How to avoid a dangerous hazard in the all-hazards approach

(CIDRAP Source Osterholm Briefing) - Are you in charge of your company's crisis response plan or part of a business team trained to manage a sizable emergency that could threaten your organization's continuity? If so, you're no stranger to the concept of "all-hazards" preparedness. The business world has increasingly emphasized such an approach since the 9/11 and Hurricane Katrina experiences—and with good reason.

But do you have a solid sense of what all-hazards preparedness means when applied to an inevitable influenza pandemic? To be sure, pandemic preparedness shares certain features with preparedness for earthquakes, hurricanes, and terrorism-related events. But it’s the differences that could sink your company if not considered.

With pandemic preparedness fatigue mounting in public and private sectors, the pressure is on planners and business continuity experts to counter management resistance and keep pandemic issues in the mix. I worry that using an all-hazards approach has become the "work-around" solution. While we must integrate pandemic preparedness into all of our preparedness activities as much as possible, I believe that blurring the distinction between all-hazards and pandemic preparedness is a huge mistake—even if it makes winning support from your boss easier. Let me elaborate.

Don't be fooled by the name

In December 2006, President George W. Bush signed the Pandemic and All-Hazards Preparedness Act, which is intended to improve the organization, direction, and utility of preparedness in this country. The law centralizes federal responsibilities, requires state-based accountability, proposes new national surveillance methods, addresses surge capacity, and facilitates the development of vaccines and other scarce resources. For government response to catastrophes like earthquakes, hurricanes, terrorism-related events, and tsunamis, this blueprint is a real step forward.

Unfortunately, it lacks practicalities for pandemic preparedness—even though the words are included in the title of the bill. I’m convinced that business preparedness planners need to be cautious about selling all-hazards preparedness as the answer to pandemic preparedness.

All-hazards preparedness assumes:

  • Events confined to local and regional geographic areas
  • Little to limited impact on a global just-in-time supply-chain economy
  • Reliance on surge resources coming from federal and state agencies outside the zone of impact within 72 hours of the unfolding event

If you are making your business preparedness plans in concert with local and regional planners, know that relying only on their assumptions is a mistake. A pandemic will likely have worldwide as well as local and regional impact—for about the same duration. While a hurricane or an earthquake causes substantial physical destruction (with the direct assault lasting for no more than minutes or hours and recovery beginning soon after), a pandemic will stretch from 6 to 18 months. Why is this important? Take a look at the following example.

A simple way to spot the gaps

Consider call centers. Try applying the same plans for maintaining your call center capacity to both an earthquake and a pandemic. During the earthquake, capacity may be inoperative in one area, and you may not have workers for a week or two following the event. But you can always shift the call burden to another center located somewhere unaffected by the earthquake, either in this country, or, with advanced planning, in a foreign country. That's a typical all-hazards response.

During an influenza pandemic, however, virtually every call center will experience the impact at about the same time. Call center employees will hesitate to come to work for fear of exposure whether they live in Peoria or Bangalore. By their very nature, call centers are tight working environments, designed to facilitate communication. But such close contact runs completely counter to the recommendations for "social distancing" that public health officials will pronounce loud and clear during a pandemic.

Now, imagine that in the absence of protective vaccines and antiviral drugs, the only other option you have to offer employees who might come to work at the call centers will be protective masks or face-fitting respirators. Have you ever tried to have your call center employees communicate on the telephone while using one of these devices? As an alternative, you could develop distributive communication capability where calls could be routed to workers in their homes—or you could just plan not to have the capacity at all.

This is only one of many examples that distinguish pandemic preparedness from almost all other potential catastrophic event preparedness you might face in your job. Relying on outside reinforcements is another example. Because every jurisdiction will be "in the soup" at about the same time during a pandemic, you won't be able to count on the 72-hour rule of thumb for emergency aid and fresh, trained helpers to arrive. Everybody will be at risk.

The bottom line for business

Yes, all-hazards preparedness as traditionally considered for most catastrophic events or emergencies is an important and sound aspect of preparing your business for what might one day confront it. But it isn't enough for pandemic preparedness. And if you try to sell it as such, you may one day find your business underprepared for a catastrophic event unlike any it has ever seen.

Use the call center example as a model for considering planning differences. Go through your plan now and flag all the potential aspects in which pandemic preparedness will need to differ. By doing so, you'll be able to spot the gaps quickly, concentrate efforts on the unique issues posed by a pandemic, and improve and support your company's all-hazards planning. Such an approach allows you to save effort—and, quite possibly, your business.

—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.

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