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.

A YEAR FROM NOW

Even if an H5N1 pandemic is a year away, the world must plan for the same problems with the same fervor. Major campaigns must be initiated to prepare the nonmedical and medical sectors. Pandemic planning must be on the agenda of every school board, manufacturing plant, investment firm, mortuary, state legislature, and food distributor in the United States and beyond. There is an urgent need to reassess the vulnerability of the global economy to ensure that surges in demand can be met. Critical heath-care and consumer products and commodities must be stockpiled. Health professionals must learn how to better communicate risk and must be able to both provide the facts and acknowledge the unknowns to a frightened or panicked population.

If there is a year of lead-time before an H5N1 pandemic, vaccine could play a more central role in the global response. Although the world would still have a limited capacity to manufacture influenza vaccine, techniques that could allow scientists to get multiple doses from a current single dose may increase the supply. In addition to further research on this issue, efforts are needed to ensure the availability of syringes and equipment for delivering vaccine. There must also be an international plan for how the vaccine would be allocated. It is far better to struggle with the ethical issues involved in determining such priorities now, in a public forum, rather than to wait until the crisis occurs.

Prevention must also be improved. Priority should be placed on early intervention and risk assessment. And an aggressive and comprehensive research agenda must be launched immediately to study the ecology and biology of the influenza virus and the epidemiologic role of various animal and bird species.

TEN YEARS LATER

If developed countries begin to transform radically the current system of influenza-vaccine production, an influenza pandemic ten years from now could have a much less devastating outcome. The industrialized world must initiate an international project to develop the ability to produce a vaccine for the entire global population within several months of the start of a pandemic. The initiative must be a top priority of the group of seven industrialized nations plus Russia (G-8), because almost nothing could inflict more death and disruption than a pandemic influenza.

The current BioShield law and additional legislation recently submitted to Congress will act to enhance the availability of vaccines in the United States. This aim is laudable, but it does little to address international needs. The ultimate goal must be to develop a new cell-culture vaccine or comparable vaccine technology that works on all influenza subtypes and that can be made available on short notice to all the people of the world.

WHAT COURSE TO TAKE?