When David Nabarro of the United Nations talks, governments should listen. He's the number-one point man on international efforts to deal with avian influenza and what could become a human influenza pandemic. "The consequences in terms of human life when the pandemic does start are going to be extraordinary and very damaging," he told the BBC. "The range of deaths could be any-thing between five million and 150 million."
No sooner had Dr. Nabarro mouthed those words than a World Health Organization public affairs official, worried about "scaremongering," urged caution. "We're not going to know how lethal the next pandemic is going to be until the pandemic begins," said Dick Thompson. That's certainly true, but Dr. Nabarro's intention was not to create panic. Until his recent UN appointment, he was one of the WHO's most senior public health experts. Given other scientific projections, his estimate is not wildly out of line, and if it has the effect of galvanizing more governments into concerted action to prepare for such a killer flu outbreak, so much the better. The goal is not to avoid being wrong but how best to get ready.
It's difficult to say how prepared Canada is, because the federal and provincial governments are publicly talking so little about the groundwork they are laying. The inability of Ontario's health and emergency-management systems to cope with a mass fatal contagion was exposed during the SARS outbreak in spring, 2003. The public has the right to ask what governments across the country have been doing since then to prepare for a flu pandemic, which has the potential to cause much more illness, death and economic and social disruption than SARS.
Since 2003, the federal government has established the Public Health Agency and appointed a chief public health officer, in large part to respond to public health emergencies and infectious-disease outbreaks. The agency has a generic emergency-management structure in place and has developed a specific pandemic influenza plan. It is trying to secure a supply of avian-flu vaccine and, until one is developed and produced, will have on hand as many as 16 million doses of anti-viral medicine to treat priority cases identified by an advisory committee. These cases would include those hospitalizedfor flu. It is putting together a "real-time" alert system for serious respiratory illnesses. It is establishing a hospital-based surveillance system to detect cases and clusters of infections and to prevent their spread.
This is all well and good, but far less is known about whether provinces are working well together and what is happening at the local level. Are municipalities gearing up for possible economic and social upheaval in the event of an outbreak? How would large-scale quarantines be handled in, say, Halifax?
On the international front, Canada is among the leaders in co-ordinating global preparation. Later this month, it will play host to a ministerial meeting to discuss an array of policy issues to support the work of a new International Partnership on Avian and Pandemic Influenza, a U.S. initiative. Dr. Nabarro says the work over the next few months will make the difference "whether the next pandemic leads us in the direction of 150 [million deaths] or in the direction of five [million]. So our effectiveness will be directly measured in lives saved and the consequences for the world."
Discussing this with the public would not be scare-mongering. It would beprudent.