Feb 7, 2007 (CIDRAP News) Orlando, FL As businesses develop pandemic preparedness plans, they need to cut through a "fog" of uncertainty about exactly what pandemic influenza will look like and how their companies will be able to respond to it, infectious disease expert Michael Osterholm, PhD, MPH, said at a summit in Orlando Monday.
Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News, said that several factors cloud the preparedness landscape:
- How our global just-in-time economy will affect access to goods and services
- How effective and plentiful antiviral drugs and vaccines will beand when they'll be ready
- How many waves of the pandemic will occur, and how severe they'll be
- How high mortality rates will be
- How our overloaded healthcare systems will cope
- How our communities will mitigate damage
Osterholm spoke at CIDRAP's "Business Preparedness for Pandemic Influenza: Second National Summit," held this week for hundreds of leaders in business, government, and academia.
He took his "fog of pandemic preparedness" concept from the theory of the "fog of war," a state of ambiguity soldiers can find themselves in when they doubt their own capabilities and feel unsure of their adversary's capabilities and intentions.
Pandemic planning can produce its own haze as planners grapple with issues like ensuring their supply chain or determining government's role. "We talk about what we might do or can do, but we really don't know," Osterholm said. "There are so many uncertainties."
This extends to experts' estimates of how a pandemic might behave. "We have only a general sense of what the next pandemic influenza strain is capable of doing in terms of human illness or subsequent collateral damage," he said.
Add to that today's just-in-time economy, in which supplies arrive as they are needed so that companies minimize storage costs. "It is the reality of today's economy," Osterholm said. "It's what MBAs are made of." That reality, though, means that "even a hiccup" of disruption will mean serious shortages, he predicted.
Another layer of mist comes in the form of making decisions about vaccines and antiviral drugs.
"Pre-pandemic" vaccines can be stockpiled in the hope that they may provide some protection against the influenza strain that ultimately causes a pandemic. However, as pointed out by vaccine expert Gregory Poland, MD, in a separate summit presentation Tuesday, a vaccine targeted to the specific pandemic strain would take months to develop and distribute.
In addition, said Poland, director of the Mayo Vaccine Research Group in Rochester, Minn., drug companieseven at maximum worldwide productioncould deliver only enough vaccine to inoculate 1% to 2% of the world's population.
The result, said Osterholm, is that "the availability of protective vaccine during the first wave of a pandemic just won't be there." He added, "For most of the world's population, a vaccine will never be available throughout the duration of a pandemic."
Osterholm lauded companies like Roche for increasing production of antiviral drugs like osteltamivir (Tamiflu), but said it remains unclear how effective these drugs will be against H5N1 if it becomes the pandemic strain.
Even if companies stockpile antivirals, they face another dilemma: when to use them. If they were to withhold them during a first pandemic wave anticipating a more severe second wave that didn't happen, people would question the decision, Osterholm said. Likewise, leaders could decide to distribute stockpiled drugs during the first wave, only to discover that the second is more severe. "When do you blow your wad?" he asked.
And with estimates of the mortality rate in a pandemic ranging widely, Osterholm surmised, "We don't really have a clue" about how many people will succumb.
Adding to that miasma is the state of US healthcare. In part because of a shortage of workers and the physical limitations of medical centers, the system has little "surge capacity" for the huge influx of patients a pandemic would cause. "We have basically taken [the healthcare] system and sucked it to the bone," Osterholm said.
Shining some light into the pandemic cloud, however, is the recent document on community mitigation measures by the US Department of Health and Human Services (see links below). "You don't want to have a [pandemic planning] policy inconsistent with this document," Osterholm said.
Other steps businesses can take, according to Osterholm, include:
- Learn from veterans. We need to look at those in the military who have studied the fog of war to explore what to do when unsure about what steps to take.
- Work around "just in time." "Don't try to change the global just-in-time economy," he said. "That's like swimming up Niagara Falls. Forget it. You've got to work around it."
- Overcome pandemic fatigue. Recognize that some executives may see pandemic planning as no longer important, Osterholm said, calling the phenomenon "pandemic fatigue" and saying, "Acknowledge, accept, and plan around pandemic fatigue."
- Maintain flexibility. Osterholm recognized the uncertainty involved in pandemic planning and stressed that plans need malleability so they can adapt to the elusive realities of a pandemic. "Anyone who develops a concrete plan is making a mistake," he said. "Be capable and be flexible.
"You're not stuck to a plan," he said. "You're stuck to a process."
Feb 1 CIDRAP News story: "HHS ties pandemic mitigation advice to severity"
Full text of Feb 2007 HHS report on community mitigation measures