What will happen when an unexpectedly virulent flu, or SARS, or Disease X—any other rapidly spreading viral infections—spreads globally causing a pandemic? How prepared are we? What do we need to do to be ready?
LANZHOU, CHINA - Woman selling live chickens and ducks in cages at a food market, Gansu province, ... [+]
These are some of the questions faced by global leaders in public health, industry, and government in a pandemic preparedness exercise called Event 201. The program was a collaboration between the Johns Hopkins Center for Health Security, the World Economic Forum, and the Bill and Melinda Gates Foundation.
Trying to improve preparedness is critically important as we will be seeing more epidemics from factors like climate change, shifting and increasing populations, urbanization, deforestation, and globalization.
The experts ran through a carefully designed, detailed simulation of a new (fictional) viral illness called CAPS or coronavirus acute pulmonary syndrome. This was modeled after previous epidemics like SARS and MERS.
What follows hasn’t happened yet, but the scenario was quite realistic, presuming that the infection began with animals and then was transmitted to people, just as has happened in past pandemics. There were even prepared “news” clips from a fictional GNN, with health experts and talking heads pontificating, and flashy graphics showing the spread of the pandemic.
At various steps, the experts discussed possible interventions and needs—were there adequate supplies of masks, for example? Or medicines? What was the capacity of factories to produce supplies and airlines to distribute them?
While I couldn’t attend the exercise, Event 201 is available to watch and was a worthwhile, if not uplifting, experience. Emily Ricotta, PhD (@Iplaywithgerms) also live-tweeted it and her thread can be seen here.
The first discussion centered around the distribution of supplies. Without knowing more about the epidemiology and transmission of the new CAPS virus, one can’t plan intelligently. For example, are face masks, or hand sanitizer, or water purification the priority? Surveillance and data collection are spotty as some LMIC (low- and middle-income countries) don’t have the capacity to obtain specimens that wealthier countries do.
As in other, real epidemics, responding to the logistical supply issues was complicated by false or misleading news reports, by on-line trolls, and by some people who just seem to want to sow discord and chaos. Fears are inflamed and people or countries can be targeted for blame. As we’ve seen with HIV, Ebola, and everything else, driving people underground and forcing them to hide illness fuels epidemics and travel and trade bans can devastate economies. None of these prevent the spread of an epidemic spread by air–or waterborne—transmission.
As the CAPS virus spread in the simulation, supplies were stretched and distribution was disrupted. How can countries plan for continued services and businesses for production? How can they maintain supply chains if there are trade or travel bans?
How can you assure equitable distribution of critical supplies? In this scenario, one country where the antiviral “Extranavir” was produced, planned on holding onto it, rather than exporting the drug.
As the virus spreads, economies become greatly weakened. Discussion turned to how to prevent collapse of governments, famine, and terrorism. Could the World Bank’s Contingency Emergency Response Components be used to allow existing loans to LMIC to be shifted to use for this public health emergency? Would the private sector help with financing? Can we mobilize and come together in such a global crisis? How—and who—will provide humanitarian aid?
As cases and deaths exploded exponentially, there was understandably more public panic, fueled by dis- and misinformation and conspiracy theories. Just as is occurring in the DRC now with Ebola, health care workers were being attacked and were unable to respond and try to contain the infections. How can this be countered?
Suggested responses included disseminating reliable information aggressively, through both social media and companies educating their employees. Use “trusted sources,” like respected community leaders and religious groups, to help spread accurate information. Focus on risk communication, providing information quickly, accurately, and without fueling panic.
Recommendations from the group were:
1. Global business should recognize the economic burden of pandemics and really fight for stronger preparedness.
2. How can corporate capabilities be used during a large-scale pandemic?
3. The World Health Organization should work with industry and national governments to enhance internationally held stockpiles of MCMs (medical countermeasures) and personal protective equipment that could be equitably distributed.
4. Countries and global transportation companies should work together to maintain travel and trade during a severe pandemic. (Previously, quarantines have been important for controlling epidemics; this was not presented here, likely unrealistic from the scale of the pandemic).
5. Government should provide more resources and support for the development of surge manufacturing of vaccines, therapeutics, and diagnostics.
6. We need to increase and reassess pandemic financial support.
7. Governments and companies should increase coordination now to prepare to combat mis- and disinformation during a pandemic.
What countries are the most prepared? This is what the Global Health Security Index suggests.
My personal assessment after watching this exercise was mixed. On the plus side, I was extremely impressed with the competence and thoughtful comments of many of the group’s members.
But my overall take was pessimism and foreboding, as we are woefully unprepared.
Dr. Eric Toner, senior scholar with the Center for Health Security and a Senior Scientist in the Johns Hopkins Bloomberg School of Public Health, cheered me a tad by noting that significant progress has been made since the last of these exercises. For example, he explained that there is now (since 2005) International Health Policy regulations that require countries to report incidents of international concern. Our ability to detect and develop countermeasures has improved significantly, and we now have BARDA (Biomedical Advanced Research and Development Authority) (not that I haven’t had misgivings about some of their projects, such as an anthrax vaccine) and a National Stockpile, which was of use during the 2009 influenza pandemic.
I have been particularly concerned about:
—the “distributive justice” issue. Recently, Indonesia did not want to share flu samples because they felt that they would not benefit from related discoveries, and that only wealthy countries would. Dr. Toner says this has been improved by the PIP (Pandemic influenza preparedness) framework.
There is similar unhappiness now over how some Ebola samples have been handled, fueling mistrust.
—the rise in nationalism and protectionism in various countries does not bode well. The best response to a pandemic requires global cooperation and a certain altruism, to do what is best for the global community. That is essential for readiness.
Perhaps the most reassuring observation from Dr. Toner was, “We’re trying to aim at making things better than they would be...I don’t think ‘prepared’ is a place…I think we can only be better prepared.”
As Lawrence Ferlinghetti wrote,
The world is a beautiful place to be born into... but then right in the middle of it comes the smiling mortician.
How much time do we have?
