School of Public Health and Community Medicine

An unprecedented rise in novel influenza viruses and an entertaining pandemic scenario with a deadly serious message

The ISER team at the World Congress of Public Health 2017

Raina MacIntyre

April 5th 2017

 

The world has seen an increasing frequency of serious epidemics such as MERS coronavirus, Ebola, avian influenza and Zika virus in recent years, more than any time in history. We have also shown  in a new paper in the Archives of Public Health that the rate of new influenza viruses infecting humans is higher than ever. This in turn increases the risk of a pandemic.  For example, from 1918 to 1957, only one new influenza virus emerged, and from then it took a decade for the next virus to emerge. In the past 5 years alone there have been seven new influenza viruses infecting humans, all over the world - China, Egypt, the US and Europe.

The reasons behind this escalation are unknown, but could be due to changes in climate, urbanisation and agricultural practices as well as better diagnostics. However, the rate of change of these factors is not as high as the rate of emergence of new influenza viruses, so questions remain about why we are seeing so many new viruses and epidemics.  It is also clear that the risk of a pandemic is higher now than in the past, due to the sheer number of new emerging infections.  

At the 2017 World Congress of Public Health on Monday (April 3), the NHMRC Centre for Research Excellence in Epidemic Response, ISER,conducted a hypothetical pandemic scenario to highlight some of the challenges and gaps in capability faced by the global community and the complex, cross-sectoral challenge of pandemic.  The scenario was set in a hypothetical country, Mendona, which was developed for our webmovie Pandemic, a teaching material for a bioterrorism course we run at UNSW.  Our team at ISER role-played the parts, including the minister for health, the director general of the Global Disease Prevention Organization, the chief of police and the chief of the armed forces. I narrated and played a feared reporter, Megyn Jelly, who keeps the government honest.  We used humour and injected some fun into the interactive scenario, to convey deadly serious lessons about the nature of pandemics as disasters.  We took participants through each phase of an escalating pandemic, bringing in the perspectives of health, defence, law enforcement, media, government and non-government agencies, as well as fringe media and conspiracy theorists. We also inserted the role of political forces, including populism, with a head of state playing constant catch-up, trying to out-do an emerging extremist leader who is playing on people’s fears and gaining on him in the polls.  We showed how this can influence public health policy decisions.

Failures in epidemic response are rarely due to lack of technical expertise – we see experts flood every major epidemic or pandemic, and a surge in peer reviewed publications accompanying each one.  Instead, failures are usually due to poor or unprepared systems and lack of connection and collaboration between sectors, conflict and disagreements, which all undermine and delay an effective response.  Take the 2014 Ebola epidemic, where there was no public health message that outlined any concrete strategy or action until after the peak of the epidemic, in September. I pointed out at the time that an excellent modelling paper showed that to control the epidemic, 70% of patients needed to be in Ebola treatment units, and that in the absence of drugs or vaccines, this should be a public health goal.  The importance of a single command and control mechanism for dealing with an acute epidemic cannot be under-estimated, with Ebola again showing us the detrimental impact of squabbling between agencies, disagreements and a lack of coordination of efforts.

In terms of pandemic influenza preparedness measures need to focus on preventing disease emergence in animals and birds, especially poultry.  This includes better control efforts to reduce the risk of infection of farmed birds and reducing the interaction of humans with animals. A One Health approach is needed, but a focus on planning around a single virus strain is misdirected, as it’s not possible to predict which virus will cause the next pandemic, as witnessed in 2009. Efforts in pandemic planning globally had focused on avian flu H5N1 from 2005 onward, but the pandemic which emerged was a completely different virus, unrelated to H5N1.  None of the pre-pandemic H5 vaccines or assumptions were useful in the 2009 pandemic.

To address the gaps in epidemic response, we need better global governance systems.  The IHR has not been revised since 2005, and is not enforceable.  Many countries cannot comply with it, and it did not serve the world well during the Ebola epidemic.  I have written previously about quantum advances in genetic engineering, and how this increases the risk of unnatural pandemics.  We have no processes or systems to differentiate natural from unnatural epidemics, Our current regulations such as the IHR, Biological Weapons Convention and Cartagena protocol do not talk to each other and even together leave critical gaps that make us vulnerable.  The Global health security agenda had been already launched when the Ebola epidemic began, but had no apparent impact  on epidemic control in that case.  Newer initiatives such as CEPI are welcome, and focus on biomedical developments such as drugs and vaccines.  However, we also need a focus on governance and regulation of new technologies that pose a biosecurity risk, as well as surveillance and rapid epidemic intelligence.  We need cross-sectoral and global collaboration. Pandemic plans are health-centric and usually fail to consider critical other first resopnder vertical sectors that must all work together in a health emergency.  In our pandemic scenario we highlighted conflicts between health, defence and law enforcement over jurisdiction and rapidly depleted resources such as PPE.  

At ISER, these aspects of epidemic and pandemic response are the focus of our research and capacity building activities through the ISER Academy. 

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