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Answer 1

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Preparing for a Pandemic virus

No one knows whether avian flu will evolve into a human pandemic. It could, possibly, remain largely confined to bird populations and be remembered years hence as a scare that didn’t materialize. But little stands between the best- and worst-case scenarios.

So far, the H5N1 strain of avian flu has infected millions of birds, mostly in Asia, but now increasingly in Europe and Africa; it has spread, with difficulty, to fewer than 200 people—although it has killed more than half of them. And it is evolving in ways that appear to allow it to infect a greater number of species, including pigs, wild and domestic cats, and dogs. From its origin in southern China in 1997, H5N1 has spread to almost 50 countries (at the time of this writing) and is now circulating through Asia, Europe, the Middle East, and Africa. This advance, coupled with the emergence of mutations that may facilitate the infection across species, increases the risk of a global pandemic.

If the virus does mutate into a form that transmits easily from person to person—and this is the pivotal unknown—in the best case, the World Health Organization (WHO) says, 2 million people could die. In the worst case, according to some experts’ projections, up to 30% of the world’s population could be stricken over the course of roughly a year, resulting in as many as 150 million deaths and perhaps more than a billion people requiring medical care. It takes little imagination to envision the impact this could have on global business as employees fall ill, supply chains fragment, and services fail.

Answer 2

INTRODUCTION

Pandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995). These trends likely will continue and will intensify. Significant policy attention has focused on the need to identify and limit emerging outbreaks that might lead to pandemics and to expand and sustain investment to build preparedness and health capacity (Smolinsky, Hamburg, and Lederberg 2003).

The international community has made progress toward preparing for and mitigating the impacts of pandemics. The 2003 severe acute respiratory syndrome (SARS) pandemic and growing concerns about the threat posed by avian influenza led many countries to devise pandemic plans (U.S. Department of Health and Human Services 2005). Delayed reporting of early SARS cases also led the World Health Assembly to update the International Health Regulations (IHR) to compel all World Health Organization member states to meet specific standards for detecting, reporting on, and responding to outbreaks (WHO 2005). The framework put into place by the updated IHR contributed to a more coordinated global response during the 2009 influenza pandemic (Katz 2009). International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity (Wolicki and others 2016).

Despite these improvements, significant gaps and challenges exist in global pandemic preparedness. Progress toward meeting the IHR has been uneven, and many countries have been unable to meet basic requirements for compliance (Fischer and Katz 2013; WHO 2014). Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including global coordination and response mobilization (Moon and others 2015; Pathmanathan and others 2014). These gaps are especially evident in resource-limited settings and have posed challenges during relatively localized epidemics, with dire implications for what may happen during a full-fledged global pandemic.

For the purposes of this chapter, an epidemic is defined as “the occurrence in a community or region of cases of an illness . . . clearly in excess of normal expectancy” (Porta 2014). A pandemic is defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people” (Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. For example, in contrast to annual seasonal influenza epidemics, pandemic influenza is defined as “when a new influenza virus emerges and spreads around the world, and most people do not have immunity” (WHO 2010).

RISKS

Pandemics have occurred throughout history and appear to be increasing in frequency, particularly because of the increasing emergence of viral disease from animals.

Pandemic risk is driven by the combined effects of spark risk (where a pandemic is likely to arise) and spread risk (how likely it is to diffuse broadly through human populations).

Some geographic regions with high spark risk, including Central and West Africa, lag behind the rest of the globe in pandemic preparedness.

Probabilistic modeling and analytical tools such as exceedance probability (EP) curves are valuable for assessing pandemic risk and estimating the potential burden of pandemics.

Influenza is the most likely pathogen to cause a severe pandemic. EP analysis indicates that in any given year, a 1 percent probability exists an influenza pandemic that causes nearly 6 million pneumonia and influenza deaths or more globally.

IMPACTS

Pandemics can cause significant, widespread increases in morbidity and mortality and have disproportionately higher mortality impacts on LMICs.

Pandemics can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth.

Individual behavioral changes, such as fear-induced aversion to workplaces and other public gathering places, are a primary cause of negative shocks to economic growth during pandemics.

Some pandemic mitigation measures can cause significant social and economic disruption.

In countries with weak institutions and legacies of political instability, pandemics can increase political stresses and tensions. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens.

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