Is the likelihood of an influenza pandemic over-played?

Get free weekly news by e-mailA comment article by Continuity Central’s editor, David Honour.

The latest report into pandemic planning was published jointly by Marsh and The Albright Group this week. (See separate report at ).The study provides some headlines which are bound to attract attention, including:

- The impact of a pandemic is likely to exceed what most corporate and governmental leaders have imagined, or are prepared for.
- The catastrophic impacts of a long-lasting pandemic are not only likely to happen, but overdue.

The basis of these claims, which are of course nothing new to the business continuity profession, are the often repeated statements that influenza pandemics occur at reasonably regular intervals and are basically unstoppable and inevitable; and the fact that modern transport networks will distribute the pandemic influenza virus more quickly and more widely than in previous pandemics.

These are undoubtedly factors which must be taken into account but they should not be left unchallenged when they are used to influence the decision that business continuity planners make on the likelihood of a pandemic actually occurring in the future.

The fact that influenza pandemics have occurred in the past does not make it inevitable that one will occur in the future. The potential for a future pandemic outbreak is one of probability; and the probability is NOT 100%. There are factors which mitigate the risk:

1) Today’s knowledge : our understanding of influenza and the factors which increase the risk of a pandemic are much greater today than they were in the times preceding previous pandemics. This increases the potential for nipping an influenza pandemic in the bud. The success in preventing SARS from reaching pandemic proportions may be a good sign of modern capabilities in this area.

2) Today’s communications infrastructure: while the modern transport infrastructure provides a factor which may increase the likelihood of a global pandemic, today’s communications infrastructure may increase the chance of preventing a pandemic. Warnings can be passed very quickly amongst governmental and healthcare sectors allowing for increased vigilance and the swift introduction of preventative measures. Accurate information can also be quickly passed to businesses and individuals enabling wide-spread awareness of the necessary preventative measures and also enabling people to watch out for disease symptoms and to seek rapid help and treatment.

3) Today’s medicines: The ability to quickly identify influenza strains and to create effective vaccines provides the modern world with an advantage that was not available in earlier outbreaks. Today’s anti-virals also provide a weapon which was not available previously.

While the above is not seeking to minimize the potential threat of a future influenza pandemic, I believe that it is important to place the risk in context. The world has moved on since previous influenza pandemics and to simply base probability decisions on extrapolations from these events is unwise.

If we are to avoid the ‘pandemic fatigue’ that the Marsh and The Albright Group report discusses, we must avoid sensationalising pandemic planning. The threat needs to be on the agenda of all business continuity planners; but the ‘fear, uncertainty and doubt’ doomsday approach does not lead to good business continuity investment decisions. More thought needs to be given to whether a global pandemic really is inevitable and unstoppable; and to what the real likelihood of a future influenza pandemic is.

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Reader comments:

David Honour’s article is timely, as a ‘reality check’ on pandemic planning is overdue. I believe other health disasters might help shine some light on this very important topic.

In 2001, the United Kingdom suffered an extremely serious outbreak of Food and Mouth Disease (FMD) a disease of cloven-footed animals, in particular cattle and pigs. Like avian flu variant H5N1, FMD is a highly contagious, viral disease that can be fatal to the animals that it infects. It differs, however, from avian flu in that animal-to-human transmissions are extremely rare and rarely fatal. The 2001 FMD outbreak devastated the UK dairy and beef farming sectors with millions of cattle and goats being destroyed across the country. The outbreak is estimated, on various government websites, as costing the UK economy about $16 billion, mainly outside of the farming industry! The previous large FMD outbreak had occurred in 1967/68 when up to half a million animals were culled.

Why was the 2001 outbreak so much worse than the 1967 one? Precisely because of some of the factors that the Marsh report highlights, in particular the transportation of animals long distances across country as part of the retail food ‘supply chain’. In this case, infected animals were moved around the UK carrying the disease from one area to another.

Before proceeding it worth noting that, following the 1967 outbreak, procedure were put in place, aimed at detecting FMD and reacting quickly, using draconian culling and quarantine methods, to minimize the disease’s spread. Despite these controls, the outbreak happened and the impact was disastrous. As Honour’s article correctly points out - just because something has happened in the past does not mean that it will inevitably happen again. However, this just means that there is a ‘likelihood’ (hopefully diminished if lessons are learned correctly) that it could happen again.

