Monday, May 11, 2009


The recent emergence of H1N1 swine flu is a powerful wake-up call to the health challenges ahead, reminding us of the important roles prevention and public health preparedness play in mitigating the spread of disease and in promoting good health.

So far, 25 countries across five continents have reported cases of H1N1 infection. In the United States alone, as of May 8, more than 1,600 cases in 43 states (including the D.C. metropolitan area) and two deaths have now been confirmed, prompting the U.S. government to declare H1N1 flu a “public health emergency.”

The World Health Organization (WHO) has raised its pandemic flu alert level to Phase 5 (the second-highest level), sending “a strong signal [to the world] that a pandemic is imminent.”

Disease outbreaks affect many sectors of society. World leaders fear that a pandemic could derail global economic recovery. Already, public speculation over H1N1 flu has caused crude oil, industrial metals and hog futures to drop and sent stock markets tumbling. The H1N1 flu has also impacted education, transportation, commerce and tourism.

The ripple effects that infectious disease outbreaks have on societies are not new. These illnesses are major killers of humans and have been decisive shapers of history. What is new, however, is the unprecedented disruptive potential that infectious diseases have in an ever more interconnected world.

Since the 1960s, WHO has documented 40 new or re-emerging infectious diseases including this H1N1 flu strain, AIDS, Lyme Disease, SARS and the H5N1 avian flu. The world has not seen a disease explosion of this magnitude since the Industrial Revolution.

Infectious illnesses usually originate where animals and humans live in close proximity and are exacerbated by rapid population growth, international travel and trade, urban crowding, poverty, climate changes, and lack of access to health care.

Stemming the spread of the H1N1 flu outbreak and effectively responding to emerging infectious diseases in the future hinges upon three essential pillars of public health: (1) prevention and preparation, (2) surveillance and detection and (3) response and containment.

These actions steps are detailed in the Pandemic Preparedness Plans developed by WHO and the U.S. government in recent years.

Fortunately, advances in the scientific understanding and detection of infectious illnesses, the establishment and effective deployment of stockpiles of medications and supplies, and the enhancement of global networks for surveillance have better equipped health professionals and policymakers to respond to emerging diseases.

Likewise, technological innovations that allow instant communication through e-mail alerts, podcasts, news feeds and even “tweets” from Twitter have expedited the rapid and wide dissemination of information.

As health experts prepare and respond to the current flu outbreak, the public also has a critical role to play. Individuals should practice good hygiene by washing their hands often, covering coughs and sneezes, staying home if they are sick, and marking their calendars to get vaccinated for seasonal flu this coming winter. People are often surprised to learn that seasonal flu every year causes about 36,000 deaths in the United States and 250,000 to 300,000 worldwide. While laboratory analysis indicates the current seasonal flu vaccine does not appear likely to confer significant immunity against the 2009 H1N1 virus, annual flu immunizations will save a significant number of the 36,000 lives lost in our country to seasonal flu every year, prevent suffering, and boost productivity.

While nations are better prepared for infectious disease outbreaks than ever before as evidenced by the rapid global response to the H1N1 flu, much remains to be done. Many developing countries, where new diseases (including strains of influenza) often originate, have inadequate public health infrastructure and limited ability to respond because of a lack of sufficient surveillance capabilities, early warning systems, laboratories and a robust health work force.

Moreover, even in the United States today, vaccines are still made using inefficient techniques from the 1960s. Based on current methods, and with many manufacturing facilities located overseas, it could take many months to create a safe, effective vaccine for the H1N1 flu and years to produce enough vaccine to meet global demand.

Other issues that can impede an effective response in the United States include regulations that separate federal and state authorities, lack of sufficient surge capacity in emergency rooms and hospitals, scarce preparedness resources at the state and local level, and inadequate investments in public health infrastructure.

Furthermore, despite the documented power of public health interventions to prevent and control disease outbreaks, only 1 percent to 3 percent of U.S. health expenditures are spent on prevention.

Additionally, the 47 million Americans who lack health insurance experience difficulty accessing and receiving care. This results in missed opportunities for early diagnosis and treatment of infectious illnesses such as the flu, which can lead to poorer health outcomes and the inadvertent spread of disease.

Looking forward, it is critical to marry the public health lessons of the past with new advances from science and medicine. Vigilance against infectious diseases requires a commitment from all nations to invest a significant portion of their health budgets on disease prevention and preparedness, to strengthen both national and global public health infrastructure, and to develop coordinated strategies for disease response that crosses sectors, agencies and countries. Every business and community should be prepared.

Taking these steps will pay a dual dividend to prevent and protect against this flu outbreak as well as other disease threats that will invariably emerge in the future. One adage remains certain: Complacency is the enemy of preparedness.

Dr. Susan Blumenthal, the former U.S. assistant surgeon general, is director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress (CSPC) in Washington and chairwoman of the Global Health Program at the Meridian International Center. Bowen Jiang will attend Stanford University School of Medicine this fall. Yi-An Ko is a research and policy assistant.

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