(CIDRAP Source Osterholm Briefing) – Any discussion of the next influenza pandemic inevitably leads to "guesstimates" of severity—the number of people who will become sick and possibly die, both in the United States and worldwide. I'd venture to say your plans may be pegged to severity, too, from mild (like 1968) to severe (like 1918) pandemics. True? If so, you are in good company.
I've reviewed a breadth of corporate pandemic preparedness plans (from manufacturers to service industries to consulting firms). My sense is that most plans focus on responding to theimmediate impact of a pandemic, such as how to maintain operations based on a prediction of how many employees will be sick, are unwilling or unable to come to work, or may die.
This may surprise you, but I believe the actual influenza case numbers, including deaths, will play a more limited role than you expect in determining the real impact of the next pandemic on your business.
A pandemic's other victim
Wise planners will also consider another threat—a pandemic's collateraldamage, specifically its immediate and potentially overwhelming impact on the global just-in-time economy. Today we live in a world where the supply chains for many of our critical products and services (pharmaceutical and other medical products, petroleum, machine parts, and even our food) originate in some distant country, with supplies being delivered to the end user in just days. A hiccup in this supply chain (which I feel certain will happen with even a mild pandemic) will produce a cascade of damage. Pandemics of 1918 and 1968 may have differed in severity, but not so much in collateral damage. And although records of influenza-like pandemics date back to the ancient Greeks and 10 have occurred in the last 300 years, not one has occurred in a global just-in-time economy or with a world population of 6.5 billion people. (The global population in 1918 was only 1.8 billion.)
Many federal, state, and local pandemic plans released to the public in the past months have focused almost exclusively on responding to the influenza illness itself, addressing the availability of vaccines, antiviral drugs, and ventilators. Unfortunately, given the status of our vaccine research and production capacity, we simply can't count on vaccines playing much of a role for most of the world for most of the pandemic.
What these plans don't address are the vulnerabilities of a delivery system for products that our employees, customers, and family members need every day to maintain life as we know it.
One life-threatening example
Consider insulin-dependent diabetes. Some 20.8 million children and adults in the United States (7% of the population) have diabetes, and most of the insulin, syringes, and needles needed to treat the disease are produced offshore. The supply chains are long and thin—long because a variety of parts, components, and ingredients come from multiple countries; thin because little surge capacity or redundancy exists for production of these items. At any given time, only a limited supply of insulin, needles, and syringes is in inventory or en route. The same is true for most of our drugs: More than 80% of all pharmaceutical products used by US residents are produced in part or entirely offshore. So thin are our supply chains that many of our hospitals now receive shipments of critical drugs three times a day.
What does this mean to your organization? One US-based international food manufacturing company has determined through its health benefits department that among its 15,000 US workers and 7,000 retirees who are covered by the company's health plan, 1,125 employees or their dependents are insulin-dependent. Imagine not being able to maintain international production and distribution (ie, transportation around the world on a just-in-time basis) of insulin during a pandemic. Very quickly, the US would experience serious shortages and a health crisis.
Now imagine a number of your employees or their family members becoming seriously ill or dying because of an inability to get insulin. Whether it's your employees or their dependents who become ill because of an insulin shortage, the employees are unlikely to be available to your organization during a pandemic. That's only one example of collateral damage that will affect your business.
The bottom line for business
Take the example of the outbreak of SARS (severe acute respiratory syndrome) in Asia and Canada in 2003. Similar in size and health impact to a mild pandemic, the SARS outbreak showed us what widespread disease can do to the world economy.
Make no mistake about it: The potential is real for a months-long shutdown of the global economy during even a mild pandemic. In short, the debate about whether the next pandemic will seriously sicken 1 to 3 billion people or kill 7 million to 350 million people is indeed critical for planning, particularly for healthcare capacity. But it is only one factor that will determine how your organization and its employees and customers will fare.
Here's what I recommend you do:
- Consider the collateral damage issue in all of your preparedness planning.
- Identify those products and services critical to sustaining your employees. What drugs do they need? What about food and water? How can you be sure they have them?
- Remember that, although you can't make such critical supplies as insulin, you can begin to work now with your health benefits and communications departments, health insurance carriers, pharmacy benefits management providers, and healthcare providers to develop contingency plans should shortages occur during a state of pandemic chaos.
I urge you not to be lulled into the pandemic preparedness mindset that only the total number of influenza cases is of concern. Avoid getting bogged down in debates about whether the next pandemic will be as severe as the outbreaks in 1918 or 1968. Prepare for the collateral damage, and you'll be well on your way to pandemic preparedness.
—Michael T. Osterholm, PhD, MPH, is Director of the Center for Infectious Disease Research & Policy (CIDRAP), Editor-in-Chief of the CIDRAP Business Source, Professor in the School of Public Health, and Adjunct Professor in the Medical School, University of Minnesota.