Preparing for the Next Pandemic

Michael T. Osterholm

From Foreign Affairs, July/August 2005

Summary:  If an influenza pandemic struck today, borders would close, the global economy would shut down, international vaccine supplies and health-care systems would be overwhelmed, and panic would reign. To limit the fallout, the industrialized world must create a detailed response strategy involving the public and private sectors.

Michael T. Osterholm is Director of the Center for Infectious Disease Research and Policy, Associate Director of the Department of Homeland Security's National Center for Food Protection and Defense, and Professor at the University of Minnesota's School of Public Health.

READY FOR THE WORST

What should the industrialized world be doing to prepare for the next pandemic? The simple answer: far more. So far, the World Health Organization and several countries have finalized or drafted useful but overly general plans. The U.S. Department of Health and Human Services has increased research on influenza-vaccine production and availability. These efforts are commendable, but what is needed is a detailed operational blueprint for how to get a population through one to three years of a pandemic. Such a plan must involve all the key components of society. In the private sector, the plan must coordinate the responses of the medical community, medical suppliers, food providers, and the transportation system. In the government sector, the plan should take into account officials from public health, law enforcement, and emergency management at the international, federal, state, and local levels.

At the same time, it must be acknowledged that such master blueprints may have their drawbacks, too. Berkeley's Aaron Wildavsky persuasively argued that resilience is the real key to crisis management -- overly rigid plans can do more harm than good. Still, planning is enormously useful. It gives government officials, private-sector partners, and the community the opportunity to meet, think through potential dilemmas, purchase necessary equipment, and set up organizational structures for a 12- to 36-month response. A blueprint forces leaders to rehearse their response to a crisis, preparing emotionally and intellectually so that when disaster strikes the community can face it.

Influenza-vaccine production deserves special attention. An initiative to provide vaccine for the entire world must be developed, with a well-defined schedule to ensure progress. It is laudable that countries such as the United States and Vietnam are pursuing programs with long-term goals to develop and produce H5N1 vaccine for their respective populations. But if the rest of the world lacks supplies, even the vaccinated will be devastated when the global economy comes to an abrupt halt. Pandemic-influenza preparedness is by nature an international issue. No one can truly be isolated from a pandemic.

The pandemic-related collapse of worldwide trade and its ripple effect throughout industrialized and developing countries would represent the first real test of the resiliency of the modern global delivery system. Given the extent to which modern commerce relies on the precise and readily available international trade of goods and services, a shutdown of the global economic system would dramatically harm the world's ability to meet the surging demand for essential commodities such as food and medicine during a crisis. The business community can no longer afford to play a minor role in planning the response to a pandemic. For the world to have critical goods and services during a pandemic, industry heads must stockpile raw materials for production and preplan distribution and transportation support. Every company's senior managers need to be ready to respond rapidly to changes in the availability, production, distribution, and inventory management of their products. There is no model for how to revive the current global economy were it to be devastated.

To truly be complete, all planning on international, regional, national, and local levels must consider three different scenarios: What if the pandemic begins tonight? What if it starts one year from now? What if the world is so fortunate as to have an entire decade to prepare? All are possible, but none is certain.

STARTING TONIGHT

What would happen today in the office of every nation's leader if several cities in Vietnam suffered from major outbreaks of H5N1 infection, with a five percent mortality rate? First, there would be an immediate effort to try to sort out disparate disease-surveillance data from a variety of government and public health sources to determine which countries might have pandemic-related cases. Then, the decision would likely be made to close most international and even some state or provincial borders -- without any predetermined criteria for how or when those borders might be reopened. Border security would be made a priority, especially to protect potential supplies of pandemic-specific vaccines from nearby desperate countries. Military leaders would have to develop strategies to defend the country and also protect against domestic insurgency with armed forces that would likely be compromised by the disease. Even in unaffected countries, fear, panic, and chaos would spread as international media reported the daily advance of the disease around the world.