Under six years later, in the summer of 2007, it did happen again. This time the outbreak was allegedly caused by lax bio-security at an animal laboratory exacerbated by unprecedented flooding in the vicinity of the laboratory (global warming?). Veterinary authorities acted quickly and at the time of writing the outbreak appears to have been contained, but, even if not, is very unlikely to cost the economy anyway near as much as the 2001 outbreak. No one today begrudges the many millions of pounds spent on improving animal husbandry management after the 2001 outbreak. These changes have reduced the cost of an FMD outbreak many times over – a tick in the box for what is, in reality, an example of ‘business continuity management’?

In August 2007, a different viral disease hit animals in Australia. Allegedly introduced into the country by a recently arrived racing thoroughbred, the equine influenza virus (H3N8) is highly contagious, though rarely fatal to mature horses. Pre-planned quarantine procedures were quickly put into practice, which had the impact of slowing the spread of the disease but also shutting down the Australian racing industry at the peak of its season. The Australian government has recently purchased stocks of equine flu vaccine, sufficient to vaccinate the vast bulk of the horse population, and so the outbreak is near to being contained. [As an aside it took several weeks for stocks of vaccine to be acquired and sent to Australia, even though stocks were available in Europe]. The cost to the Australian economy has not yet been estimated but is likely to run into many hundreds of millions of dollars.

In relation to pandemic influenza, the points that can be learned from these two outbreaks of viral diseases are:

1. Despite very strong quarantine controls being in place, these very costly events happened. There are no similar quarantine measures in place today for human influenza of any types, increasing the likelihood of the virus spreading rapidly if carried by the traveling public.
2. These two animal diseases were well understood before the outbreaks and vaccines had been developed. However, they were either not used or employed after the disease had taken hold. The medical profession is nowhere near being in the same state for pandemic influenza.
3. The control measures for animals in the event of a contagious viral disease outbreak are draconian – no one has (yet) suggested mass culling of human ‘flu victims. Once in the human population, therefore, pandemic influenza will spread rapidly with little check. It will take weeks, if not months, to put effective human quarantine procedures in place.
4. The two outbreaks did not spread to other countries, other than in a minor way, precisely because transportation of live animals across borders is actively discouraged and trans-national quarantine procedures in place are strict (though, as we see in these cases, can be fallible). No such barriers are in place to stop human borne diseases crossing borders.
5. The knock-on costs of these animal outbreaks were many times the impact on the farmers and horse breeders involved. It should be noted that pandemic influenza will not be restricted to lightly populated rural areas but will affect a large number of businesses in large cities, and the knock on effects could be enormous.

In summary, countries have none of the controls in place that have slowed and then stopped serious outbreaks of animal viral diseases, which had been considered to be under control. If we use these recent cases as examples, the consequences of a highly contagious deadly pandemic influenza crossing national borders could, in the words of the Australian government, be ‘mind-boggling’.

In answer to the question posed in the article, the likelihood (and consequences) of an influenza pandemic is probably not over-played!

Pat Mc Connell

I think you are spot on in your critique of Marsh et al.

In my view, the type of scare-mongering we are seeing is likely to lead to what I would call ‘BCM fatigue’. People have only so much capacity to put aside the day job and work on BCM so if we use it up for this, it won't be there for other higher probability, high impact events. All the planning for Year 2000 meant that there was little appetite for BCM in 2000 and 2001 causing many organisations to face 9/11 with out of date plans.

The second point to make is that if the situation could become as bad as Marsh et al are suggesting, why bother planning at a business level anyway? We all make assumptions in our planning (recovery site available, enough staff available, trading partners operational, etc) but the more assumptions we make about the spread of a pandemic, the less valuable detailed plans will be as many of the assumptions will be wrong.

For lots of reasons, organisations need:
• Crisis management procedures and protocols
• Delegated authorities and the situations when they apply
• Escalation paths including preventative measures (e.g. if this happens, we will do that)
• A list of principles and priorities in different situations (which start with the safety and welfare of staff)
• Ability to work remotely.

By all means, think about whether your organisation will supply wipes, Tamiflu, etc to staff and next-of-kin and decide high level principles (wills and probates will be number one priority, etc.) but I personally cannot see the point of detailed plans until we know how the disease is spreading (if it ever does). That argues for greater emphasis on crisis management and decision-taking, not the current madhouse.

