Exploring Lessons Learned from a Century of Outbreaks Readiness for 2030: Proceedings of a Workshop (2019) / Chapter Skim
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2 Is the World Ready to Respond to the Next Influenza Pandemic?
2 Is the World Ready to Respond to the Next Influenza Pandemic?
Pages 7-22
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From page 7... ...
Since then, scientific and medical advances in antibiotics, diagnostics, vaccines, and other areas have enabled the international community to better prepare for infectious disease outbreaks. However, outbreaks have continued to cause devastating outcomes over the years, and emerging infectious disease events are increasing significantly over time (Jones et al., 2008)
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Dzau then discussed recent progress made that aims to strengthen pandemic preparedness. Since the Ebola outbreak in West Africa, the NAM, the Harvard Global Health Institute, the London School of Hygiene & Tropical Medicine, and the United Nations (UN)
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He concluded, "Improving pandemic preparedness will require sustained attention to collective action across many sectors. This is why I am so pleased to see all of you come together for this workshop." HISTORICAL INFLUENZA PANDEMICS Laurie Garrett, science journalist and founder of the Anthropos Initiative, explained that the historical record of influenza pandemics stretches back to the 1100s.
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AN IN-DEPTH EXAMINATION OF THE 1918 INFLUENZA PANDEMIC According to Garrett, the 1918 influenza pandemic was exceptionally virulent because it behaved fundamentally differently from previous outbreaks in its ability to cause disease. The symptoms of the disease in many cases were very severe, including hemorrhage with profound bleeding, blood-laced vomit, high fever, delirium and hallucinations, miscarriage, heliotrope cyanosis, and acute respiratory distress.
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From page 11... ...
In addition, soldiers spent long periods in close contact in below-ground trenches to protect themselves from bombs, and this also may have contributed to increased influenza transmission. She explained that efforts to address the influenza pandemic in the United States were hampered by major deficits in the domestic health workforce during World War I; at the time of the initial outbreak, thousands of physicians were working on foreign battlefields and thousands of nurses had been recruited to serve on battlefields and in rehabilitation centers abroad (Crosby, 2003)
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scientific establishment was that the pandemic was caused by Bacillus influenza, a bacterial disease. Conjecture and speculation were rampant about the nature and cause of the disease, as well as how people could protect themselves from it.8 A common presumption was that improved personal hygiene and public space cleanliness would somehow quash the pandemic; people also thought that face masks would provide protection against influenza, but no one understood what type of mask should be used, how it should be used, or how much protection a mask would offer.
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. Garrett explained that the 1918 event was a turning point in the recorded history of influenza pandemics.
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However, pandemic mortality rates varied widely across the world. For instance, all-cause mortality between 1918 and 1920 reached 40 percent in parts of Iran and was very high among some rural and indigenous communities in the United States (Brady et al., 2014; Hatami, 2016)
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. Response to the 2009 Influenza Pandemic According to Garrett, the president of Mexico responded swiftly and contained the spread of the virus at the end of April 2009, announcing that many public services, government offices, private business, schools, churches, and mass transit modalities would be ordered to close.
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Face mask production plants struggled to meet global demand for masks, and markets were flooded with fake antivirals because of the global medication shortage. Mortality of the 2009 Influenza Pandemic Garrett provided an overview of the mortality associated with the 2009 influenza pandemic.
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POTENTIAL IMPACTS OF A MODERN PANDEMIC Garrett considered the potential impacts a major influenza pandemic might have if it occurred today. According to an analysis that extrapolated the 1918–1920 mortality rates to the 2004 global population, between 50 and 80 million people could be killed by a modern influenza pandemic of similar severity to the one in 1918 (Murray et al., 2006)
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In addition to the availability of vaccines, antibiotics, and antiviral drugs, the modern context benefits from improved respiratory care and support therapy, a larger and more skilled health labor force, the absence of intense combat and world war, WHO and other international governance mechanisms, and the Global Health Security Agenda (GHSA)
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. Garrett also mentioned that while the absence of intense combat and world war is certainly a boon, attacks against health care workers are increasing around the world.13 International Governance and Global Health Security Agenda Regarding the potential for international governance to mitigate the effects of a pandemic, Garrett commented that WHO is underfunded, and presumably, its existing funds continuously deplete with each new outbreak.
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DISCUSSION After the keynote presentation, the audience asked Garrett a couple of questions. Pia MacDonald, senior director of applied public health research at RTI International, asked whether the common belief that pandemic influenza strains originate in Asia is a misconception.
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Christopher Eddy, president of All1Health Systems, LLC, asked Garrett about the potential significance of future alternate transmission pathways for influenza, such as fecal-oral contaminated surfaces and fomites. Garrett replied that if a pandemic emerged with a highly virulent strain and efficient human-to-human transmission, the general population would immediately want to know how to protect themselves in practical ways.
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