There is every reason to believe this scenario is plausible. With each report of the avian influenza A (H5N1) virus showing up in birds and moving from one continent to another, concern grows that the world is at risk of a human flu pandemic, an outbreak of disease occurring over a wide geographic area and affecting an exceptionally high number of people.
At the moment, media coverage, conjecture, and curiosity are spreading far faster than the flu itself. The word pandemic ranks seventh on the list of words looked up most in 2005 in the online Merriam-Webster dictionary. (The top six words were tsunami, insipid, filibuster, contempt, refugee, and, at No. 1, integrity.) And there is plenty of debate among scientists and health experts as to whether the conditions for sustained human-to-human transmission of the H5N1 strain will ever materialize. But health experts aren’t debating that a flu pandemic could happen. Several such outbreaks occurred in the 20th century and, sooner or later in the 21st, another outbreak is expected.
A crisis in itself — whether it is a pandemic, a hurricane, a tsunami, or a terrorist attack — is not the greatest cause for worry. Rather, the concern is whether we are prepared for such crises. Or, as followers of the Merriam-Webster list might put it: Do the public and private institutions of our society, with their traditional structures and organizational behaviors, have the requisite “integrity” to manage the crisis as needed?
The answer seems to be: not yet. Individually, organizations are developing their capabilities, especially after such catastrophes as the Indian Ocean tsunami and Hurricane Katrina. But the threat of a pandemic will require organizations to work together in ways that have not yet been tested. One of the biggest challenges is rooted in the historical division of roles and responsibilities between the public and private sectors. This division puts all the weight of serving a broad population’s welfare on government agencies and nongovernmental organizations, while the private sector acts independently to serve its own priorities. Corporate leaders increasingly talk of extended enterprises and interdependence. But in practice, many companies’ risk management and planning approaches focus only on protecting their people and assets to keep their businesses going. They are thus not prepared for the role that they may have to play in keeping the broader societal infrastructures running.
“Engagement by business cannot be a luxury,” said Dr. David Nabarro, senior United Nations system coordinator for avian and human influenza, at the 2006 World Economic Forum in Davos, Switzerland. “It is perhaps the most important factor in the global preparation and response to the threat of pandemic influenza.”
The improvements that have occurred in science and medicine in recent years are important in responding to a pandemic. But science alone can’t save us from the worst. We will need a different level of preparedness and far greater multi-institutional communication and collaboration than we have ever had before.
Past and Future Pandemics
Public concern about pandemics is inevitably colored by the tragic experiences of the past century. Since 1918, there have been three influenza pandemics. The 1957 Asian flu and 1968 Hong Kong flu pandemics killed 2 million and 1 million people worldwide, respectively. The most severe pandemic was the 1918 Spanish flu, which killed 500,000 people in the United States and 50 to 100 million worldwide, nearly half of whom were between 20 and 40 years old.