Bird Flu, Swine Flu — What's Next?

The World Health Organization’s official recognition of the H1N1 virus as a pandemic this past June focused global attention on the challenge of responding to human outbreaks of zoonotic diseases, which are diseases transmissible from animals to humans. Through work in 49 countries in the past five years, Management Sciences for Health (MSH) has developed a unique multisector approach to assist countries not only in responding to pandemics but also in preventing future outbreaks. The approach is based on the understanding that whether the threat is swine flu, avian flu, or the next strain of animal flu, countries must institute practices for prevention of disease and pandemic preparedness at all levels, with emphasis on community-level activities that reduce transmission. 

MSH’s work in this area began in response to bird flu, formally known as avian influenza, which still threatens to become a human pandemic, one more severe than H1N1. Although relatively few people have contracted avian flu, more than 60 percent of those people have died. By contrast, most people who contract H1N1 recover quickly. And avian flu is still widespread in poultry and could mutate into a form highly infectious in humans. MSH has developed tools through the STOP AI project that help countries prevent a human pandemic of highly pathogenic avian influenza (HPAI) through improved detection and containment of avian flu and help them prepare to respond if an HPAI pandemic does occur. 

The tools that help countries prepare for an HPAI pandemic are adaptable for the H1N1 pandemic. They include an impact projection tool, which calculates the numbers of cases and deaths that nations, municipalities, and villages can expect across a range of pandemic severities; a municipal-level planning tool, which extends national plans to the municipal level; and infection control and outbreak response guides for all levels of activity. 

Community-level activity, which has often been overlooked in national planning, is critical to effective pandemic response because when global and national resources are overwhelmed, health care systems are overflowing, and transport of supplies is delayed or disrupted, municipalities must be the front line of action. And pandemic response is most efficient at the local level: MSH works with municipal governments to educate communities on how to identify and report signs of infection and how to prevent transmission through hand-washing, cough etiquette, voluntary isolation, ventilation, and disinfection—inexpensive, accessible, and effective practices that greatly minimize the reach of an outbreak. 

Community activity is also important in preventing potential pandemics, such as could arise from HPAI. MSH helps communities increase their capacity to detect and respond to all HPAI outbreaks within 48 hours by strengthening surveillance systems for flu-like illness, training joint human and animal health rapid-response teams, and conducting simulations of HPAI outbreaks. Through this work, MSH decreases the number of both poultry outbreaks and human cases of HPAI, which decreases the potential for an HPAI pandemic. 

Although H1N1 is still a relatively mild virus, it too could mutate into a much more severe virus and result in a second, more lethal pandemic wave, as happened with the flu pandemic of 1918, which resulted in 40 million deaths worldwide. The response to H1N1 must therefore also include basic, inexpensive activities at the community level that will reduce transmission and prevent the virus from spreading and mutating into a stronger form. Countries that institute well-coordinated multisector activities will then be fortified as much as possible against the next new flu as well.