Ruminations

Preparing for a Pandemic

"Are we ready in 2018? The answer is we are better off than we were before 2009 but not where we need to be and vaccine readiness has a long way to go."
"The 1918 pandemic was exceptionally severe. A similar pandemic today would cause tremendous illness, death and economic cost [ranging between 105 to 110 million possible deaths]. That is a very sobering number."
Nancy Cox, past head, U.S. Centres for Disease Control Influenza Branch

Biologist Jason Plyler prepares to test how immune cells react to possible flu vaccines at the Vaccine Research Center at the National Institutes of Health, in Bethesda, Md. As scientists mark the 100th anniversary of the 'Spanish' influenza pandemic, labs are hunting better vaccines. (Carolyn Kaster/Associated Press)

"People think of 2009 [the H1N1 pandemic] as being very mild, but if the Olympics [Winter Olympics held in Vancouver the winter of 2009] had been planned for the fall of 2009, we would have had to cancel because we did not have [enough] ICU [intensive care] beds [to cope]."
"Many of us remember the challenges of not knowing when vaccines would come [be delivered from source]. A lot of things happened that we were not prepared for that led to inconsistencies."
"We are still not where we need to be [in preparation for the next pandemic]."
Dr. Bonnie Henry, provincial health officer, British Columbia, chair, Canadian pandemic influenza task group

Flu vaccinations. Ed Kaiser / Edmonton Journal

Pandemic influenza represents an outbreak of influenza on a global scale, occurring when a new flu virus has manifested for which humans have little or no immunity and once having emerged, then rapidly spreads to infect great numbers of people. The deadly Spanish flu took the lives of millions of people around the world. Experts warn, as they have been doing for quite some time, that conditions leading to the emergence of yet another such deadly influenza strain are in place, and it is merely a matter of time before a dread pandemic emerges.

And the world is not prepared to meet the challenge of protecting itself against the inevitable; a viral strain of influenza so lethal that it will speedily cut a wide swath of death on populations unable to defend themselves. The Spanish influenza pandemic caused the death of between 50-million to 100- million people globally. Those gathered at the biannual Canadian Immunization Conference in Ottawa this week, heard leading international experts warning that more work is urgently required before the next severe pandemic arrives.

In this November 1918 photo from the Library of Congress, a nurse takes the pulse of a patient in the influenza ward of the Walter Reed hospital in Washington. Historians think the pandemic actually started in Kansas in early 1918. (Harris & Ewing/Associated Press)

Yes, there have been been wide-sweeping medical advances following the 1918 Spanish pandemic. Despite which, though vaccines and anti-viral treatments have been produced, none are as near to reliably effective as medical science would have hoped them to be, particularly as new strains of influenza constantly evolve in response to new vaccines whose efficacy at best is partial, but to which the virus responds by mutating and evolving, producing new threats.

Every year brings along new strains of influenza, some more powerful than those that erupt in other years. A universal flu vaccine in replacement of seasonal vaccines developed in response to science evaluating current strains of flu, remains an as-yet unattainable goal. Seasonal vaccines that are relied upon to armour society's vulnerable against the predation of the virus are only partially effective. Hope and progress go hand-in-hand even while concern over global surveillance and treatment availability remains high.

Should a severe pandemic arise, Dr. Cox emphasized, sufficient ventilators or reusable respiratory protective devices in support of protecting people world-wide would be in short supply. Dr. Cox revealed estimates of a current-day pandemic in terms of a universal death count and that number would range from 105-million to 110-million possible deaths. Dr. Henry spoke of medical authorities in Canada working to prepare the country for the next pandemic, leaning heavily on lessons learned from 2009.

Though there has been progress, she stated to delegates, should even a relatively mild pandemic erupt, responding health services would be overwhelmed. British Columbia's health system, for example, months before the Winter Olympics was to be held in Vancouver, was completely overwhelmed, so the task group aiming to minimize serious illness and disruption has a goal; the provision of a safe and effective vaccine along with the monitoring of the safety and efficacy of that vaccine.

One lesson learned during the 2009 H1N1 outbreak was the emergent uncertainty over vaccine supply. Canada, learning from that event, has contracted to ensure that two doses of vaccine for every Canadian would be instantly available in the event of a pandemic, and has strengthened that assurance with the redundancy of a backup contract. Along with ensuring that vaccine is available to remote communities, prioritizing who receives the more immediate vaccinations.