An Action Plan For Averting Next Flu Pandemic.
This year’s flu season is hitting early and hard, the worst the U.S. has seen in more than a decade. Every day more people are falling ill and getting hospitalised, and some are dying, including young children. Though we are not yet at the peak of flu season, schools have closed in communities across 49 infected states. Businesses can expect employee absenteeism to soar, and the Centers for Disease Control and Prevention expect the death toll to rise. The outbreak has thrown the health-care system into turmoil, with some hospitals unable to treat the people flocking to emergency rooms and clinics. Crucial supplies are running low across the nation, including lifesaving ventilators, and staff shortages are deepening as nurses and other personnel fall ill.
Our current flu crisis eerily coincides with the 100th anniversary of the 1918 Spanish Flu Pandemic, which killed 50 to 100 million people worldwide. The disease arrived in the U.S. early that year, resulting in a cascade of illness and suffering, family and community chaos, stymied businesses and industries. Despite medical advances, we are just as vulnerable today to a flu pandemic as we were a century ago. Vaccines in recent years have, on average, reduced the risk of flu illness among those vaccinated by just 40% (less than 30% this year). Current antiviral drugs only slow the virus—we have no reliable way to destroy it. The flu as deadly and contagious as the 1918 strain remains a very real possibility. Worse, in today’s world, it would be able to leapfrog on the back of air travel and spread quickly through our much more urbanised populations. It could kill 200 to 400 million people worldwide and throw the global economy into a deep downturn.
Despite the starkness of the threat, we seem to be so used to wasting lives and resources every year on flu that we’ve grown numb to the annual onslaught, much less to the prospect of something far worse. There are five critical actions we need to take to stop future pandemics. First, we must accelerate the development of a universal flu vaccine that would offer broad protection against most types of flu. Flu viruses are perpetually evolving through mutation to evade human immunity, and today’s vaccines target the most frequently mutating parts. A universal vaccine would eliminate the need for annual flu shots by attacking those parts of the virus least apt to mutate and most common across different strains. It would be akin to ripping out the roots of a giant deadly weed rather than just chopping off each year’s new growth. A universal flu vaccine would be a triumph for humankind on a level with smallpox or polio vaccines. Half a dozen major labs around the world are taking alternative approaches to creating one. But we need more public and private investment for these labs to continue through the costly and unpredictable development process to the finish line of a safe, effective vaccine.
Second, we need more targeted investments in vital areas of flu prevention and treatment. This includes better antiviral medicines, more accurate and widely available diagnostic tests, and low-cost face-masks that are truly protective. Tamiflu, Relenza and other antiviral drugs are modestly effective, especially when taken early by individuals at high-risk of flu complications. This year’s most dangerous flu strain (H3N2) is not showing resistance to these drugs, but others strains have. When used appropriately at home, low-cost diagnostic tests can help in making decisions about staying home from school or work, which can reduce the burden on hospitals and doctor’s offices. But the tests available today vary in their ability to detect different flu strains, and they are less accurate for adults. As for the inexpensive surgical masks available in pharmacies, they aren’t the germ-barrier that people think they are. Wearing one in a crowded subway is unlikely to help you if the person next to you is ill with the flu.
Third, we must do much more—through media campaigns and programs in schools, workplaces and communities—to encourage the adoption of personal prevention habits. Good flu prevention habits (staying home when sick, proper hand-washing, covering sneezes and coughs, etc.) have been shown in previous flu pandemics to significantly reduce transmission of the virus. Social “distancing” measures, such as school closures and the cancellation of large gatherings, also reduce the spread of flu. During the 1918 outbreak, infection rates varied dramatically among U.S. cities, depending on how quickly localities undertook such measures. By acting early, New York City had the fewest number of deaths of any city on the East Coast. Pittsburgh delayed and paid with the highest mortality rate.
Fourth, every school, business, government agency and place of worship and even every household should have a flu-preparedness and emergency response plan. Annual drills and exercises are essential refreshers and provide an opportunity to update the list of actions to take to reduce the spread of flu, maintain essential services in the face of absenteeism and step in to help others. Hospitals and doctor’s offices, particularly, should use annual drills to review methods that can reduce demand and stretch capacity during large-scale epidemics. Households and individuals can find help on Ready.gov, and businesses can work with public health officials. Preparedness also includes making sure that a range of health professionals are ready to act quickly. We must be able on short notice, for instance, to staff call centres with nurses and other medical personnel to provide information to the public, and we must have mechanisms set up for rapidly dispensing antiviral drugs.
Finally, we must stop starving state and local health departments of needed funds for preparedness. We depend on these agencies to stand sentry for the nation’s disease detection—not only for flu but all infectious diseases and agents of bioterror. Their job is to slow and stop the spread of a pandemic while limiting the impact of such an emergency on the functioning of society. That’s a very tall order and can’t succeed at current budget levels. Every dollar spent on preparedness results in savings, by my calculations, of $2 to $10 from reduced emergency costs and economic disruption. The overall return on investment would be substantial, considering that the U.S. loses as much as $90 billion a year on direct and indirect flu costs, according to researchers at the CDC. Beyond the flu threat, the benefit of preparedness is that it builds a system that works in the face of any biological, chemical or radiological emergency or natural disaster.
It might seem impossible to prevent future pandemics, but when leaders in public health, government and business have come together in the past, we have won the wars against smallpox, SARS, Ebola and a whole host of other devastating attackers. Too often, however, we have waited until the body count, and panic rose to a crescendo. What turned the tide in every instance was the combination of urgency and political will. We need to approach the problem of flu as if all the fury of a pandemic were bearing down upon us today.
Credit: Jonathan D. Quick for The Wall Street Journal, 20 January 2018. Dr Quick is a senior fellow at Management Sciences for Health in Boston and an instructor in global health and social medicine at Harvard Medical School. His new book, “The End of Epidemics: The Looming Threat to Humanity and How to Stop It,” will be published later this month by St. Martin’s.