Pandemic Panic

Robin Cook’s assertion that an influenza pandemic as bad as, or worse than, the 1918 one is imminent is better suited for pulp fiction than a serious magazine like Foreign Policy ("Plague: A New Thriller of the Coming Pandemic," November 2009). Cook ignores or downplays key developments that reduce the likelihood that a 1918-level pandemic could occur today.

For one, the international community now has a far greater scientific understanding of influenza and the risks it can pose. Billions of dollars have been spent to enhance national preparedness plans and capabilities, activities that have been greatly facilitated by the development of a global public health system over the past 60 years. The World Health Organization’s Global Influenza Surveillance Network, including more than 130 laboratories in 99 countries, serves as a global alert mechanism for the emergence of influenza viruses with pandemic potential. Another difference is the availability of new medical countermeasures-vaccines, antiviral drugs, and antibiotics — that can reduce the morbidity and mortality of an influenza pandemic.

Cook also ignores the key role World War I played in worsening the 1918 flu’s impact. The overcrowded and unsanitary conditions in the trenches and the continuous infusion of troops from around the world to replace those who were killed, injured, or sick created an environment that favored the emergence of a highly virulent influenza strain. The war also hampered medical and public health responses to the pandemic by diverting doctors and nurses from civilian health-care systems into the military. Wartime censorship and officials who were more concerned about the public’s morale than the public’s health also hindered the response.

I don’t wish to downplay the immense toll that another influenza pandemic could wreak on humanity. But it is vital that we move the debate beyond facile analogies and worst-case scenarios. The response to pandemic influenza should be guided by sound science, realistic risk assessments, and good public policy.

Robin Cook replies:

Gregory Koblentz’s letter emphasizes the main reason I wrote my article: namely, the general lack of respect for the "lowly" influenza virus and the resultant complacency such an opinion generates. Koblentz downplays the potential threat by noting money spent on influenza monitoring and preparedness. Although that money might help us see the dark cloud coming sooner than we might have, it’s not going to have much effect on potential morbidity. It also flies in the face of what we are currently watching: how ill-prepared the world is vaccine-wise in respect to swine flu, a relatively mild influenza bug.

As far as the antiviral drugs Koblentz refers to, I think we are in a very early stage of development, with drugs that seem to moderate symptoms but do not cure. On top of that, the virus seemingly has the ability to develop resistance rather quickly. And though antibiotics are often lifesaving for secondary infections such as bacterial pneumonia, they do nothing in the initial phase of influenza A.

Koblentz does not mention that over the last 25 years or so there has been a diminution of hospital beds for cost-saving purposes across the United States and in most other industrialized countries, nor does he make reference to the low number of positive pressure respirators in our hospitals, both of which will be crucial in attempting to deal with a swine-avian worldwide plague.

I think a worst-case scenario is important to consider because it is definitely possible, with swine flu and avian flu currently coexisting in their respective animal reservoirs in the same areas of the world. I agree wholeheartedly that the appropriate response should be based on sound science and good public policy. In this case, that policy should be to produce vaccines for the world. As for myself, my isolated ski cottage is going to stay stocked with food, wine, Tamiflu, and N95 masks.