Jakarta Pandemic, The (68 page)

“Certainly an ominous possibility, let’s hope this doesn’t pan out. Have you heard any speculation about why the travel ban is one way, and that travelers are allowed to leave China?”

“Well, Matt, once again, no definitive information exists regarding the logic behind the ban, however, there are several theories. The predominant theory is an economic one, speculating that if there is an outbreak, China does not want to disable its economy by limiting exports or imports, or even the export of its talented human force around the world. China is a dominant world power, having catapulted back onto the world economic scene after the 2008 pandemic, in a more powerful position than before. It is possible they hope to contain any problem arising. I can tell you this, despite an enhanced capability to handle pandemic threats, officials at the WHO are concerned about China’s lack of timely communication. They do not want a repeat of 2008.”

“Interesting, Carolyn, what are some of the other theories?”

“Matt, another theory on the table is that China is concerned about an external disease threat. This would make more sense given the one-way travel ban, clearly aimed at keeping travelers out of China, however, more credence is being given to the first theory, especially in light of China’s track record in 2005 and 2008.”

“Carolyn, have health officials at the WHO detected any suspicious virus activity throughout Southeast Asia that might support the second theory about an outside threat?”

“Our sources have not confirmed any unusual patterns, and WHO, CDC and GeoSentinel outbreak alert web pages have not highlighted any trends. However, the International Scientific Pandemic Awareness Collaboration is focused on the second theory. Our contact at the ISPAC states that they are actively investigating several dozen unidentified flu-like cases spread throughout Asia, specifically focused on the areas south of China.”

“What has been going on in this area?”

“Unfortunately, there is not much information on the ISPAC website, and our contact said that they just dispatched additional resources to the area. But our source did say that several International Society of Travel Medicine (ISTM) sponsored clinic sites linked into the GeoSentinel system have reported uncorrelated illnesses, mostly from foreign travelers.”

“Thank you, Carolyn, I am sure we will be hearing from you again shortly.”

“Thanks, Matt.”

“It’s thirteen after the hour and time for a quick break. When we return, we’ll hear from Dr. Donald Fendelman of the CDC, who will provide some background information about the world’s pandemic outbreak detection capability.”

Morning View
Interview with CDC Virologist

Late October 2013

“Good morning, everyone, welcome back. We now shift back to the U.S. to speak with Dr. Donald Fendelman of the CDC, who is one of the world’s leading virologists. Dr. Fendelman, good morning.”

“Good morning, Matt.”

“Doctor, thank you for taking time out of what must be a hectic schedule, given the circumstances.”

“Always a pleasure, Matt.”

“So, what can you tell us about the current situation in China.”

“Well, first, thank you for inviting me to speak to such a wide audience. I hope I can shed some light on current events, but I am afraid that the CDC may not have much more to offer than the WHO. I can say that we are working with the WHO to formulate a plan to address the situation in China, with the Chinese Health Ministry. Our hopes and intentions are to resolve this within the realm of International Health Organizations and avoid further political, military or economic posturing. We are also operating in a liaison mode with the ISPAC and providing them with assistance to further investigate some of their concerns regarding recent developments. As you are aware, the relationship between the ISPAC and WHO is strained, to put it mildly. However, it is the CDC’s position that the ISPAC provides a unique perspective to the pandemic preparedness equation and should be afforded every opportunity to participate on a wide-scale level. Because of this stance, some of us at the CDC probably won’t be receiving Christmas cards from the WHO any time soon.”

“Yes, I imagine you won’t. You just mentioned recent developments. Are you referring to the uncorrelated illness cases surfacing in Asia, outside of China?”

