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  • Experts say we are "due" for one. When it happens, they tell us, it will probably have a greater impact on humanity than anything else currently happening in the world. And yet, like with most people, it is probably something you haven't spent much time thinking about. After all, it is human nature to avoid being consumed by hypotheticals until they are staring us squarely in the face. Such is the case with a highly lethal flu pandemic. And when it comes, it will affect every human alive today.
  • Pandemic flu is apolitical and does not discriminate between rich and poor. Geographical boundaries are meaningless, and it can circle the globe within hours. In terms of potential impact on mankind, the only thing that comes close is climate change. And, like climate change, pandemic flu is so vast, it can be challenging to wrap your head around it.
  • When most people hear "flu," they typically think of seasonal flu. No doubt, seasonal flu can be deadly, especially for the very young and old, as well as those with compromised immune systems. For most people, however, the seasonal flu virus, which mutates just a little bit every year, is not particularly severe because our immune systems have already probably seen a similar flu virus and thus know how to fight it. It's called native immunity or protection, and almost all of us have some degree of it. Babies are more vulnerable because they haven't been exposed to the seasonal flu and older people because their immune systems may not be functioning as well. Pandemic flu is a different animal, and you should understand the difference.
  • Panˈdemik/: pan means "all"; demic (or demographic) means "people." It is well-named, because pandemic flu spreads easily throughout the world. Unlike seasonal flu, pandemics occur when a completely new or novel virus emerges. This sort of virus can emerge directly from animal reservoirs or be the result of a dramatic series of mutations -- so-called reassortment events -- in previously circulating viruses. In either case, the result is something mankind has never seen before: a pathogen that can spread easily from person to defenseless person, our immune systems never primed to launch any sort of defense.
  • History tells us that it is likely the next big outbreak will be something we have not seen before. It may seem strange to be adding an 'X' but the point is to make sure we prepare and plan flexibly in terms of vaccines and diagnostic tests. We want to see 'plug and play' platforms developed which will work for any, or a wide number of diseases; systems that will allow us to create countermeasures at speed. [...] As the ecosystem and human habitats change there is always the risk of disease jumping from animals to humans. It’s a natural process and it is vital that we are aware and prepare. It is probably the greatest risk.
  • A deadly pathogen like Disease X, which would likely be a respiratory virus, according to Adalja, could already be circulating in animal species and is just not able to be transmitted to humans yet.
    "That could be bats like COVID-19, it could be in birds like bird flu, or it could be some other type of animal species, swine for example," he said. "It's really about that interface between humans and animals, where interactions are occurring, that these types of viruses get a foothold."

“Two decades of pandemic war games failed to account for Donald Trump” (04 August 2020)

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Amy Maxmen & Jeff Tollefson, “Two decades of pandemic war games failed to account for Donald Trump”, Nature, (04 August 2020), 584, pp.26-29

