Jakarta Pandemic, The (66 page)

These experts acknowledged that even the quickest and most effective containment could not completely prevent a pandemic threat from escaping into the world. However, they theorized that with a rapid and overwhelming international response at the point of origin, the pandemic would spread at a very slow and controlled rate, similar to the cluster outbreaks seen outside of China, and arguably on a much smaller scale.

With an overwhelming consensus of the international scientific community’s support, the WHO requested additional resources from member nations. The requested resources included increased funding, enhanced vaccine research and production capability, and the augmentation of personnel to support nearly a 30% organizational expansion. The WHO received unfettered access to what it requested, and by the beginning of 2010, boasted an even more robust and effective capability to handle future pandemic threats. Throughout 2010, the specter of a global pandemic threat quickly faded from the world’s general consciousness.

However, not all scientists were convinced that the threat of a devastating pandemic had been vanquished. From early 2009, skeptics quickly highlighted that the avian flu pandemic of 2008 only yielded a quarter of the deaths caused by the Spanish flu of 1918. Casualty estimates for the 1918 flu range from 50-120 million deaths worldwide. For many, this comparison served as a basis for declaring the pandemic efforts of 2008 to be an unqualified success; however, a smaller group saw the 1918 figures as cause for further alarm.

These skeptics, comprised of a small number of virologists, epidemiologists, public planning experts and assorted international academia, championed a minority opinion, casting serious doubt on the capability of the WHO and the world community to handle the next pandemic. Needless to say, their views were not popular in the WHO-dominated aftermath of the 2008 pandemic. Their theories were similarly unpopular with most national governments and public officials, due to the alarmist and potentially panic-inducing nature of their scientific claims. With little official support, these experts cast their lots together and formed an organization dedicated to educating the public, further promoting international pandemic awareness and lobbying major governments to increase preparation for a deadlier, more difficult pandemic.

The International Scientific Pandemic Awareness Collaborative (ISPAC) officially launched in February of 2010.

Despite major political challenges, ISPAC founders garnered enough financial and political support from private sources to promote their agenda internationally, tirelessly lobbying national and regional government agencies directly involved in public planning. Although small in size and of apparently limited influence, ISPAC created three regional operations centers, dedicated to coordinating ISPAC efforts and monitoring potential pandemic threats. The first center, located in Atlanta, U.S., maintained close, but strained ties with the U.S. Centers for Disease Control. This relationship provided real-time virus tracking and research information and allowed ISPAC representatives to indirectly influence CDC programs.

Although under U.S. government control, the CDC remained committed to exploring all available options and resources to prepare for another pandemic, remaining relatively impartial to ISPAC’s agenda at the CDC, despite WHO pressure to severe any and all ties to what they described as a fringe, doom and gloom organization. ISPAC located their next station appropriately in Seoul, South Korea, where they could travel to and interface with international agencies responsible for monitoring and tracking viral flu cases in Southeast Asia. Although much of this information was readily available from the CDC tracking database, developing ties to local agencies and governments directly in the path of initial flu outbreaks enhanced their credibility and provided critical tools for promoting their agenda. The final station settled in London, England, where ISPAC officials established a working relationship with the United Kingdom’s Department of Health, Infectious Disease Division.

In response to the establishment of these centers, the WHO leveraged their international political weight to blockade ISPAC efforts to expand influence. Particularly, the WHO established a persistent presence at the UN, under the aegis of major UN charter members, where they regularly lobbed veiled threats toward UN member nations that interacted with ISPAC representatives. Mainland Europe, South America, Russia, and most regions of the world dependent on UN and WHO support, fully cooperated with WHO requests to sever ties with ISPAC and ignore future lobbying efforts. This essentially denied them access to a vast majority of international resources and influence, but did not render them ineffective.

U.S. CDC and U.K. leadership remained unmoved and unimpressed by WHO intimidation, maintaining their commitment to a more objective and unbiased approach to pandemic disease planning and study. Furthermore, in the U.S. and the U.K., a general disdain for external political pressure, especially from international organizations like the UN or WHO, permitted ISPAC to continue limited operations with the CDC and U.K. Department of Health. Regardless of this stance, considerable political pressure, generated by powerful WHO influence, continuously pushed downward from each nations’ government, effectively prevented ISPAC from influencing major policy decisions regarding pandemic planning.

Fortunately, due to these two key relationships and their unremitting field presence in Southeast Asia, ISPAC continued to maintain and enhance their own capacity to track potential pandemic virus. ISPAC established a public website and hotline system to provide real-time flu information to the world’s population. Information, publications, manuals and leading essays regarding pandemic planning remained constantly updated and available to the public and private sector, with the hope that this resource would be used to strengthen what they considered to be the most critical and neglected aspect of the pandemic defense. In their view, the very least they could provide to the world was the earliest possible warning of a legitimate emerging pandemic threat, so that individuals and grass-roots-level organizations could make life-saving, immediate planning decisions. This became their focus and mission in the face of a nearly insurmountable blockade of their efforts to impact policy.

ISPAC website resources and live-tracking updates continued to remain available to those with access to power and satellite website service until mid-January 2013.

ISPAC and WHO Controversy following the 2008 Avian Flu Pandemic

Linking apparently sound logic, scientifically-based statistical theories with a basic cautious approach to their contrarian views, they forwarded the notion that the world caught a break with the 2008 H5N1 strain. The H5N1 strain’s lower pathogenicity hovered around 6%, instead of the 40-50% seen with previous H5N1 strains. Also noted, the pandemic H5N1 strain displayed a quicker than normal asymptomatic to symptomatic shift. Infected individuals showed symptoms within 1-2 days, instead of the 3-5 day period seen in previous seasonal and pandemic flu strains. Since symptoms surfaced quickly, infected individuals were more rapidly detected, contained, and treated, greatly reducing the geographic spread of the virus.

