The best laid plans of mice and men

We suffer cultural amnesia about pandemics, since 1918, the world has experienced three additional pandemics, in 1957, 1968, and most recently in 2009. These pandemics were less severe and caused considerably lower mortality rates than the 1918 pandemic. The 1957 H2N2 pandemic and the 1968 H3N2 pandemic each resulted in an estimated 1 million global deaths, while the 2009 H1N1 pandemic resulted in fewer than 0.3 million deaths in its first year.  Earlier this century the CDC wrote The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 “could a high severity pandemic on the scale of 1918 could occur in modern times?”

They answer the question with a qualified yes “Many experts think so”, and they go on to say that “If a severe pandemic, such as occurred in 1918 happened today, it would still likely overwhelm health care infrastructure, both in the United States and across the world. Hospitals and doctors’ offices would struggle to meet demand from the number of patients requiring care. Such an event would require significant increases in the manufacture, distribution and supply of medications, products and life-saving medical equipment, such as mechanical ventilators. Businesses and schools would struggle to function, and even basic services like trash pickup and waste removal could be impacted.” Sound familiar, it should this is our world today.

When considering the potential for a modern-era high severity pandemic, it is important; however, to reflect and recognize that there are a number of ways that global preparations for the next pandemic still warrant improvement.

As part of WHO’s International Health Regulations (IHR), countries must notify WHO within 24 hours of any case of human infection caused by a novel influenza A virus subtype. This requirement is designed to help quickly identify emerging viruses with pandemic potential.

Since 2010, CDC has used its Influenza Risk Assessment Tool (IRAT) to evaluate and score emerging novel influenza A viruses and other viruses of potential public health concern. The score provided by the IRAT answers two questions: 1) What is the risk that a virus that is novel in humans could result in sustained human to human transmission? and: 2) What is the potential for the virus to substantially impact public health if it does gain the ability to spread efficiently from person to person? Results from the IRAT have helped public health experts target pandemic preparedness resources against the greatest disease threats and to prioritize the selection of candidate vaccine viruses and the development of pre-pandemic vaccines against emergent viruses with the greatest potential to cause a severe pandemic.

When pre-pandemic vaccines are made, they are stored in the Strategic National Stockpile, along with facemasks, antiviral drugs and other materials that can be used in case of a pandemic.

In the United States, the Department of Health and Human Services (HHS) maintains a national Pandemic Influenza Plan and this plan was updated in 2017, but the Republicans disbanded the plan in 2018. The World Health Organization (WHO) has published instructions for countries to use in developing their own national pandemic plans, as well as a checklist for pandemic influenza risk and impact management. 

So, the plans were in place and everything was in place, in theory, to stop or slow down a pandemic. But as the poet Robbie Burns said in his poem “To a Mouse” “The best-laid schemes of mice and men, Go often askew, And leave us nothing but grief and pain, For promised joy!”