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The Next Pandemic

July 12, 2010

John Barry, pandemic biographist extraordinare, has an interesting editorial in the Summer edition of the World Policy Journal here. Titled, The Next Pandemic, Mr. Barry takes us on a quick tour of the lessons learned from H1N1 and finds that while a lot of us who are rewriting the rulebook have learned the right lessons:

Based on their results, health organizations will likely adopt modest management changes. The WHO previously defined an influenza pandemic as basically any occurrence in which a new influenza virus enters the human population and passes easily between humans; it may refine that definition by adding a virulence factor, similar to the Saffir-Simpson scale for hurricanes (category 1 to category 5). Vaccine delivery systems will improve. Local hospitals will upgrade their triage practices. And some fundamental changes which were already underway—such as shifting vaccine production away from chicken eggs, a technology used for more than half a century, to new production technologies—will accelerate.

Mr. Barry then rails against the political machinations that we saw during H1N1:

The WHO has come under intense attack for declaring a pandemic at all, and critics have even charged the pharmaceutical industry with influencing the decision.

(SNIP)

If the current criticism of the WHO makes it more cautious in the future, the world will become a more dangerous place.

He then lists a variety of decisions made purely for political reasons that — should the pandemic been what we originally feared — would have, at best, done nothing or, at worst, exacerbated the situation.

Barry’s summation is harrowing:

Meanwhile, a sense of complacency seems to be settling over the world. Because H5N1 has not become pandemic and H1N1 turned out to be mild, the idea that influenza is no longer a threat has become pervasive. Everything that happened in 2009 suggests that, if a severe outbreak comes again, failure to improve on our response will threaten chaos and magnify the terror, the economic impact and the death toll. And it will come again.

My take? Barry is spot on. After all, pandemics only happen every thirty years or whatever, right? Seriously, though, the scapegoating process is very familiar in pandemic situations. The Spanish flu will always be the Spanish flu, if only because they were the only country to really admit to it. Swine flu is still swim flu (to most people), no matter what the pork board says. And the bit about vaccine hoarding is a real concern.

My worry, though, from a planners perspective (because I think we’ve learned the major lesson about over-planning for worst-case only), is what Gerald Baron has been seeing in the Deepwater Horizon clean up. Political machinations, by government and corporation, have hampered the response; have misdirected the focus of the responders (read: you and me). Knee-jerk reactions to shunt blame (whether it’s culling pigs in Egypt, or complaining that BP won’t release raw video footage) will derail any response, whether it’s PR related or public health related. And nothing, but nothing, will enable the response to quickly refocus. That’s why it’s essential to involve the political players in your planning, early and often. Table-top it out and if your Alderman says, “I would never say that,” then you’ve got a problem.

I don’t always agree with Mr. Barry, but think he’s sounding the right alarm bells here. I highly recommend you check out the short article here (PDF).

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