The reality of pandemic planning: I've hit the 'wall' but I'm not giving up

Special feature alert: Welcome to CIDRAP Business Source, a subscription service from the University of Minnesota designed to help businesses prepare for public health threats. This commentary by infectious disease and preparedness expert Michael T. Osterholm, MPH, PhD, Editor-in-Chief, appeared in the Sep 11 Osterholm Briefing. In view of the importance of Dr. Osterholm's message to all organizations and individuals, we're making this column available to the general public. We encourage you to explore our content-rich site for additional context and commentary.

Michael T. Osterholm

September 11, 2008 (CIDRAP Business Source Osterholm Briefing) – Like marathon runners or long-distance swimmers, I hit the "wall" this week when it comes to pandemic preparedness planning—big time. It wasn't pretty. And while I am not giving up, recent events certainly gave me pause. So, I'm changing my strategy—and sharing it with you.

What brought me to this place

Yesterday, our presidential campaign devolved into "lipstick and pigs" nonsense, and it became so clear to me that no politician can get elected today by telling the electorate the painful truth: We're not prepared for our future, and we're not going to do much to get prepared. True preparedness requires sacrifice, and, frankly, as a nation we're mostly too "in the moment" to consider sacrificing for the future.

Here are two non-pandemic examples that call for sacrifices:

• Paying more at the pumps. We should be promoting $7 a gallon gas to reduce consumption and create the incentives for alternate fuel development. Yes, it would be painful, but in the words of STP CEO Andy Granatelli, "You can pay me now, or you can pay me later."
• Looming burden of entitlements. This past Sunday, Peter Peterson, the highly respected senior chairman of the Blackstone Group, published a two-page letter in the New York Times, describing America's $53 trillion black hole—the sum of our government's current liabilities and unfunded entitlement promises. More than $41 trillion of this hole is related to Medicare and Social Security entitlements for the soon-to-come-of-age baby boomers. This amounts to more than $455,000 per American household. No national or state candidate has the courage to tell this story because it would mean she or he would have to promise "future pain" under her or his watch. No tax cuts—instead, major tax increases! (And by the way, this situation won't go away if we just ignore it. Instead it will smother our kids in their adulthood years and future generations.)

So you tell me: Will the honesty and vision to do what is necessary to prepare for the next pandemic come from any of our current or newly elected leaders or even from our business leaders?

And what of pandemic planning?

For more than 15 years, I've spent a good deal of my professional heart and soul trying to convince a distracted world that there are two public health threats that require us to make special efforts to prepare for them. Both bioterrorism and pandemic influenza have the potential to wreak havoc in our world far and beyond the direct cost of illness and death.

We need look no further for evidence that a bioterrorism event can have such an impact than when we recall what letters filled with anthrax spores did to our country in 2001. Of 22 human anthrax cases, 5 people died—a number that, while tragic, hardly puts this event on the same scale as massive public health concerns. And yet the resulting fear and even panic almost shut down the US Postal Service. Imagine what an aerial release of anthrax spores across an entire US city would do both in terms of deaths and our national psyche.

An influenza pandemic, regardless of whether it's mild, moderate, or severe in terms of human illnesses and deaths, has every potential to bring the global just-in-time economy to a screeching halt. As I've detailed in these columns before, such an impact will result in many collateral deaths from the lack of availability of critical drugs, food, and even clean drinking water.

Why now?

So, if I've made it my professional mission to promote preparedness for these two potential catastrophic events for so many years, why I am hitting the wall now? It's not because we haven't had some successes.

I'm actually impressed with efforts that we have made in the US during the last 7 years to better prepare to deter, detect, and respond to bioterrorism events. We now have:

• Extensive caches of new and effective smallpox vaccine and antibiotic stockpiles that can be brought to communities quickly for the treatment of up to 10 million people potentially infected with anthrax or plague
• Better systems for quickly detecting releases of these infectious agents by terrorists

But these pale in comparison to efforts to prepare us for the next pandemic. Pandemic influenza, unlike a local or regional terrorist attack, will quickly overwhelm our preparedness efforts to date.

As I've detailed on numerous occasions, to be genuinely prepared for the next pandemic we need the public health version of a Manhattan Project to develop, produce, and distribute an influenza vaccine effective against most strains of flu virus for the entire global population. And we need to anticipate the impact of suddenly halting the global just-in-time economy so we can plan accordingly.

Both of these efforts are enormous in scope and I believe are doable with (1) a commensurate political and private-sector commitment to medical research, science, business leadership, financial resources, and human ingenuity and (2) a real sense of urgency.

I'm hitting the wall because I've finally come to the conclusion that, as a nation, we don't have and can't find either the political will or private-sector commitment needed to address our pandemic preparedness challenges of today. To make matters worse, other national governments and their private-sector enterprises are not making meaningful progress in preparing for the next influenza pandemic, either. In the US, we have a national pandemic influenza plan, but it doesn't even begin to address the disastrous implications of a collapsing global just-in-time economy.

Yes, I know that you as planners have tried your best to prepare your organizations—including developing pandemic plans and perhaps even exercising them. But you, better than anyone, also understand the challenges that can't be addressed because they are out of your control. In many instances, your management hasn't given you the support you need to move your plans past the first draft.

A new order of business

So, where do we, where do I, go from here? I can't give up preparing for the next pandemic if for no other reason than my duty to ensure the safety and security of my kids.

What I am doing is changing my approach. In upcoming columns, I will focus on what we can do to better prepare for the collateral damage of the next pandemic, rather than on preparing for the pandemic itself.

This approach may sound like a subtle difference, but in the public health world, such a shift is like knowing when it's not possible anymore to prevent a disease outbreak, so we choose to focus our energy and resources on limiting the impact of the outbreak. In a long-distance competition, it's the same as mustering the physical and mental wherewithal to break though the "wall" so you can get to the finish line. In the world of business, it's what Jim Collins calls in his book, Good to Great, the Stockdale Paradox—combining the courage to face the brutal facts with the unwavering belief that you can and will prevail.

Helping you prevail

So here's my plan. I will address the following topics in upcoming columns:

• Electricity. What must we do to ensure that our communities don't lose electricity during the next pandemic, and if they do, what should our plan be?
• Critical life-saving drugs. To be sure, we will run out of drugs that have nothing to do with preventing or treating pandemic influenza. So, what can your organization do now to prepare for the 5% or more of your workers or their families who won't be able to get their life-saving insulin?
• Food. Finally, I'll address why we'll see major food shortages within hours of the official declaration that the pandemic has begun. What can you do now to be better prepared?

Bottom line for business

In short, I am no longer counting on any substantial or meaningful pandemic preparedness efforts that require major national leadership or significant financial investment. I believe that's far more than we can expect among our get-elected-at-any-cost "leaders." Though I've hit the "wall," I'm not stopping my efforts to prepare or giving up my belief that we'll get through this catastrophe. After all, my efforts, your efforts, are about our kids, all kids, and their future. For that alone I could never give up.