printable versionPandemic inevitable; local planning and leadership critical, health expert says
BY LISA TREI
At a Nov. 16 conference, Michael Osterholm offered a grim view of an influenza pandemic.
After listening all morning to the myriad manmade and natural risks facing the world in the 21st century, Michael Osterholm, an expert on public-health preparedness, offered a stark analysis of the threat of pandemic influenza.
"All the events we've heard about today may or may not happen," Osterholm told 400 scholars, students, policymakers and diplomats attending the Freeman Spogli Institute for International Studies' conference, "A World at Risk," on Nov. 16. "This is going to happen." In a globalized, just-in-time economy with no surge capacity, local preparation and leadership will be critical to survival. "Community planning is not an option," he said.
Osterholm, who is director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said 10 influenza pandemics have taken place during the last 300 years. "They are recurring events," he said. The virulence of the 1918 Spanish flu, which killed an estimated 50 million to 100 million people, paled in comparison to one in 1516 that swept across Asia and Europe in just six weeks—in an age before modern transportation. In Rome, he said, 9,000 out of 81,000 residents died within one week, and many Spanish cities were left totally depopulated.
Osterholm delivered the luncheon address. Following opening remarks by former U.S. Secretaries of State Warren Christopher and George P. Shultz, and former U.S. Defense Secretary William J. Perry, attendees listened to a range of discussions by Stanford scholars on understanding and measuring risk, efforts to keep fissile materials out of terrorists' hands and whether the nuclear nonproliferation regime has collapsed.
Experts also focused on challenges posed by natural, national and international disasters; the neglect of critical infrastructure and terrorism; and energy shocks to the global system. Smaller breakout sessions included analyses of food security and the environment; the challenge of governance in failed and failing states; the rise of China and its implications for the world economy; and U.S. efforts at democracy promotion in Russia, Iraq and Iran. CNN terrorism analyst Peter Bergen delivered an evening address on the successes and failures of the war on terrorism since 9/11.
Despite the concrete dangers posed by such threats, Osterholm asserted that the unpredictable nature of pandemic influenza makes it particularly tricky to prepare for and combat. The last four pandemics have occurred in all four seasons, he said, and they have differed in mortality rates and phases of greatest virulence. For example, the second wave of the 1918 flu was the most deadly.
"If there is a silver lining to many of the terrorist events, when they happen we go into a recovery phase within minutes," Osterholm said. "They blow up and then they're done. That's a horrible thing, but it's tremendously advantageous. Imagine something that unfolds over a matter of months."
Osterholm explained that influenza pandemics occur when a unique, virulent strain of the disease emerges that is readily transmissible among humans. So far, the H5N1 virus, which is found mainly in birds (it can cause the illness referred to as "avian influenza," or "bird flu"), has resulted in 153 confirmed human deaths worldwide. "We don't have a clue," Osterholm said, about when and where the next pandemic might start. "The influenza virus is one of the most sloppy, promiscuous viruses we know."
According to a September report issued by the World Health Organization, the H5N1 virus has a 65 percent mortality rate, compared to 2.5 percent for the 1918 virus. In the event of a pandemic, however, "this [rate] will probably attenuate because you will die before you can pass it on," Osterholm said. If a pandemic occurs in the near future, vaccines and antiviral medicines will have limited impact due to delays in developing effective drugs and limited manufacturing capacity. Steps such as quarantine and infection control also will have little effect, he said. "Stanford will never close—[because] every parent, every loved one, will take out their student before you have a chance," he said. "My concern is how do you open? When do you get people to come back?"
Despite the grim forecast, Osterholm said it is unacceptable for society to do nothing. Even if a 1918-like scenario unfolds, most of the world's population will survive. "If local was ever important, it's important now," he said. "What happens in Palo Alto is going to be more important than what happens in the Bay Area. Business continuity planning is not optional—as goes business, so goes our society. If we can't get food, heating oil and medicines to our population, we are in trouble. Hope and despair are not strategies—that's a common place to go. We'll get through it, but, ultimately, it's going to depend on how we prepare and the leadership during that time."