“Yes, Matt, most of our efforts are focused in line with the WHO’s to address China’s travel restrictions. As such, we will allocate resources to help the ISPAC investigate any angles that we cannot simultaneously prosecute. At least a few dozen cases have attracted the attention of international health agencies, spanning several locations within Southeast Asia, but absolutely no conclusions can be drawn from these cases. They appear flu-like, and in most cases were reported second hand to local ISTM sites and picked up by the GeoSentinel system. Some of these cases have been reported first hand to ISTM sites, and these are the easiest to investigate. I presume ISPAC officials will start with these cases. Keep in mind, Matt, that tensions are high in this region, and rumors of some sort of outbreak in China are running rampant. So it is likely that we will see a massive increase in reported illnesses, of many varieties, including sicknesses not typically reported to GeoSentinel linked sites.”

“Doctor, you mentioned the GeoSentinel system, could you give us a brief rundown of this systems current capabilities?”

“Sure, Matt, in 1995, scientists at Emory University, backed by both the International Society of Travel Medicine (ISTM) and the Centers for Disease Control and Prevention (CDC), established a system called GeoSentinel, which served to monitor emerging infections of potential global impact. Currently utilizing 52 GeoSentinel sites and 253 ISTM clinics on six continents, CDC and WHO officials can track the introduction and progression of diseases with pandemic potential. Since 2005, the main focus of the GeoSentinel system has been the detection and tracking of flu virus strains.”

“This system has been significantly enhanced since 2008. Right?” Matt said.

“Yes, Matt, in 2008, only about 41 GeoSentinel sites existed and about 145 ISTM clinics. The newly-expanded system is truly the backbone and primary detection capability of the WHO’s Global Outbreak and Response Network (GOARN). The WHO also utilizes Forward Liaison Teams (FLT), first introduced at the outset of the 2008 pandemic.”

“Doctor, refresh my memory if you could, the FLTs are deployed once a pandemic outbreak is identified and sent to locations likely to receive infected travelers?”

“Yes, Matt, good memory, the FLTs are deployed in the likely path of the pandemic outbreak, with the mission of augmenting GeoSentinel detection capabilities. The FLTs interface with host-country health officials and assist with the immediate development and implementation of a grass-roots-level virus detection and reporting network. The network utilizes national and local level representatives, comprised of health service providers and government service officials, to extend the capability to detect the early onset of flu cases within their area of responsibility. Ideally, within a week of FLT arrival, a system would be developed that could detect the presence or intrusion of suspected flu virus activity, and immediately report it to the WHO for further investigation. Once an effective system was developed, the FLTs would either remain in place to further develop host capabilities, or be re-deployed to another area of interest. This system worked very well during 2008.”

“Doctor, can you confirm whether any of these teams have been deployed to Southeast Asia?”

“Matt, I really can’t say for sure, the WHO retains complete authority over the use of these assets, although in many cases CDC personnel fill slots on those teams. To my knowledge, none of our personnel have been notified. That is a great question for the WHO.”

“Finally, Dr. Fendelman, what are some of the other capabilities that the CDC can deploy?”

“Well, the CDC does not actually deploy its own teams overseas, it agrees to fill slots, at nearly all levels, within the WHO’s Global Outbreak and Response Network. Currently, this network includes the previously mentioned Forward Liaison Teams, Rapid Response and Surveillance Teams (RRST) and the Rapid Response Assistance Packages (RRAP). In a declared pandemic environment, the RRSTs tirelessly scour the planet, investigating potential virus outbreaks and reporting the findings to the WHO for immediate asset allocation. Ideally, an RRST is deployed within a few hours of a credible virus report. RRSTs operate under the full support of the United Nations’ military enforcement arm. Likewise, admittance and full cooperation with the RRST by the host governments is mandatory, and noncompliance is decreed by the UN security council to be an immediate, hostile action against world safety and security. With the full weight of the UN, RRSTs typically operated unhindered, as was seen during 2008.

“Once the RRSTs detect a pandemic virus, rapid mobilization of the host nation’s resources is implemented in accordance with WHO pandemic containment and treatment plans. These plans can be tailored for the full spectrum of economic and industrial development found throughout the world and serve as a baseline for immediate action. Quickly following the activation of the host nation’s resources, Rapid Response Assistance Packages (RRAPs) are deployed, sometimes in several stages, containing vaccine, medical augmentation material, and additional WHO personnel. RRAP personnel also provide education and pandemic plan implementation expertise to the host nation’s government and health services infrastructure. In extreme cases, they will simply assume control of all efforts to fight the pandemic.”