Scientists calculated that if the strain had behaved differently, with a longer asymptomatic virus shedding period, then the disease would have been harder to detect and contain, and easier to transmit. Consequently, the pandemic flu could have infected a significantly higher percentage of the population.

Either scenario, higher pathogenicity or elevated transmission rates, could push pandemic response plans, national healthcare systems and social/essential services beyond their capacity to handle a pandemic. These scientists pointed to the disasters in Pakistan, Mexico City and Yugoslavia/Serbia as examples of what could happen everywhere in the world if just one of the scenarios materialized.

Even worse, combining both pandemic scenarios, in their opinion, could trigger a global disaster of truly epic proportions. They simply forwarded the theory that, if any of the severely pathogenic H5N1 strains seen in 2005-2006 had made the antigenic shift to effective human-to-human transmission, then the world would have faced a more highly-contagious and transmittable strain of flu, with a 40-50% case fatality rate, that could be spread for days by individuals showing no outward signs of the virus. The outcome of this pandemic would have been drastically worse than the 2008 pandemic, regardless of the presence of an effective vaccine.

Another key element fueling the contrarian view involved vaccines. When the 2008 pandemic started in China, an effective vaccine already existed for the deadly strain, and the international community put the vaccine into immediate wide-scale production on a level never seen before. If a novel strain evolved, most disease and health experts concur that it will take at least 4-6 months to develop an effective vaccine once the pandemic virus strain is identified by world health officials.

Large-scale production of the vaccine would follow, after vaccine production facilities converted to the creation of the new pandemic vaccine. This conversion could add weeks, or possibly months to the entire process, followed by the difficulties of nationwide or worldwide distribution during pandemic conditions. Overall, the world could very likely be forced to wait 6-9 months before the general delivery of an effective vaccine. Even worse, the distribution of the new vaccine would follow national and international rationing protocols, further delaying widespread distribution of the vaccine.

The world’s population will face a stark reality. The majority of people could be forced to live and survive in a hostile and deadly pandemic environment for nearly a year before receiving vaccination to the flu.

Many of the critics paint a grim picture of this pandemic world. In 2008, for both modernized and developing nations, hospital-based care remained available to a vast majority of infected individuals, drastically improving outcomes and contributing heavily to the low overall case fatality rate. Although the situation in many developing nations approached, and in some cases, crossed the tipping point for the availability of hospital or clinic-based care, the modernized nations’ system was never truly challenged by the 2008 pandemic.

The outcome would be different in the face of a deadlier and more infectious virus. The breakpoints for inpatient healthcare availability, in both modernized and developing nations, would be reached quickly, and the result would be catastrophic.

The scenario described by these scientists was depressing, with statistics citing that within 2-3 weeks of a pandemic outbreak in a given area, all available inpatient services such as hospital beds, ventilators, observation rooms, medical staff, would be occupied. Based on 1918 pandemic flu patterns, within weeks, in the U.S. alone, the health care system would need 200% of all existing hospital beds, 500% of intensive care unit beds, and over 200% of ventilators to meet the flu demand. Once inpatient capacity was filled, patients would be given a set of home-based care instructions and turned away.

The predicted survival rates for hospital-based care versus home-based care differ greatly, based on the severity of the patient’s flu symptoms and easily recognizable patient risk factors (age, chronic disease, and general health). The best example is demonstrated by patients in a medium-high risk category, who are typically either very young or very old, or have an underlying chronic disease that can lead to further complications (diabetes, heart disease, pulmonary disorder).

For this group, patients treated within a stable and fully-resourced inpatient setting would survive at a rate of 80-85%, while patients treated in a stable home setting, with access to basic medical supplies, would be expected to survive at a rate of 40-50%. It is important to note that these figures applied to best-case scenarios in each setting, where access to power, water, medical supplies, competent medical personnel and equipment remains constant.

The projected difference between the two, in even the best of circumstances, is remarkable. Once all inpatient services were occupied within the first few weeks of a more virulent pandemic flu, and basic medical stockpiles started to disappear, the expected rates of survival would plummet in both settings to 20-40%.

Another notable difference predicted by ISPAC (International Scientific Pandemic Awareness Collaborative) was the widespread loss of essential services. Their public planning experts agreed that with the predicted onset of a more severe pandemic, the combination of a rapidly growing infection rate and an overwhelming fear of infection will lead to massive absenteeism rates for all sectors of public and private service. Inevitably, high absenteeism rates combined with rampant sickness will seriously deteriorate the reliability of fuel delivery and degrade both municipal and regional public service departments’ ability to repair, maintain and operate their systems.

In a short period of time, once local fuel reserves are exhausted, or system repairs exceed the capability of remaining personnel, a general collapse of essential services like electricity, public water, food distribution, communications (phone, cable, cell phone) and public safety (fire and police) will follow. Eventually, even the hospitals and temporary pandemic treatment centers may face severe personnel shortages, exhaustion of essential supply stockpiles, and the loss of a stable power source.

These experts found it nearly impossible to predict the duration of time that these essential services would be affected, only that the likelihood of losing many of these services was extremely high. Without basic survival needs, like running water, food, heat and medical supplies, they theorized that adequate home treatment of the flu would be nearly impossible, further exacerbating the flu’s case fatality rate.

Given the inherent difficulty to predict the duration of an essential services black-out, experts began to voice concern for the basic survival prospects of non-infected individuals and flu survivors. Statisticians and epidemiologists cited that even in the most modernized parts of the world, like Europe and North America, very few families have an adequate stock of food or water to survive for even one week, and national food reserves might remain inaccessible to most population groups.