Nick Simms

A good article and I particularly agree with the need to stop sensationalising the consequences of a pandemic. That said, I refer to my article which you published earlier this year wherein I suggested that significant benefits are achievable by implementing, today, a range of pre-pandemic planning measures. Not only can they deliver productivity improvements, they will also lay an effective base for response if/when a pandemic does occur.

In Australia this year we have seen a particularly nasty strain of influenza which resulted, amongst other incidents, in the death of several young children in Western Australia. The resulting panic response from many parents almost brought the WA hospital system to a standstill. Medical associations endeavoured to rapidly educate the public via media releases outlining symptoms for which to look in young children, but it was all too little, too late. Once again this highlights my argument that information should be made available now and good practices should be adopted now. It is no good waiting for a pandemic and as the WA events prove we don't need a pandemic - a seasonal epidemic can produce, locally, just as many problems.

In essence, keep a sense of perspective, but don't overlook the benefits that sensible pre-medical incident planning can provide.

Leslie T Whittet FBCI MACS MRMIA

In ‘Is the likelihood of an influenza pandemic over-played?’ David Honour offers to place the pandemic risk highlighted in Marsh’s report in context with a few mitigation factors in an effort to avoid sensationalizing pandemic planning. Mr. Honour also challenges the business and scientific communities with the statement, “More thought needs to be given to whether a global pandemic really is inevitable and unstoppable; and to what the real likelihood of a future influenza pandemic is.” The assumption seems to be that this has not yet happened.

I would charge that this has happened and that the case continues to be made for urgent response, even if the answers are not economically palatable. The situation is not all that different from the so-called controversy around global warming. The implication is that if the answer is not what we want to hear, it must be wrong, exaggerated, sensationalized, or saddled with an agenda of fear- and doubt-mongering.

Each of the three mitigation factors can be countered and displaced with more factors leading to an even more alarmist position than the Marsh report gives us:

1. Today’s knowledge of the influenza virus is perhaps surprisingly little advanced since previous pandemics. We still do not know what genetic changes lead to increased virulence, or proclivity to easily transmit between humans. We still do not have a clear picture of the transmission process: Large droplet or aerosolized? Short-lived outside the body or resilient? It was not modern knowledge that saved the world from a SARS scourge, it was dumb luck. The SARS virus was not contagious until symptoms presented, allowing quarantine and isolation techniques to be effective. The influenza virus has no such weakness.

2. Modern communications infrastructure and technology have certainly sped up the dissemination of knowledge and information, but have also enabled the rapid and profuse expansion of mis-information, propaganda, and rumoring. Quality oversight has suffered with the proliferation of information feeds. This mitigation also is sited as “enabling people to watch out for disease symptoms and to seek rapid help and treatment.” That might have been the case if the health-care industry was able to provide surge capacity for such emergencies. Sadly, the health-care industry as a whole is already operating at maximum capacity and all surge capacity has evaporated in the name of fiscal efficiency. In a pandemic, all medical facilities and staff will be over-burdened by demand, hampered by supply shortages, and devastated by their own staff reductions. This will impact not only the provision of any influenza treatment, but also treatment for all other conditions and diseases.

3. Today’s medicines: Much stock has been invested in the new anti-viral drugs yet the two dominating emergent strains of H5N1 are showing signs of resistance to these drugs. As for vaccines, short of some new experimental cell-culture methodology not yet ready for scaled production, vaccine production is mired in 1950’s era technology and economic constraints. This means we cannot expect the first vaccine (against an emergent, mutated highly human contagious strain) to become available for about six months (for healthcare workers, critical infrastructure workers and the military). Wider production that would generate vaccine for the wider population may take 9-12 months leaving the majority of the population to fend against the pandemic without the aid of modern medicine.

Mr. Honour is correct that, “the threat needs to be on the agenda of all business continuity planners” and that an approach is needed which will lead us to “good business continuity investment decisions,” but wishful thinking and half formed hopes will not take us there. As to the probability of the next influenza pandemic, I would argue that modern conditions have increased rather than reduced the probability of another pandemic.

