The Future?

Predicting the future of influenza pandemics is difficult. Many participants in Flublogia, including me, are concerned about the effects of a high case fatality rate pandemic on our globalised, interconnected civilisation.

We’re not the only ones.

The Rockefeller Foundation and The Global Business Network have envisaged four future scenarios in a document entitled: Scenarios for the Future of Technology and International Development (published May 25, 2010) [hat-tip, MAinVA at PFI_Forum]. The first scenario describes the response to a severe influenza pandemic:

In 2012, the pandemic that the world had been anticipating for years finally hit. Unlike 2009’s H1N1, this new influenza strain — originating from wild geese — was extremely virulent and deadly. Even the most pandemic-prepared nations were quickly overwhelmed when the virus streaked around the world, infecting nearly 20 percent of the global population and killing 8 million in just seven months, the majority of them healthy young adults. The pandemic also had a deadly effect on economies: international mobility of both people and goods screeched to a halt, debilitating industries like tourism and breaking global supply chains. Even locally, normally bustling shops and office buildings sat empty for months, devoid of both employees and customers.

The pandemic blanketed the planet — though disproportionate numbers died in Africa, Southeast Asia, and Central America, where the virus spread like wildfire in the absence of official containment protocols. But even in developed countries, containment was a challenge. The United States’s initial policy of “strongly discouraging” citizens from flying proved deadly in its leniency, accelerating the spread of the virus not just within the U.S. but across borders. However, a few countries did fare better — China in particular. The Chinese government’s quick imposition and enforcement of mandatory quarantine for all citizens, as well as its instant and near-hermetic sealing off of all borders, saved millions of lives, stopping the spread of the virus far earlier than in other countries and enabling a swifter postpandemic recovery.

Every empirical study of the effect of movement restrictions that I am aware of has demonstrated the effectiveness of movement restrictions in mitigating flu pandemics. Although commonly cited, most “modeling” studies assume just enough movement will continue to occur as to make such efforts fail. This is equivalent to the “lenient” option that the United States is suggested to take in the Rockefeller study.

One of the curious features of the 2009 H1N1 pandemic was the strong recommendation by the Chinese Director-General of the WHO, Margaret Chan, that countries refrain from imposing any movement restrictions whatsoever while China imposed the strongest movement restrictions in the world. Did Director-General Chan criticise the Chinese government for their response? On the contrary. From China Daily, May 29, 2009:

The Chinese government has mounted “a very robust response” to the threat of A(H1N1) influenza and the efforts are paying off, the head of World Health Organization (WHO) said on Thursday.

“The ministry of health under the coordination of government leaders mounted a very robust response so that they are able to track down all the cases,” Dr Margaret Chan said in an interview.

“So far the efforts are paying off,” she added.

The WHO director-general reiterated the unpredicability of the H1N1 virus and stressed the importance of continued surveillance as well as response adjustments.

“And of course my advice to them is that they need to adjust their public health response in line with the changing pattern of this virus,” she said.

“It’s important that they do not let their guard down,” she added.

What’s wrong with this picture?

In another scenario from the Rockefeller Foundation report, the following is suggested:

New threats like weaponized biological pathogens and destructive botnets dominate public attention…

Suppose this scenario was combined with the first one.

Just suppose.

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Filed under Flublogia, public health

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