Experts warn much to do before next flu pandemic
Scenario like 1918 Spanish flu could cause an estimated 105 million deaths
One hundred years after the deadly Spanish flu killed tens of millions of people around the world, the conditions are ripe for another severe flu pandemic, say experts, and Canada is not as ready as it needs to be.
Canada is not alone. At the biannual Canadian Immunization Conference, being held in Ottawa this week, delegates heard from a leading international expert who warned that more work needs to be done globally before the next severe pandemic.
A focus of the conference was on the Spanish influenza pandemic that killed between 50 million and 100 million people around the world, as many as 50,000 in Canada alone. Canada and other countries are preparing for the next one.
“Are we ready in 2018?” asked Nancy Cox after giving a brief history of the 1918 pandemic. “The answer is we are better off than we were before 2009 but not where we need to be and vaccine readiness has a long way to go.” Cox headed the U.S. Centres for Disease Control influenza branch and led a World Health Organization centre on influenza control and surveillance.
Despite medical advances since 1918, neither vaccines nor anti-viral treatments are as effective as they should be and there are new challenges, including disseminating accurate information in the age of social media, conference delegates were told.
Meanwhile, the goal of developing a universal flu vaccine, to replace seasonal vaccines created annually, remains elusive, and seasonal vaccines are often not very effective.
And, while there has been progress, gaps remain in global surveillance and in availability of treatments. During a severe pandemic, said Cox, there would not be enough ventilators or reusable respiratory protective devices to support and protect people around the world.
“The 1918 pandemic was exceptionally severe. A similar pandemic today would cause tremendous illness, death and economic cost.”
Cox said estimates range from 105 million to 110 million potential deaths.
“That is a very sobering number.”
Pandemic influenza is a global outbreak that occurs when a new flu virus for which humans have little or no immunity emerges and spreads easily.
Canadian officials have been working to prepare the country for the next pandemic, building on lessons learned during the 2009 H1N1 pandemic, said Bonnie Henry, British Columbia’s provincial health officer, who chairs the Canadian pandemic influenza task group.
While progress has been made, gaps remain, she said. And Henry warned that even a pandemic with relatively mild to moderate impact can overwhelm services.
The 2009 pandemic, for example, was considered to be relatively mild compared with other pandemics. But it severely stressed British Columbia’s health system just months before the Winter Olympics were to be held in Vancouver.
“People think of 2009 as being very mild, but if the Olympics had been planned for the fall of 2009, we would have had to cancel because we did not have ICU (intensive care) beds.”
Canada’s pandemic influenza task group aims to minimize serious illness and societal disruptions, to provide a safe and effective vaccine for all Canadians and to monitor the safety and effectiveness of the vaccine, Henry said.
During the 2009, there were logistical problems getting vaccines to all parts of the country quickly.
“Many of us may remember the challenges of not knowing when vaccines would come,” she said. “A lot of things happened that we were not prepared for that led to inconsistencies.”
Canada now has a contract for two doses of vaccine for every Canadian in the event of a pandemic, along with a backup contract, she said.
Planning is underway to do a better job of getting vaccine to remote communities and prioritize who gets vaccinated first.
Among areas where more work is needed are effective electronic systems to manage vaccine inventory and track vaccine uptake, among other things, Henry said.
“We are still not where we need to be.”
While Henry says there is work to be done, Canada is likely in better shape than many countries.
Most countries lack robust pandemic plans, said Cox, and very few countries hold emergency response exercises to ensure they are ready.
We are better off than we were before 2009 but not where we need to be.