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Is the World Prepared?

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Is the world prepared for a flu pandemic?

By Rafael Castillo, MD
Philippine Daily Inquirer
Posted 00:26:00 09/13/2008

MANILA, Philippines—A long-time heart patient, who already received his annual shot of anti-influenza vaccine, recently came to our clinic reporting that his whole family was down with flu. And he joked, “There is a flu pandemic already in our household.”

The hyperbole may indeed be a joke for now, but an influenza pandemic is always a looming possibility which hangs over our heads like the sword of Damocles. And not even our annual shot of the flu vaccine may be adequate to protect us from it.

A pandemic occurs when a new influenza virus appears against which humans have not developed an immunity. Simultaneous epidemics worldwide with enormous numbers of deaths result which is tantamount to a global catastrophe.

Threats with pandemic potential

During this last decade, health experts report that the world has faced several threats with pandemic potential, making the occurrence of the next pandemic just a matter of time. Flu outbreaks in animals can also happen making the situation worse through the merging of animal and human influenza viruses.

Viruses including the flu virus undergo changes in their structure which can make them break through the immune defenses humans have built up through previous infections or vaccinations. Outbreaks of influenza have been attributed to minor changes in the surface proteins of the virus. Should there be a major mutation or change in their surface proteins giving humans hardly enough time to develop partial or full immunity against the virus, then a pandemic may occur.

It’s not only the aggressive mutation of the virus which is the culprit. Given a fertile environment with increased global transport, and overcrowded conditions particularly in urban areas, the ingredients for a flu pandemic is really set.

During the 38th annual convention of the Philippine College of Physicians (PCP) this year, Dr. Weigoeng Zhou, a medical epidemiologist from the WHO-Western Pacific Region Office (WPRO) Emerging Infections group, talked about the pandemic preparedness plans needed to be done by countries, especially those in the third world, to be able to respond to the threats posed by this global epidemic.

“The only way to reduce the morbidity and mortality of total disasters is through a well-developed pandemic preparedness plan,” Dr. Zhou said. This national pandemic preparedness plans must have a multi-sector involvement and close collaboration. This contingency plan will help minimize the impacts of the pandemic on health, economic and social disasters.

What governments have to contend with

National governments will have to contend with the following reality in the event of a pandemic:

• There will be an utterly short supply of vaccines, antiviral agents and antibiotics to treat secondary infections; and it will take several months before an added supply of these necessary drugs become available. By that time, it might be too late already.

• Medical facilities will be overwhelmed. Shortages in medical personnel will occur. It will be a case of spreading one’s resources and facilities thinly. This is a terribly grim scenario since we’re already short in healthcare personnel now that we even don’t have an epidemic. It’s unimaginable how much worse it would be in the event of a pandemic.

• Outbreaks will reoccur producing a vicious cycle. The adverse impact on the communities affected will be prolonged and sustained. This is why a serious attitude at a pandemic preparedness plan is necessary to ensure that concrete steps are put into place so the plan not only remains on file.


“The pharmaceutical interventions (preparedness) are at the peak of this hierarchy,” stressed Dr. Zhou. Included in these pharmaceutical or medical interventions that should be readily available, especially once the pandemic escalates, are antiviral drugs, vaccines, medical care, and infection control and personal protective equipment (PPE).

Nonmedical or nonpharmaceutical interventions are also important, Dr. Zhou added. These include effective risk communication, personal hygiene, travel restriction, quarantine and social distancing or isolation. Nonmedical and medical interventions are public health measures that should be given more attention by the government and other sectors.

“And most importantly, the foundation of all of these is actually the social services,” Dr. Zhou said. “Without the support of all of these, you really won’t have a foundation to have that working plan about the medical intervention.” Included in this category are food, water and power supply, transportation, telecommunication and other essential services needed to keep a society running.

Dr. Zhou reported that most countries already have national pandemic preparedness plans in place. The big question one always asks is whether or not these plans could be operational when the pandemic occurs. Exercises to ensure operational effectiveness of the plan must be done from time to time, Dr. Zhou said. National pandemic preparedness plans are continuously having simulation exercises to test its effectiveness and to update guidelines and policies.

The WHO is currently focusing on health-related preparedness through the implementation of the International Health Regulations of 2005, capacity-strengthening through the Asia Pacific Strategy for Emerging Diseases (Apsed), availability of critical resources such as antiviral drugs, PPEs and vaccines, more effective risk communication and further education on these emerging threats.

Medical professionals and organizations are also being encouraged to support WHO programs to fight the emerging threats of global pandemics. Dr. Zhou stressed that the global process of preparing for global pandemics requires also global cooperation. He explained that all sectors of society have the opportunity and responsibility to make the pandemic preparedness plan work if and when the pandemic happens. May God forbid the flu or other pandemics from happening.


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