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One hundred years ago, the 1918 Spanish influenza pandemic infected one third of the global population, killing between 50 and 100 million people, and representing both the deadliest and fastest epidemic in human history. Two-thirds of these deaths occurred in 10-weeks during the autumn of 1918. Within the United States, the Spanish flu killed about as many individuals as AIDs would over 40 years. Major cities such as New York City and Philadelphia saw slowdowns of commerce as streets and large gathering areas emptied out. Unlike most other strains of the influenza virus, this strain killed millions of young adults with strong immune systems; in fact, this strength became a weakness because the Spanish Flu killed individuals by causing their immune systems to react so powerfully that it caused them to asphyxiate from bloody coughing and bleeding from different orifices, usually resulting in death. Breakthroughs in medical technology, such as vaccinations, and the advancement of scientific knowledge since the Spanish Flu pandemic have provided practitioners new tools to prevent epidemics.

Purple microscopic image of the H1N1 Influenza Virus
Image of the H1N1 (Swine Flu) virus (Wikimedia/CDC Influenza Laboratory)

Despite these developments, the risk of globally catastrophic epidemics has not disappeared and multiple trends may be increasing the potential consequences of a modern pandemic. The increasing share of the global population living in urban areas, projected by the UN to be 66% by 2050, means that diseases can spread faster in more densely co-located populations. Globalization in trade and travel has resulted in millions of people travelling the globe daily, creating new potential pathways for the transmission of undetected diseases to spread internationally within days. The spread of SARs in 2003 through a doctor in China who visited Hong Kong spread the disease to individuals with whom he interacted, and eventually resulted in 4,000 cases and 550 deaths in four months —  a powerful demonstration of how the ties of globalization can also make society vulnerable to pandemics. Terrorism can also function as a vector for a future pandemic. Dr. Tom Inglesby, Director of the Center for Health Security at University of Pittsburgh, testified before the House of Representatives that biological weapons could be obtained without obvious signals and that attacks could come from diseases that are relatively unknown, such as the 2001 anthrax letter attacks. Although this type of large-scale bioterrorism is relatively unlikely, they have occurred; one of the most well-known is the 1995 Sarin Gas attack on the Tokyo subway system by Aum Shinrikyo, a doomsday cult. This attack ultimately left 13 people dead, injured 6,300 people, and resulted in 13 collaborators being sent to death row in Tokyo. Even as these risks develop, the United States Center for Disease Control (CDC) is reducing funding focused on epidemic prevention and monitoring in 39 out of 49 countries, as the $600 million slated toward the program is expected to dry up by September 2019. This could diminish the ability of low and middle income countries that lack well-resourced healthcare systems to recognize and contain the outbreak of disease.

Recognizing the risks that a pandemic poses to the global economy, demonstrated in the 2014 Ebola outbreak that resulted in 11,000 deaths worldwide, the World Bank hosted an exercise to simulate and analyze current plans to address this threat and systematically improve those plans. The participants included government officials from a variety of nations, as well as representatives from the World Health Organization, Center for Disease Control, and International Air Transport Association. These simulations revealed reluctance on the part of countries dependent on tourism to report outbreaks, and the relative ineffectiveness of quarantines that may aggravate the situation by devastating the economy. Ron Klain, the United States “Ebola czar” commented on the risk of a pandemic during the simulation, “We still are not ready for the big one. We’re frankly not ready for a medium-sized one. The threat is still out there.”

The previously mentioned Dr. Inglesby comments that in the face of these risks, nations should take steps to increase cooperation, invest in bio-surveillance through data gathering and analysis, improve global health, among other steps to reduce the risk of a pandemic. Although it’s impossible to completely eliminate risk, global cooperation and investment in disease monitoring, containment, and treatment, as well as learning from previous outbreaks, can help make nations across the world more resilient against pandemics.  Although progress has been made, significant work is still required to manage new sources of pandemic risk.

Sources and Further Reading:

  1. The flu can kill tens of millions of people. In 1918, that’s exactly what it did – Washington Post
  2. Seven reasons we’re at more risk than ever of a global pandemic – CNN
  3. CDC to cut by 80 percent efforts to prevent global disease outbreak – Washington Post
  4. World leaders rehearse for a pandemic that will come ‘sooner than we expect’ – Washington Post
  5. Bioterrorism: Assessing the Threat – Center for Health Security
  6. 1995 Aum sarin attack on Tokyo subway still haunts, leaving questions unanswered – Japan Times Co.