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Another influenza pandemic may inevitably occur in humans soon, many infectious disease experts agree. Yet the general public does not appear to share this perception, especially in the shadow of equally scary but less likely risks such as a bioterrorist attack with aerosolized smallpox. Moreover, recent problems with the availability and strain-specificity of vaccine for annual flu epidemics in some countries and the rise of pandemic strains of avian flu in disparate geographic regions have alarmed experts about the world's ability to prevent or contain a human pandemic.
For these reasons, the Institute of Medicine's Forum on Microbial Threats will host the public workshop Pandemic Influenza: Assessing Capabilities for Prevention and Response on June 16 and 17, 2004, in Washington, D.C. Through invited presentations and discussion, this workshop will aim to inform the Forum, the public, and policymakers of the likelihood of an influenza pandemic and to explore the issues that must be resolved now to prepare and protect the global community.
Perhaps one of the most important issues to be considered is that suggested by historian Alfred Crosby in the title of his authoritative book: America's Forgotten Pandemic: The Influenza of 1918. The "Spanish flu" killed an estimated 20 million people worldwide--twice the number slain in combat in World War I--after spreading around the world in four months without the aid of modern airlines. "The important and almost incomprehensible thing about Spanish influenza," Crosby writes, "is that... it has never inspired awe, not in 1918 and not since, not among the citizens of any particular land and not among the citizens of the United States." It's time for a wake-up call.
Prevention
Although influenza pandemics have arisen three times each century for the past three centuries, it would be ideal to prevent another one through the application of yesterday's lessons and today's knowledge. First and foremost, this workshop will elucidate the transmission mechanisms and epidemiology of influenza virus from wild to domesticated birds and from animal hosts to humans. Workshop presenters will identify effective barriers to zoonotic transmission of the virus and potential tools to implement them. What economic incentives would influence such changes in today's global animal-production systems? Should live-animal markets be eliminated altogether?
Other presentations will detail global surveillance and detection capabilities and will consider how they might be strengthened. In addition, presenters will identify the principal obstacles to the development, production and distribution of adequate quantities of vaccine for a pandemic strain. In that context, the workshop will illuminate key scientific gaps in understanding of the pandemic strains of the past 100 years.
Response
Many have argued that resource-rich countries--let alone the global community--are unprepared to respond to an influenza pandemic fast enough to prevent hundreds of thousands of deaths. At the workshop, presenters will identify the pivotal unresolved issues at each major step of a response to pandemic flu. These include hospital surge capacity, production surge capacity, the stockpiling of drugs and vaccines, liability protection for vaccine manufacturers and for those who administer shots, legal and logistical issues in the application of quarantine and isolation, the application of intellectual property law, and coordination among sectors, jurisdictions, and countries. Workshop participants will respond to new preparedness plans developed by the U.S. Department of Health and Human Services and the World Health Organization, and will discuss recent exercises in pandemic planning by the G-8.
In addition, workshop presenters will identify the principal obstacles to the guaranteed availability of safe and effective prophylaxes and therapeutics in both resource-rich and -poor nations. Special attention will be paid to antiviral agents as prophylaxes. Presenters will discuss novel vaccine development and production platforms as well as novel therapeutics and ancillary treatments. Other speakers will elucidate the role of bacterial superinfection in recent cases of influenza A and identify relevant countermeasures.
Present disease-containment strategies for animals and people will be examined to identify where improvements in methods and policy might be needed. In this context, mechanisms for strengthening incentives and policies to raise the level of industry engagement will be considered. Through further discussion, participants will seek to clarify how the quality and nature of routine influenza activity affects the world's ability to respond to a pandemic.
Consequences
To appreciate the socioeconomic consequences of pandemic influenza, biostatisticians and economists will present various plausible 21st century scenarios. As Crosby writes, "We live in a world that has become in some ways a better place for nasty viruses and a worse place for us than it was in 1918." While another influenza pandemic is possibly inevitable and even overdue, no one knows whether it will occur in 2005 or in 2025. Presenters will tackle the question of how to sustain the necessary market incentives and political will to be ready for a pandemic that may lie beyond the next election.
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