It is all too easy to reduce the pandemic threat to a medical or public health issue, and then to extrapolate general modern medical advances as a sufficient counter-measure to an influenza pandemic. But for business continuity, the pandemic threat is a logistics issue, not a medical issue! Many of the advances in technology, science, agriculture and business that have so increased our standard of living are not only not mitigations against the next pandemic, but are in fact enablers of the next pandemic:

• Transportation has grown in speed, access, and volume, greatly expanding the avenues and speed of human viral transport and spread.
• The globalized economy has greatly complicated and expanded the role of the supply chain, increasing our dependence on it, and increasing our vulnerability to supply chain disruptions.
• Just-in-Time inventory systems have exacerbated the supply chain disruption problem.
• Exponential growth in large-scale animal husbandry (particularly poultry production) has greatly increased the potential for novel viruses to develop, mutate and propagate across the globe.
• Exponential growth and increased density of human populations increase the virus hosting potential and viral transmission speed and extent.

The current difficulty with corporate pandemic planning is that the very systems that have lead to economic prosperity – systems we have purposefully designed and built – are counter-indicated in a program of true pandemic preparedness. It will take a broad and far-sighted view, and committed determination to embark on meaningful logistical changes in the way we do business if we are to in some measure minimize the economic effects of a new influenza pandemic.

Dan Dorman

It is good to have a voice playing down the hysteria that often surrounds the subject of an influenza pandemic, however, I have a few comments and a few issues with some of the content.

• In August the Department of Health (UK) issued a series of ‘scientific evidence base’ documents, which are pretty good and sensible. One of them ‘DH_077273 - Risk of a human influenza pandemic emerging from avian H5N1 viruses’ provides some justification to assertions about the risk of an influenza pandemic. Its overall summary hits the mark pretty well:

“47. Experts agree that the likelihood of a highly pathogenic human influenza virus, capable of causing a pandemic, evolving in the near term is real but unquantifiable. However, this unquantified probability must be set against the possible huge impact of a pandemic, especially if the virus retained some of the high virulence of the current H5N1 or the 1918 avian origin viruses.“

• There is a common misconception that we can draw lessons from SARS when considering pandemic influenza. They are completely different types of disease. SARS can be contained; pandemic flu to all intents and purposes cannot.

• Effective communications is unlikely to have any effect in combating the pandemic. Good communications may help delay its spread but that is all. The DoH booklet also points out that

“46. It has been noted that travel patterns between the UK and countries where a pandemic is more likely to start because of close proximity between poultry and humans mean the UK may have less planning time between outbreak and action needed than other European countries. There is a small chance that, if the pandemic starts in a country where the public health infrastructure may mean that the emergence of a pandemic is not detected until it has become firmly established, a case imported into the UK may be the first one recognised.”

• The Department of Health ‘scientific evidence base document ‘DH_077277 - Use of antiviral drugs in an influenza pandemic’ assesses the currently available on scientific and clinical aspects of influenza antivirals and draws the following conclusions:

“23. Effectiveness of antivirals against pandemic influenza cannot be known until a pandemic virus has emerged. In the pre-pandemic period, it is only possible to extrapolate the potential effectiveness and optimal dosage schedule on the basis of experience in managing seasonal influenza and human cases of avian influenza.

24. The available evidence suggests that antivirals could have a significant beneficial impact in reducing morbidity and thus mortality. Given that a pandemic specific vaccine is unlikely to be available for the early months of the pandemic, treatment with antivirals will be the main clinical intervention during the initial response. It is therefore prudent to stockpile in advance of a possible pandemic.”

In other words, the main benefit is reduced mortality. The impact on absenteeism (the major concern in the context of business continuity planning) is unlikely to be significant.

• One of the main problems with vaccine is how long it will take to create and produce the pandemic specific vaccine in sufficient quantities. I attended a World Economic Forum dinner in May last year at which a David Salisbury, who sits on the Joint Committee on Vaccination and Immunisation explained how long it takes between isolating the virus and full production – many months. Issues around vaccines are addressed in ‘DH_077272 - Pre-pandemic and pandemic influenza vaccines’, in which one of the conclusions is:

“41. A pandemic-specific vaccine is unlikely to be available until after the end of the first pandemic wave.”

I am all for playing down the hype and encouraging organizations to plan sensibly based on a considered assessment of the how a pandemic might affect them.

Malcolm Cornish FBCI FCA.

Date: 27th Sept 2007• Region: World •Type: Article •Topic: Pandemic planning
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