Preparing for the next global pandemic - we are not doing enough
by Sol Iglesias and Rachmat Irwansjah
The debate over studying avian influenza - or H5N1 virus - transmissibility returns pandemic risk to the fore of public anxiety. Regardless of the specific agent, influenza or otherwise, a robust plan for preparedness and response must contend with multiple uncertainties. Containing transmission is key. The 1918 Spanish flu wiped out 30 per cent of the world's population at the advent of modern transportation that, by the start of the 20th century, offered global coverage. Infected passengers of ships and trains spread the flu; moreover, severe epidemics occurred in shipyards and among railway personnel.
Concerns about the emergence of a new pandemic are warranted, in light of the severe acute respiratory syndrome outbreak in 2002-3 and the swine flu – or H1N1 - pandemic in 2009. The diseases spread quickly because of the convenience and advancement of global air travel. Since the incubation of the average influenza virus lasts up to four days, there is ample time for an infected individual to journey from one end of the world to another without any symptoms.
In 2009, measures to restrict people's mobility included border closures and health screening at the airport. The World Bank estimated in 2006 that a severe pandemic could cost between 0.7 to 4.8 per cent of global gross domestic product, translating into trillions of dollars. How can authorities best manage global mobility of people and goods against the need to contain transmission? Protecting public health versus limiting people's mobility is a matter of dispute. Although even the World Health Organisation discourages travel-restriction measures during pandemics, some governments are still in favour of imposing limits.
Spurred by the H1N1 crisis, many countries and private companies have put together preparedness and business continuity plans. However, these plans inadequately address the specific complexity of the air transport sector in any crisis. Experts from airlines, transportation authorities and major airports agree that cooperation between officials and the private sector is indispensable. In any public health crisis affected by global mobility, airlines must liaise cooperatively with both health and civil aviation authorities. The WHO is the primary reference for international health regulations; in Europe, the European Centre for Disease Control surveillance system is also an important reference point for risk assessment. Airports and airlines would do well to adopt best practice and maintain a crisis management team on hand.
While we wait in dread until a new pandemic emerges, two very concrete actions can be feasibly implemented. Standards and regulations maintained by both companies and official entities should be cross-checked and coordinated to comply with national and international regulations. Preparedness and response plans made by companies should be certified to ensure standardised measures are applied across countries, airports and airlines.
Authorities, airlines and airports can cooperate to manage coherent, passenger-driven surveillance and response mechanisms. This would entail a centralised reporting system and robust database on the movement of passengers for contact tracing. This system and database could be run by an independent and jointly public-private agency, with representation from consumer watchdogs and passenger rights' groups, to ensure independence and quality in information delivery.
Sol Iglesias and Rachmat Irwansjah work for the Asia-Europe Foundation
Only by working together across international boundaries can Europe and Asia be fully prepared for public health disasters, warns Martin Seychell of the European Commissio
While I am delighted that you are thinking about pandemic planning, I would be a lot happier if some data checking was employed. The 1918 H1N1 pandemic has a wide range of estimated fatalities - usually given as between 20 and 100 million - with a global population at that time of a little under two billion. A reasonable statement might be "The 1918 Spanish Flu wiped out 2 per cent of the world's population", 30 per cent is ridiculous. The 1347 Black Death is estimated to have wiped out 30 per cent of Europe's population - perhaps, that's where the confusion came from.
You can not stop a flu pandemic, if it has an asymptomatic infectious period. The only thing you can do is vaccinate and for this we need to change the global vaccine production system, as the current seasonal-flu technology is too slow to produce pandemic vaccine. Thank you for considering pandemic preparation and please advise your readers to learn a little about vaccine production as it is the only thing that will save large numbers of lives in a highly pathogenic flu pandemic.
JJackson - UK
We are not ready and we may never fully be ready and even if we are, we don't have the stockpiles of tami flu that we need; and what to do with the dead bodies. It would be a grim dark world, indeed.
Jennifer Stewart - United States
Some 3 per cent of the global population died as a result of the Spanish flu, not 30 per cent. Still a remarkably high number of deaths but such basic mistakes undermine arguments for implementing the measures suggested.
Chris - UK
