Exploring Lessons Learned from a Century of Outbreaks Readiness for 2030: Proceedings of a Workshop (2019) / Chapter Skim
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4 Reflections on a Century of Infectious Disease Outbreaks and Pandemics
4 Reflections on a Century of Infectious Disease Outbreaks and Pandemics
Pages 43-60
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From page 43... ...
IMPACT OF OUTBREAKS AND PANDEMICS ON PEOPLE, COMMUNITIES, AND ECONOMIES Rick Bright, director of BARDA, began by explaining the role of ASPR: Its mission is to save lives and to protect Americans from health security threats in the 21st century. ASPR tracks a wide range of microbial threats, which span emerging natural threats, scientific accidents, and threats imposed intentionally by individuals or state actors.
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From page 44... ...
By 2009, the country's capacity to make more vaccines had improved but not quickly enough to get in front of the curve. In 2018, Bright reported that national capacity had improved to the extent that around 800 million doses of pandemic influenza vaccine could be produced if needed.
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From page 45... ...
. • Between 2009 and 2010, the influenza A H1N1 pandemic caused more than 200,000 deaths worldwide.1 • In 2012, Middle East respiratory syndrome (MERS)
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In 2016, the Commission on a Global Health Risk Framework projected the average expected economic losses from infectious disease crises in the future would be around $60 billion per year (GHRF Commission, 2016)
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Three months into the simulated pandemic, more than 10 million people had died around the world. After 4 months -- the point at which factories would be able to start producing a pandemic influenza vaccine, given the world's current best efforts -- the death toll had increased to 22 million people.4 Six months into the simulated pandemic, when maximum vaccine production would be available, an estimated 33 million people had died.
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From page 48... ...
Specifically, the first step was to model the impact of early virus detection through at-home diagnostics and wearable devices, which enable earlier disease detection and treatment and may encourage people to take faster action and to seek faster treatment. He explained that at-home technology could send alerts to people who are still pre-symptomatic and notify them if they are exposed to influenza, for example; this alert could be augmented by messaging from local public health entities if there were an outbreak or pandemic in the community.
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From page 49... ...
they choose, individuals will act responsibly to try to reduce further transmission of the organism. Bright emphasized that the model suggested the synergistic impact of NPIs: When combined with early antiviral treatment, models of NPI implementation significantly flattened the epidemic curve to around 60,000 new infections per day and pushed out the apex of the curve by roughly an additional 50 days.
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• Cultivate strong leadership structures at the local, community, national, regional, and global levels. • Foster global collaboration, alignment, and knowledge sharing.
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From page 51... ...
It is also important to routinely consider the impact of local-, community-, and hospital-level preparedness and of how such preparedness ties into global mechanisms, he added, because each country cannot have a unique national preparedness-response posture in an effective global effort. He added that this again underscores the importance of ensuring the functionality of global coordination, alignment, and collaboration mechanisms prior to a bioincident through implementing robust national planning and through testing to failure of countries' pandemic response capabilities.
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From page 52... ...
. if we had a better idea of what went on in the past, we might be better prepared for some of the things that should not be surprises as we go forward." Responses to Coronaviruses Monto's presentation focused primarily on pandemic influenza but began with a brief overview of global responses to SARS and MERS outbreaks.
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Influenza Pandemics of the Past Century Monto discussed several influenza outbreaks and pandemics over the past century in order to highlight specific lessons that can productively inform future preparedness efforts. He drew lessons from the H1N1 pandemic in 1918, H2N2 pandemic in 1957, H1N1 nonpandemic in 1976, and the H1N1 pandemic in 2009.
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. A more recent analysis of annualized 1918 data examined age-specific influenza death rates among females in England and Wales during a first-quarter wave of regular seasonal influenza and a fourth-quarter wave of pandemic influenza.
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, but Monto added that this trend had to be "rediscovered" during the most recent influenza pandemic. 1957 H2N2 Influenza Pandemic Monto used data from the 1957–1958 H2N2 influenza pandemic to illustrate how major outbreaks can occur at any time of the year when schools are open.
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From page 56... ...
Monto noted that this strategy is currently under serious consideration by governments based on the premise that delivering vaccines to people directly is a better alternative to stockpiling. He said this holds particularly true when they are delivered prior to a pandemic scenario, in which it would be difficult to administer stockpiled vaccines to people in the midst of an incident.
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From page 57... ...
Monto said the International Health Regulations were tested by a pandemic influenza epidemic in 2009, and this shifted the emphasis of response efforts toward the fourth phase. He noted that the fourth phase should be recognized as a key time; it is the point at which the virus becomes transmissible to humans, and health care professionals transition to pandemic preparedness as a result.
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. Observations on a Century of Facing Evolving Pandemic and Emerging Infectious Disease Challenges Monto concluded his presentation with a set of observations gleaned from a century of facing evolving pandemic and emerging infectious disease challenges.
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From page 59... ...
Bright said that his agency's broad aim is to encourage individuals to take responsible action to reduce transmission and to seek earlier antiviral treatment. Furthermore, Bright noted that the capacity to miniaturize molecular technology to an affordable home-based system already exists, and the next step for at-home technologies is wearable devices.
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From page 60... ...
Moon asked how response planners should prioritize interventions that are especially synergistic in settings where layering is not feasible. Bright noted that although the United States appears to have the capacity and knowledge to do so, interventions in the country remain unlayered because layering requires extensive coordination and preparation from individual to federal levels.
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