Peter Curson: Ten ways to prepare for a pandemic

Over the past 40 years, the world has witnessed a seemingly endless parade of new infectious diseases.

Today the outlook remains bleak, with HIV/Aids continuing to wreck havoc in sub-Saharan Africa and elsewhere, bioterrorism emerging as a potential threat, increasing antibiotic resistance among many diseases with little international interest in developing new antibiotic drugs, as well as the emergence of a whole range of new zoonotic infections with implications for human health.

There seems little doubt that despite the considerable medical and technological advances of the past half-century, infectious disease will continue to play an important role in world events over the next few decades. Many now argue that it is only a matter of time before another pandemic is launched on an unprepared world.

Certainly it would appear that the world is long overdue for such an occurrence and currently the bird flu virus seems to have established a permanent niche amongst tens of millions of wild and domesticated birds throughout Asia.

As this virus changes and spreads to infect more hosts, and as resistance grows to existing antiviral drugs, some argue that the virus will inevitably encounter the human flu virus and transform into a deadly new infection capable of transmission from person to person.

If this happens, then the world may be confronting a new pandemic of human flu with potentially catastrophic implications for human health and wellbeing.

Given all this, how well prepared is New Zealand to confront such a circumstance?

In the case of Sars and influenza, New Zealand prepared management plans which lay down a basic traditional response to epidemic containment and management. Much of this has been debated in the public arena over the past few months.

Conscious that Crown agencies are currently in the process of preparing strategies to deal with a possible bird flu pandemic, what I wish to do here is simply put forward a set of key pandemic response principles, essential for any overnment confronting outbreaks of infectious disease in the 21st century.

1. First, New Zealand needs to enhance its capacity for the surveillance of animal and human diseases both at home and abroad.

We need an efficient, effective and centralised global and national neighbourhood watch system which keeps tabs on potential infections and evaluates their possible impact.

Such measures should provide an early warning system and should view animal diseases here and abroad as sentinel outposts for possible human outbreaks. Such a surveillance network should be built on a substantial network of reporting GPs, laboratories, hospitals and vets, widely distributed across the country. An important part of this would be a fast and secure internet link between health providers and public health authorities.

Only with such a system would we get the sort of neighbourhood disease watch that we require. In addition, animal infections need to be included in the human surveillance network. Perhaps we also need to explore new systems of disease surveillance such as satellite monitoring of bird migrations.

2. We urgently need to expand our national public health capacity and our crisis response systems, not only so we have the ability to react quickly and decisively when confronted by disease outbreaks, whether naturally occurring or deliberate, but also so that we have a body of experts who fully understand how disease impacts on all aspects of life and society, from biology and medicine to social policy, politics, the economy, education, law and human rights and geography. Thus we require a holistic, interdisciplinary/multidisciplinary approach and we need to ensure that our public health specialists are trained to appreciate, and benefit from, the synergies that would flow from such an arrangement.

3. We need to look back at, and learn from, New Zealand's experience of past epidemics: the containment measures, the human reaction that they engendered and the problems they raised. This way we can learn from previous mistakes and better comprehend the reasons why such epidemics occurred, the demographic, social and economic impact, the mechanisms of their transmission, and the attitudes and behaviour they produced.

4. New Zealand must have at its disposal a rapid diagnostic service that can quickly identify the disease agent so that the appropriate response might be initiated. This would be no problem with common infections like influenza, but does raise some problems with more exotic infections like pneumonic plague that bioterrorists might use.

5. If our containment and management plans involve stockpiling relevant antiviral drugs and/or vaccines, then we need to have a discussion about the relevant mix of drugs and the volume required, and try to ensure that adequate supplies are readily available for all New Zealanders.

If this proves impossible, as at present with bird flu, and limited supplies are destined only for key health and emergency workers, and the severely ill, then the public needs to know who would have access, and why.

In the case of antivirals and/or vaccines, the Government must also have systems to deliver drugs efficiently and quickly to millions of people.

6. We need to fully appreciate the impact that major epidemics/pandemics can have on our healthcare system and plan accordingly. The sheer volume of demand would quickly overwhelm the hospitals. Respiratory equipment such as ventilators would be in short supply, and many healthcare workers would themselves be sick.

7. The seventh principle involves the importance of risk communication and fully involving the public and raising awareness about the epidemic/pandemic and the measures being advanced to contain it. Continually reassuring people that there is nothing to worry about, when such episodes are frightening and threatening, is as good as encouraging apathy and denial.

Allowing people to make decisions about issues which directly affect them increases credibility and ownership. An important part of this involves recognition that the "epidemic of fear" that accompanies the epidemic of cases and deaths, can overwhelm all other aspects of the epidemic. In such circumstances it is critical to address and "manage" such fear, hysteria and panic.

8. We need to understand that the containment and management procedures advanced to handle a major disease outbreak, such as quarantine, isolation, surveillance, restricted travel, closure of public institutions and the restricted delivery of antivirals, may in themselves aggravate fear, hysteria and panic. Home quarantine can have important psychological consequences.

9. My penultimate point relates to co-ordination of the pandemic response and the need to ensure that there is full co-operation between all government authorities and agencies.

10. Finally, we need to encourage "old-fashioned" concepts of personal hygiene and preventative strategies such as covering the face when sneezing or coughing, keeping hands away from the face, regular washing of hands, and avoiding contagious situations as much as possible.

* Professor Peter Curson is the director, health studies programme, division of environmental and life sciences, Macquarie University.