- The Washington Times - Sunday, March 18, 2007

Senior officials from six Southeast Asian nations practiced their handling of a bird flu pandemic in a tabletop exercise last week prepared by a group of specialists from U.S. think tanks — the region’s first multinational flu response simulation.

The exercise was the latest effort to promote regional cooperation in planning responses to a pandemic and raise the ability of governments around the world to mitigate and deal with the huge population displacements and economic chaos that might ensue.

The high mortality rate of people who catch avian flu makes the prospect of a pandemic alarming. If an outbreak is not contained, it could quickly overwhelm the limited capabilities of health care facilities by flooding hospitals with dying patients and disabling infected health care workers.

Experience with the spread of severe acute respiratory syndrome (SARS) has shown the danger for the afflicted as well as a region’s economy.

Cambodia, China, Vietnam, Laos, Burma and Thailand sent health ministry officials “at the undersecretary or [agency] director level,” to participate in the two-day exercise, said Terrence Taylor, director of biological programs at the Washington-based Nuclear Threat Initiative (NTI) and one of the organizers of the exercise.

Participating governments also sent officials from their foreign affairs, agriculture, tourism and internal security ministries, Mr. Taylor told UPI by telephone from Siem Reap, Cambodia.

Their participation was essential, he said, because the kind of influenza pandemic envisaged by the exercise scenario, with millions infected and survival rates low, would be much more than just a health crisis.

“If you’re going to deal with this properly, you have to address questions of population movement, border controls, of how to quarantine a population that feels threatened,” he said.

One of the biggest problems, he added, is dealing with what professionals call “risk communication” — how to assess and explain the risks of, for instance, staying indoors and avoiding contact with other people versus attempting to flee.

The problem, he said, is that people generally have a poor understanding of risk. Their perceptions, even if inaccurate, have a profound effect on their behavior.

“You have to factor the public perception of the risk in at the very heart of your analysis,” he said.

Politics set aside

Representatives of the six countries — all members of the Mekong Basin Disease Surveillance Network, a program run by the NTI — joined observers from the United Nations, the World Health Organization and regional institutions: in all, about 80 people, he said.

The participants were “very practical and down to earth,” he said. “There is obviously a political background to what we’re doing, but when the entry point is public health, people tend to be very pragmatic.”

The exercise was designed and run by the participants, working with health specialists from the Rand Corp., a think tank based in Santa Monica, Calif. The Rand Corp. was founded by the U.S. Air Force and maintains close ties with the military.

Mr. Taylor said the game, which was the culmination of a series of similar, national-level exercises in each country over the past year, was organized by the Mekong Basin Disease Surveillance Network and was sponsored by NTI, with additional funding from the U.S. Centers for Disease Control and Prevention and the Rockefeller Foundation.

In the past few years, the Mekong Basin region has emerged as an epicenter of a feared avian-flu pandemic.

Mr. Taylor said a similar program involves Israel, Jordan and the Palestinian Authority, and he hopes to establish a third soon in South Asia.

Battle plan for flu

Using techniques similar to those in war gaming, the tabletop exercise envisaged a three-stage pandemic influenza emergency unfolding over a six-month period, after the mutation of the deadly bird flu virus H5N1 enabled it to be transmitted easily among humans.

In the first stage, a small number of cases of human-to-human transmission were confirmed in a neighboring country, Malaysia. In the second stage, infected travelers had brought the new virus across the border to Thailand. By the end of the third stage, six months later, all six countries had confirmed cases of the deadly disease, with half of them experiencing pandemic-level infection rates of 15 percent to 20 percent.

The six countries share thousands of miles of land borders crossed daily by tens of thousands of people, making the control of infectious disease a major logistical challenge.

Once the outbreak was pinpointed, the exercise was designed to test the ability of government agencies to contain disease, protect their medical and public health workers, plan for medical surge, and improve the quality of operational planning and communication among governments and with the public in multiple countries and through the press.

The key is accurate, swift identification and communication of the facts about the outbreak, Mr. Taylor said.

In the fourth stage of the game, he said, participants re-examined their responses to assess the missing pieces in terms of equipment and policies.

“What equipment don’t they have that they need?” was one of the questions asked, he said, along with discussions about the development of data-exchange protocols and common standards and formats for diagnostic analysis.

A statement from the NTI said the exercise identified “gaps and weaknesses in systems for detecting, monitoring, tracking and containing” pandemic influenza.

“A disease outbreak on one continent can be on another in a day. In a global economy, national borders are no defense against the spread of disease,” said former Sen. Sam Nunn, Georgia Democrat and NTI’s co-chairman. “Finding gaps now in disease monitoring and control systems through this exercise will help us save lives in a real crisis.”

“Poor countries and populations are the most vulnerable to the current avian flu outbreaks and likely to suffer most in the event of human-to-human transmission,” said Judith Rodin, president of the Rockefeller Foundation, saying investments in the region “have focused for the last several years on promoting greater inter-country collaboration in planning, surveillance and response.”

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