Foreign Affairs focuses on pandemic threat

Jun 10, 2005 (CIDRAP News) – The influential journal Foreign Affairs is adding its voice to the warnings about a potential influenza pandemic by publishing a special section on pandemics in its forthcoming July/August issue.

Titled "The Next Pandemic," the section includes four articles by a panel of experts. They focus on the evidence that the H5N1 flu virus may spark a pandemic, the challenges of preparing for a pandemic, the need to integrate disease-control efforts for people and animals, and the lessons of the HIV/AIDS pandemic.

Foreign Affairs is the second well-known journal in less than three weeks to publish a sizable collection of articles on the threat of a pandemic. The British journal Nature published 10 articles on the subject in its May 26 issue.

Foreign Affairs has also scheduled a special press briefing on the pandemic issue for Jun 16 in Washington, DC. The briefing will feature two of the article authors, Laurie Garrett and Michael T. Osterholm, along with Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and James F. Hoge Jr., editor of the journal.

Following are summaries of the Foreign Affairs articles.

'The next pandemic?'
The H5N1 flu virus is showing potential to cause the next flu pandemic. It is impossible to predict when a pandemic might hit—the swine flu of 1976, which failed to materialize, is a notable example of the risks of such predictions—but author Laurie Garrett is certain that the world is currently unready to address such a threat. Garrett is a senior fellow for global health at the Council on Foreign Relations.

The imbalance of wealth, the weakness of public health systems in countries worldwide, and the numerous hurdles to fast, efficient vaccine production are just a few of the issues that will affect how the world copes with a pandemic, Garrett says. She recommends that national policymakers prepare now "for worst-case scenarios involving quarantines, weakened armed services, dwindling hospital space and vaccine supplie." Further, it is in every government's interest to bolster the funding and authority of the World Health Organization and the Food and Agriculture Organization so they can offer timely, impartial assessments of an epidemic's progress.

People engaged in policy and security worldwide "cannot afford to ignore the warning" of a possible pandemic, Garrett writes.

'Preparing for the Next Pandemic'
The next flu pandemic could well cause hundreds of millions of deaths around the world and bring the global economy to a standstill, writes Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of this Web site.

Recent evidence suggests that the H5N1 strain of influenza A could trigger a pandemic like that of 1918-19, which probably killed between 50 million and 100 million people, Osterholm writes. In today's world, that could mean up to 360 million deaths. The SARS (severe acute respiratory syndrome) epidemic gave a hint of the kind of economic disruption a pandemic could cause. Though only about 8,000 of SARS cases occurred, the disease cost the Asia-Pacific region an estimated $40 billion.

If a major pandemic began today, the global economy would shut down, Osterholm predicts. The disease would trigger shortages of food and other essential commodities. No vaccine would be available in the first several months, and in the first year the world could produce only enough vaccine for about 14% of the population. The antiviral drug oseltamivir could help countries that have stockpiled it, but in most of the world it would be unavailable. Other medical supplies such as masks and ventilators would be in short supply.

As he has done in other recent writings, Osterholm calls for detailed operational planning to get through a pandemic. He also advocates an international project to develop the ability to produce a vaccine for the entire world population within several months of the start of a pandemic. If there isn't enough vaccine to go around, economic disaster will overtake all countries, regardless of their vaccine supplies. "No one can truly be isolated from a pandemic," he writes.

'One World, One Health'
Many diseases that have scared the public and disrupted global commerce in recent years have been zoonoses—diseases that originated in animals and crossed into humans. The emergence of diseases like avian flu, SARS, and Ebola tell us that it's time to knock down the walls between the agencies and groups that deal with diseases in humans, domestic animals, and wildlife, according to William B. Karesh and Robert A. Cook. Karesh directs the field veterinary program at the Wildlife Conservation Society (WCS) and co-chairs the World Conservation Union's veterinary specialist group; Cook is vice-president of the WCS and its chief veterinarian.

Burgeoning international travel, population growth, the global trade in animals and animal products, and a growing dependence on intensified livestock production have made humanity more vulnerable to cross-species diseases, Karesh and Cook write. But "no government agency or multilateral organization today focuses on the numerous diseases that threaten people, domestic animals, and wildlife alike."

The authors observe that the eradication of smallpox—the only major infectious disease that has been eradicated—was possible largely because smallpox, at least under natural conditions, affects only humans. When a pathogen can infect a range of hosts, controlling it becomes far more difficult and requires an integrated approach, they write.

They call for a number of steps to integrate efforts to deal with human and animal diseases. Examples include better surveillance of wildlife diseases, requiring animal traders to pay more of the cost of preventing and controlling outbreaks, and inducing governments to improve the regulation of trade in animals.

"Bridges must be built between different scientific disciplines, and trade in wildlife must be dramatically reduced and, like the livestock industry, properly regulated," Karesh and Cook argue.

'The lessons of HIV/AIDS'
To understand the impact of a potential avian flu pandemic, author Laurie Garrett suggests, one should first examine a slower-moving global pandemic: HIV/AIDS. Garrett details the massive destabilization of countries across the world as soldiers, teachers, and political leaders die and countless children are orphaned.

Donor states should spend heavily on HIV/AIDS prevention, care, and treatment, but also emphasize development to usher the poorest countries into the global economy, Garrett contends. Donor states also should step up international programs that prevent high-risk sex and drug use while providing condoms and sterile needles, she adds. The survival of some developing countries may rest on risking tension over unequal treatment to provide antiretroviral therapy to important people and workers in key sectors of society.

In addition, science and global security interests must recognize the importance of developing more sophisticated methods to identify and track specific strains of HIV and factors, such as drug smuggling, that contribute to the spread of the disease.

See also:

Foreign Affairs July/August 2005 Table of Contents page with links to excerpts of three of the articles
http://www.foreignaffairs.com/issues/2005/84/4

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