Strategy for Pandemic Influenza Mitigation plan. This 108-page document covered a variety of topics, including the creation of a pandemic severity scale, and the expected role of NPI's (Non Pharmaceutical Interventions) in combating any pandemic outbreak (see The CDC Does NPI).
In 2009 an influenza pandemic finally arrived, but instead of H5N1 it turned out to be a less virulent swine-origin H1N1 virus. Deaths were far less than expected (although younger people were hit hardest), and in its aftermath many countries scaled back their pandemic planning.
In 2009 an influenza pandemic finally arrived, but instead of H5N1 it turned out to be a less virulent swine-origin H1N1 virus. Deaths were far less than expected (although younger people were hit hardest), and in its aftermath many countries scaled back their pandemic planning.
The CDC/HHS updated their pandemic plans in 2017 (see CDC/HHS Community Pandemic Mitigation Plan - 2017), but around the country (and around the world), actual pandemic preparedness was largely put on a back burner.
As a result, the world was caught flat-footed and unprepared for the COVID pandemic of 2020. More than five years later, however, we are starting to see a wave of new pandemic plans (and pandemic vaccine purchases) unveiled around the globe:
- Earlier this month Switzerland Unveils New Pandemic Plan
- Last summer both South Korea and Japan issued revised pandemic plans
- Last November Hong Kong held a Coordinated Avian Flu Drill `Amazonite'.
- Last April the ECDC published ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats,
- Over the past year, PAHO (Pan American Health Organization) has repeatedly urged its member nations to proactively prepare to deal with a potential influenza pandemic
- and recently the WHO ratified a 2025 Pandemic Agreement.
But these updated response plans remain rare, and many countries, states, and agencies are still using badly outdated plans from 2006-2007; most of which envision a mild-to-moderate influenza pandemic - and are gathering dust in some file cabinet.
I've tried, but have failed, to find a comprehensive list of current state pandemic plans (if anyone knows of one, please let me know). ASPR/TRACIE published a short list of plans in 2020 (n=10), many of which dated back to 2007/2008, and many of those links are now broken.
They reported an updated Pandemic Plan from Kansas in 2020, but the link is broken, and a search (earlier today) of the Kansas DOH returns the following error:
ASPR/TRACIE included an updated 2019 Pandemic Plan for the state of Arizona, but once again the link is broken. While a search returned a relatively new (2023) Infectious Diseases of High Consequence Plan, the most recent pandemic plan I could find was dated 2011. .
If there is a newer pandemic plan on the DOH site, it is well hidden
Illinois has a pandemic flu webpage and plan, but it hasn't been updated in more than a decade (2014). To give you an idea of what this 125-page document is planning for, I've reproduced their assumptions below:
COVID killed nearly 5 times their maximum estimate for pandemic flu, and that is almost certainly an undercount.
Missouri is a bit of an outlier, coming in with a newly minted (52-page) Pandemic Influenza Response Plan (2024), but it is 100% influenza-centric; COVID is never mentioned, and the word `coronavirus' only appears twice (in a list of acronyms).
To their credit, they do suggest a CFR of `up to 2%' is possible, and warn that a vaccine will likely be unavailable in the opening months.
I've run into multiple dead ends looking for (old or updated) state pandemic response plans, with many seemingly no longer accessible by the public.
The CDC did post a list of National Pandemic Strategy documents in May of 2024.
Of the 8 links provide, half (n=4) are dated 2006, 1 is from 2009, while 3 others are from 2015-2020. All predate both the emergence of the new H5Nx threat and the worst of the COVID pandemic.
Although my brief survey of state plans is far from comprehensive, and there may be plans `in the pipeline' that have yet to be released, we appear to be falling further behind in our preparedness for the next pandemic.
Prior to 2020 table-top exercises and pandemic drills were relatively commonplace, but if they occur at all today, they do so with little or no publicity.Many of the CDC's pandemic guidance documents now have broken links, have been `retired', and can only be found in the https://stacks.cdc.gov/ archive.
Ready.gov provides a rudimentary pandemic preparedness section, but the robust guidance that was once available to the public is now very hard to find, including the following 16-page Household Pandemic Planning guide, which emphasized the use of NPIs - or Non-Pharmaceutical Interventions - during a pandemic.
There is an old adage that no pandemic plan ever survives contact with the virus, and as we saw in the opening months of COVID, many countries quickly abandoned nearly all of their existing protocols.
- China quickly went `off-book' in fighting their novel coronavirus epidemic; quarantining hundreds of millions of people, shutting down cities, blocking roads, and essentially implementing martial law.
- While less dramatic, the responses by governments, airlines, and public health agencies outside of China have greatly exceeded what was envisioned in the WHO's NPI guidance plan. Particularly in regards to travel restrictions.
To quote President Dwight D. Eisenhower on D-Day; `Plans are worthless, but planning is everything.'
But if we don't up our game, the only thing we'll be planning for is failure.
