The imminent but not inevitable onset of a swine influenza pandemic has tested US preparedness plans for very different threats — terrorism, avian flu and natural disasters like hurricanes, which made public health a national security priority.
The flu virus is a daunting foe: deceptive, lethal and can mutate as it spreads. Three times this century — in 1918, 1957 and 1968 — a new virus emerged to which human beings had no immunity, killing millions.
The current strain of A(H1N1) influenza, a mix of genetic material from pigs, birds and human beings, is a novel virus that doesn’t appear to be as virulent as first feared. But it could return in a more deadly form.
PHOTO: AP
It has sickened more than 3,000 people around the world and killed 45 in Mexico and two in the US, with no signs that the outbreak has peaked.
Virologists worry that the next flu pandemic could come in waves at any time, and the US has sharpened its preparedness since the Sept. 11, 2001, terrorist attacks, anthrax-laced letters, the H5N1 avian flu and SARS epidemics in 2003, and Hurricane Katrina in 2005 that killed 1,800 people on the Gulf Coast.
“Much has happened since 9/11, which saw the renaissance of emergency planning. We think more about the risks we face as a nation — in terms of pandemics, natural disasters and terrorism — and examine more critically our ability to deliver,” Dr Andrew Garrett, director of planning and response at the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, told reporters.
Rear Admiral Steven Galson, acting US surgeon-general, voiced confidence: “It’s important to know that the world is better prepared for a potential influenza pandemic than any time in history.”
The US National Strategy for Pandemic Influenza was in place by November 2005 and has been constantly revised and rehearsed, with pharmaceutical stockpiles and plans for inter-agency and international coordination.
US President Barack Obama’s new administration has relied heavily on the strategies his predecessor, George W. Bush, put in place, tempering urgency with caution to counter panic.
“Thanks to the work that the last administration and Congress did ... states and the federal government have fully operable influenza readiness plans and are better prepared to deal with such a challenge than ever before,” Obama said earlier this month, paying a rare tribute to Bush.
The US strategic national stockpile holds 50 million treatment courses of antiviral drugs, and states have another 23 million. A few days into the current outbreak, US Health Secretary Kathleen Sebelius announced the purchase of an additional 13 million courses.
“The world is now benefiting from the preparedness measures undertaken from the threat of ... avian influenza. We can now track the evolution of the virus in real time,” said Rear Admiral Mitchell Cohen of the Centers for Disease Control and Prevention.
The swine flu outbreak has spawned swift cooperation and unprecedented openness between governments and international health agencies. Countries have made their investigations public, helping disease detectives to demystify the virus and craft prevention strategies.
SARS taught governments all over the world “that transparency is smart and ... hiding outbreaks is not,” said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. “China suffered deeply for having made the choice to pretend that they didn’t have an outbreak in the capital city.”
She said that the US public health system is better prepared today than before Katrina.
But Garrett cautioned: “The truth is that public health has gone so long with lousy budgets, lousy equipment — only infused with cash after 9/11, with the concern about bio-terrorism — that it’s by no means at the level it ought to be, where we could feel we’re ready should this turn into a highly virulent rollout.”
There have been advances in disease tracking and identification of emerging viruses, but the Government Accountability Office has warned in numerous reports that a pandemic would overwhelm the public health system.
More than 90 years after the worst modern pandemic — the flu of 1918, believed to have killed 100 million people — virologists say there are too many gaps in the knowledge of flu epidemiology and transmission, as well as the technology to quickly produce vaccines.
Even in a regular flu season, an estimated 36,000 people die each year in the US alone, and at least 200,000 are hospitalized. Yet, for decades there has been a paucity of flu research.
This week, Obama called on Congress to approve his budget request for next year of US$8.6 billion — and US$63 billion over six years — for a new global health strategy.
“We cannot wall ourselves off from the world and hope for the best, nor ignore the public health challenges beyond our borders. An outbreak in Indonesia can reach Indiana within days, and public health crises abroad can cause widespread suffering, conflict and economic contraction,” he said.
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