The Council on Foreign Relations held a conference on Nov. 16 in New York where a number of high-powered panelists discussed the threat of a flu pandemic and the status of avian flu preparedness in the U.S. and around the world. The intensity and complexity of the problem, as laid out in the discussions, is truly mind-boggling. The experts seem to mostly agree that we don’t know when the pandemic is going to begin, and we don’t know how bad it’s going to be. Most also agree that we are pretty sure it’s going to be bad, but just how bad is a matter of debate.

“Hope for the best and prepare for the worst” is the operating mode for folks involved in crisis preparation and contingency planning. Some of the scenarios kicked around in the discussions talk about a massive pandemic, a horror scenario where millions die, 1 in 2 are sick, critical infrastructure breaks down, hospitals are totally overwhelmed. Hundreds of millions have no power, no fuel, no medicines, little food or water. I have not seen any predictions as to the real probability of this worst-case scenario, but it is clearly out there as a possibility. The factors that will determine the scale of the pandemic are either unknown or variable. What we don’t know is how soon the H5N1 virus will be able to start jumping easily from human to human and the pathogenicity of that virus. And one of the changing variables we control is our level of preparedness.

The effects of the next flu pandemic are difficult to predict, because these major variables are unknown or changing. Preparedness is a major factor, and there is now momentum on a global scale to get ready. However, preparations are only in the beginning stages, and we need a lot more time to be able to cope with a major pandemic.

In a discussion with David Nabarro, UN system senior coordinator for avian and human influenza, and David Fedson of Aventis-Pasteur, Michael Osterholm, Director of the Center for Infectious Disease Research and Policy at University of Minnesota lays out this picture in Session 2 of the CFR conference:

OSTERHOLM: (…) I mean, when you think about the fact that this if a pandemic were to occur today, there’s a very high likelihood we would begin to shut borders around the world. We live in a global, just-in-time economy today where this country, in particular, absolutely lives on the goods and services of much of the rest of the world. Many of our critical medical supplies, our pharmaceutical products, our food supply everything you can name that would come to a screeching and crashing halt if, in fact, pandemic began today.

Now, I can’t think of a much greater security risk to this country, or for that matter, to the world, and yet if you look at the investment that’s been made, the entire world’s investment doesn’t equal that of one aircraft carrier. So to me, there’s still a major disconnect between the issue of really committed to understanding what a pandemic might do.

Remember and I agree fully with David’s assessment on the numbers of cases but we don’t even need the number of cases to do what I just talked about. Remember anthrax in this country, following 9/11, affected 22 people, killed only five people, and yet we shut down better parts of the mail service around the country. The economic implications were huge.

Today in this world where we do live, in a sense, on steroids of media concern one day it’s a big problem, next day it’s not; one day we’re at risk of losing the world, the next day it seems as if it’s a by-forgotten issue. We don’t have sustained and committed resources to go to what could be, I think, the single greatest threat to the global security of the world, at least surely the economic security of the world.

So I think that until we get that, we’re not going to get the kinds of commitment to long-term vaccine production. I would just add that even if today, the researchers could come up with all the information that David just very nicely detailed following 1976, we don’t have the buildings; we don’t have the machines; we don’t have the pipes; we don’t have the experts to make that vaccine. We are at least five to seven years off (with ?) having the kind of infrastructure that could make vaccines for the world.

Let me just conclude with one last piece on that. What I worry desperately about is everything I’ve heard so far coming primarily out of the vaccine-production area has been a very American-centric piece. It’s been how can we wave the magic wand and protect us? I will tell you right now that if a global economy crashes, there will be many pharmaceutical products that we take for granted cardiac drugs, cancer drugs, the antibiotic, anti-virals, et cetera that will not be here tomorrow. There will be many other products that I could list for you that are all made offshore, that all have complicated supply chains that won’t be here.

And, so, in a sense, we have to think about taking care of the world. It’s not enough for us to think about protecting us, because the collateral damage to this country, even if we could avoid a pandemic, will be huge.

Bob, I’ve not seen any of that commitment yet on an international level.

BAZELL: Okay. Speaking of that, we’ll go to Dr. Nabarro, last week there was a meeting in Geneva of the World Bank three United Nations Organizations and you. The first thing that came up, and please don’t take this too personally, but everybody a lot of people at the World Health Organization and other agencies were grumbling in the back room, well who the hell is this guy? All of the sudden, Kofi Annan appoints somebody to be avian flu coordinator, and there’s already all these other U.N. agencies, and, you know, what do you see your job as doing and why now?

NABARRO: I think my job is being set out by Mike Osterholm very clearly just now, but let me be very precise what I think it is.

He said the global economy’s going to crash when we have the next pandemic. Let’s say that’s the truth. I personally believe it’s pretty close to the truth. My job as the U.N. system coordinator is to help the United Nations prepare countries for the possibility that if they don’t act in a sensible and effective and coordinated way, the global economy will crash and the whole world will be hit a blow that it will take a very long time to recover from. That’s my job.

Now, in order to do that job, I draw on the expertise, the leadership, of the World Health Organization, which is the technical organization for health, the Food and Agriculture Organization, which is the technical organization for animal health, and lots of other institutions and bodies in the United Nations. But working under the leadership of the secretary-general, my job is to focus on how we organize ourselves to avert a global economy crash as a result of the next pandemic.
Council on Foreign Relations Conference on the Global Threat of Pandemic Influenza, Session 2: Containment and Control

More flu-pandemic-related material on my del.icio.us site.

Council on Foreign Relations Conference on the Global Threat of Pandemic Influenza:
Session 1 – Avian Flu—Where Do We Stand?
Sessions 2 – Containment and Control
Session 3 – The U.S. Government’s Role
Session 4 – The Business Community’s Role
Session 5 – What Would the World Look Like After a Pandemic?

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