Jeremy Konyndyk, a senior fellow at the Center for Global Development in Washington DC, says that members of the biosecurity community have often focused on vaccines, rather than on the complex, systemic deficiencies in the public-health system. They often overlooked the “middle game” in outbreak responses.
“We have a strong end game once there is a vaccine, and we have a strong opening game if countries contain an outbreak when case numbers are low,” he says. But insufficient attention is devoted to harnessing and coordinating enough health workers and biomedical resources to efficiently test people, treat them, find their contacts and quarantine them.
  • Like all pandemics, it started out small. A novel coronavirus emerged in Brazil, jumping from bats to pigs to farmers before making its way to a big city with an international airport. From there, infected travellers carried it to the United States, Portugal and China. Within 18 months, the coronavirus had spread around the world, 65 million people were dead and the global economy was in free fall.
    This fictitious scenario, dubbed Event 201, played out in a New York City conference centre before a panel of academics, government officials and business leaders last October. Those in attendance were shaken — which is what Ryan Morhard wanted. A biosecurity specialist at the World Economic Forum in Geneva, Switzerland, Morhard worried that world leaders weren’t taking the threat of a pandemic seriously enough. He wanted to force them to confront the potentially immense human and economic toll of a global outbreak. “We called it Event 201 because we’re seeing up to 200 epidemic events per year, and we knew that, eventually, one would cause a pandemic,” Morhard says.
    The timing, and the choice of a coronavirus, proved prescient. Just two months later, China reported a mysterious pneumonia outbreak in the city of Wuhan — the start of the COVID-19 pandemic that has so far killed around 650,000 people.
  • The exercises anticipated several failures that have played out in the management of COVID-19, including leaky travel bans, medical-equipment shortages, massive disorganization, misinformation and a scramble for vaccines. But the scenarios didn’t anticipate some of the problems that have plagued the pandemic response, such as a shortfall of diagnostic tests, and world leaders who reject the advice of public-health specialists.
    Most strikingly, biosecurity researchers didn’t predict that the United States would be among the hardest-hit countries. On the contrary, last year, leaders in the field ranked the United States top in the Global Health Security Index, which graded 195 countries in terms of how well prepared they were to fight outbreaks, on the basis of more than 100 factors. President Donald Trump even held up a copy of the report during a White House briefing on 27 February, declaring: “We’re rated number one.” As he spoke, SARS-CoV-2 was already spreading undetected across the country.
    Now, as COVID-19 cases in the United States surpass 4 million, with more than 150,000 deaths, the country has proved itself to be one of the most dysfunctional. Morhard and other biosecurity specialists are asking what went wrong — why did dozens of simulations, evaluations and white papers fail to predict or defend against the colossal missteps taken in the world’s wealthiest nation? By contrast, some countries that hadn’t ranked nearly so high in evaluations, such as Vietnam, executed swift, cohesive responses.
    The scenarios still hold lessons for how to curb this pandemic, and for how to respond better next time. Deadly pandemics are inevitable, says Tom Frieden, a former director of the US Centers for Disease Control and Prevention (CDC). “What’s not inevitable is that we will continue to be so underprepared.”
  • Pandemic simulations first started gaining popularity in the 2000s. Biosecurity and public-health specialists took their cue from war-game exercises used by the military, in an effort to stress-test health systems, see what could go wrong and scare policymakers into fixing the problems. In these round-table events, academics, business leaders and government officials made real-time decisions to deal with an expanding crisis, laid out in television-news-style reports.
    Two early simulations involved biological attacks, in which other countries unleashed smallpox in the United States. Operation Dark Winter, in 2001, and Atlantic Storm, in 2005, were orchestrated by biosecurity think tanks in the United States and attended by influential leaders, such as the former head of the World Health Organization (WHO), Gro Harlem Brundtland, and Madeleine Albright, the secretary of state under former president Bill Clinton.
    During the course of Dark Winter and Atlantic Storm, participants found that power struggles between federal and state leaders bogged down a health response as the epidemic doubled and quadrupled. Hospitals were unable to handle the influx of people requiring care, and national vaccine stockpiles ran dry. Tom Inglesby, director of the Center for Health Security at Johns Hopkins University in Baltimore, Maryland, which helped to lead both of the exercises, says that along with the fresh memory of terrorist and anthrax attacks in 2001, these events encouraged the US Congress to act. Not long after the Dark Winter exercise, the US government committed to developing a national supply of smallpox vaccines. And in 2006, Congress passed the Pandemic and All Hazards Preparedness Act, to improve the nation’s public-health and medical response capabilities in the event of an emergency. This included funding for research on emerging infections.
    Anxiety about pandemics was also rising internationally. Not long after the 2003 outbreak of severe acute respiratory syndrome (SARS) spread to more than two dozen countries, and killed 721 people in mainland China, Hong Kong and Taiwan, the 194 member states of the WHO agreed to bolster the world’s defences against health threats through a set of rules called the International Health Regulations. These included commitments by countries to invest in pandemic preparedness, and to report outbreaks to the WHO so that other nations could be alert. The regulations were put to the test in 2009, when an H1N1 influenza virus is estimated to have killed more than 100,000 people, and again in 2013, with the spread of Middle East respiratory syndrome (MERS). Then came the world’s largest outbreak of the Ebola virus, in 2014–16, which killed around 11,000 people — roughly half of those infected.
  • In May 2018, with leaders in the White House and Congress who had never dealt with a major epidemic, Inglesby and his colleagues at Johns Hopkins University hosted an exercise in Washington DC called Clade X. It featured a respiratory virus that was engineered in a laboratory. One early lesson of this simulation was that travel bans didn’t stop the virus from gaining ground. Infections spread rapidly below the radar because half of the people infected showed few or no symptoms. Medical supplies ran short, and hospitals were overwhelmed. Federal and state leaders issued conflicting messages. More than 20 months passed before a vaccine was available.
    Six top-line recommendations emerged from the exercise. These included reducing vaccine production time, and creating a “robust, highly capable national public health system that can manage the challenges of pandemic response”. Some argue, however, that this emphasis was misplaced in subsequent discussions. Jeremy Konyndyk, a senior fellow at the Center for Global Development in Washington DC, says that members of the biosecurity community have often focused on vaccines, rather than on the complex, systemic deficiencies in the public-health system. They often overlooked the “middle game” in outbreak responses.
    “We have a strong end game once there is a vaccine, and we have a strong opening game if countries contain an outbreak when case numbers are low,” he says. But insufficient attention is devoted to harnessing and coordinating enough health workers and biomedical resources to efficiently test people, treat them, find their contacts and quarantine them. This is precisely the conundrum that the United States finds itself in right now.
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