why we're not ready for a pandemic

Complacency is the enemy of pandemic preparedness and right now, we've gotten awfully complacent.

And so the world ends not with a bang, not with a whimper but with an oink. Or at least that's what it looks like if you've been following the news. Extensive coverage of the swine flu outbreak is triggering fears that the long awaited influenza pandemic is finally here and sending conspiracy theorists into overdrive.

We know we're not ready. We know we have too few vaccines and very limited slack in our resources. If the outbreak can't be contained, we could be in trouble and this is why so many people are alarmed. But why exactly aren't we ready to deal with a pandemic, especially since we've been expecting one for decades? Two works on the subject seem to indicate a consensus between business experts and academics.

In September 2005, BusinessWeek Magazine ran a cover story about how the nation should prepare for the next disaster. Two of the biggest points stressed by the writers were a lack of emergency plans and overall preparedness for countless organizations, and the downside of running a just-in-time economy. We've never been all that good about making sure we have a large scale emergency plan unless we know the disaster is imminent and when it's going to hit.

In fact, the government removed a $900 million provision for a pandemic preparedness budget because some lawmakers considered it a waste of money without a concrete problem to tackle. Now, when the problem is here, that money no longer is. Of course funds can be re-allocated but the attitude behind the initial response to pandemic-battling funds feeds into the second problem.

While we're all about cutting waste and fat, we forget that being ready for a disaster requires excess capacity. It looks bad on a balance sheet but it will get you through an emergency. Just a few months before this story however, Dr. Michael T. Osterholm, an expert on influenza research and potential pandemics, published a paper that cited similar concerns while explaining why we still have such a high level of susceptibility to the flu.

He's concerned that the current method of making influenza vaccines was revolutionary in the 1950s, but today we should be working on creating a cell culture-based process which will use antigens that can be found in many influenza subtypes, not just seasonal variations. By vaccinating much of the public with this basic key to fighting numerous types of flu, we should be able to boost our resistance to the virus in general and have an easier time fighting its seasonal variations.

Another big question facing us with the swine flu outbreak is just how deadly the disease can be. Many of its known victims were young people who were supposed to be able to shake it off. Meanwhile, of the several thousand cases estimated so far, there doesn't seem to be a high rate of mortality. So what's happening? The paper provides a possible explanation. The immune system of these seemingly strong and highly resilient individuals had an overzealous reaction to the virus known as a cytokine storm.

This overreaction can cause a potentially fatal condition that wreaks havoc on the lungs and causes acute respiratory distress. It's possible that the young and seemingly tough victims were done in by their immune systems, something we could see many times over in a pandemic. The paper cites a study which concluded that cytokine storms were probably responsible for the death of many 18 to 40 year olds during the 1918 pandemic, half of the total death toll. As if that wasn't disconcerting enough, a large number of deaths would create very grim biohazards with which we currently don't have a plan or the capacity to adequately deal.

But Osterholm's biggest concerns by far are the ones later brought up by BusinessWeek. There's an alarming lack of what he calls "surge capacity," or the ability to reallocate a lot of extra supplies when and where they're needed in case of a pandemic or a major outbreak.

Our entire system is simply not built to be prepared thanks to our obsession with "reducing waste" by any means necessary and viewing lean and mean as the only way to be in good financial and industrial shape. As a result, dealing with a pandemic would be a stress that we're just not ready or able to take. Of course, having few to no detailed contingency plans to deal with shortages or panic in place wouldn't help in this situation either.

See: Osterholm, Michael T. (2005). Preparing for the next pandemic. The New England Journal of Medicine, 352:1839–1842