“Incredible, I truly hope this is not where we are headed. Dr. Fendelman, thank you again for talking with us, good luck today.”

“Thank you, Matt.”

“It’s reassuring to know that a lot of agencies are working on this as we speak. Hopefully, we’ll all get some solid information soon.”

First Interview ISPAC Virologist

Early November 2013

Alex enjoyed the stretch of road between Falmouth and Yarmouth. Nothing but trees and the occasional business or neighborhood development tucked away between tall thick pine trees. He’s absently listening to 80s music on satellite radio, when he suddenly remembered that NPR’s
Talk of the Nation
started a few minutes ago. He pressed the remote control preset button for NPR and confirmed that the talk show already started. Alex slowed his car and pulled off into the uncrowded parking lot of a landscaping business.

“…worldwide we promote a pandemic awareness and preparedness agenda, reaching past WHO supported measures, and augmenting WHO plans with additional layers of readiness. I can’t stress enough, that we are not opposed to their efforts, as many appear to believe. We both pursue the same agenda. To combat the pandemic threat and better prepare the world for a pandemic flu. It’s just that we put more emphasis on preparing the public for pandemic flu.”

Alex heard the topic and commented to himself that he probably won’t be making any sales calls until after 11 a.m., when the show ends. Actually, he contemplated the reality that he won’t be making any calls at all today. He still needed to check out all of the websites and blogs. That could suck him in for hours.

“Dr. Harris, a consensus of UN members feel that your organization attempts to undermine the WHO’s credibility and authority, whenever possible, by attacking their positions and plans. How do you respond to that?”

Ah, he’s one of the ISPAC’s more diplomatic spokespeople. Not as much fun as Dr. Ocampo.

“First, I think that these nations are giving us more credit than we are due, considering that we operate on a fraction of the WHO’s budget. Not to mention the embedded material and transportation support of UN member nations. Frankly, I only wish we could be as effective as they claim. To answer your question, yes, we are highly critical of the WHO’s monopoly of the world’s pandemic planning and response efforts. The WHO bills itself as the sole competent provider of this role, and the world buys into their rhetoric, literally. Most nations pay large financial sums to the WHO and wash their hands of the problem. They’d rather let the WHO bear the burden of preparing for the next pandemic. This financial support takes the form of contributions to the WHO, well above and beyond amounts paid to the United Nations. Once again, we are not opposed to WHO efforts, on the contrary, we firmly believed that WHO involvement in the next pandemic will be critical to mitigating fatalities and fighting the pandemic on a large scale. However, given the frightening prognosis of a deadlier pandemic flu, ISPAC officials project that the next pandemic could quickly render the WHO’s big picture plans ineffective. In effect, most nations are investing all of their pandemic budget in the wrong place.”

“Could you explain that in more detail?”

“Sure, we believe that the most important aspect of pandemic readiness and response needs to stem from municipal and regional governments, the private service sector, and individual households. Let me break it down a little better. The WHO plan acts like a castle wall, to prevent or slow the flu’s entry into the castle. But once the defense is overwhelmed, WHO plans provide little capability to protect the inhabitants of the castle against the flu. So if the flu is worse than 2008, the castle wall will be breached very quickly. Even worse, most nations have allocated nearly all of their authorized pandemic preparedness funding to the WHO, leaving little funding left to seriously implement a domestic plan inside the castle wall. Sure, most nations have committees and departments that develop and maintain pandemic plans at all levels, on paper, but few countries financially empower these entities to seriously implement the plans. It is very unfortunate that ISPAC’s efforts to augment WHO plans meet with endless resistance from the WHO and international community. The WHO continues to maintain their international pandemic planning monopoly, which yields them generous funding from nations that have little interest or motivation to assume further financial responsibility for domestic planning costs. It’s easier for governments to write a check and pass the responsibility on to the WHO.”