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Rapporteur: Ronald St. John
There will be pandemics at some time in the future.
Small outbreaks of infectious diseases occur daily throughout the world. Depending on the transmission potential for specific or unknown pathogens, a small cluster of infected people can rapidly become an epidemic at a local, district/provincial or national level. In the absence of a comprehensive and internationally accepted definition of what constitutes a pandemic, for purposes of this paper, a pandemic is an epidemic that is occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people with a high degree of morbidity and mortality. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127276/
Why are pandemics inevitable?
The worst kinds of pathogens – ones with the highest mortality rates and limited countermeasures – are increasing globally due to population increases, population density, more global travel, and changing migratory and environmental patterns that result in encroachment upon animal and other ecological systems. Social determinants such as poor housing, poverty, and lack of access to clinical and preventive health care can favour the transmission of communicable diseases and result in more morbidity and mortality, which can be pre-conditions to a global pandemic.
- Population density – Around 55 percent of the world’s population is thought to be living in an urban area or city, with that figure set to rise to 68 percent over the coming decades, according to the “Population Division” report. Source: UN’s Department of Economic and Social Affairs. May 17, 2018.
- Rapid Population Movement – The International Air Transport Association (IATA) expects 7.2 billion passengers to travel in 2035, a near doubling of the 3.8 billion air travelers in 2016. https://www.iata.org/pressroom/pr/Pages/2016-10-18-02.aspx
- War/Insurgency – armed conflict interrupts health services, both clinical and preventive.
- Emergence of New/novel pathogen – there is on-going mutation of known pathogen or exposure to novel pathogen, e.g., by human encroachment on deforested land
- Cultural resistance – the risks of transmission and poor disease outcomes may be amplified by unfavourable behaviours by affected populations, with reluctance to adopt prevention and risk mitigation strategies (e.g., cultural resistance to vaccination or “western” medicine).
- Fear and resistance to intrusion of outsiders who arrive to stop an epidemic.
- Governments may wish to cover-up or minimize an incipient epidemic due to concern for economic impacts (e.g., a negative impact on tourism or foreign investment).
Stopping a pandemic requires early detection of an outbreak of an infectious disease before it reaches epidemic levels. To mitigate the transition from a localized outbreak to a large-scale epidemic to a world-wide pandemic, an efficient and effective response to contain the disease outbreak at the local level is required. To be able to respond quickly, early detection by an astute clinician or health care worker of a cluster of an unusual illness is essential. Some obstacles limiting early detection include lack of primary care capacities; lack of trained personnel; weak surveillance systems; no rapid communication linkage for remote areas; limited laboratory capacity for pathogen identification or referral of specimens to more sophisticated laboratory. Obstacles to effective containment once an emerging communicable diseases is detected include a lack of well-resourced, trained and coordinated emergency preparedness and rapid response infrastructure.
Addressing the Challenges
It is beyond the scope of this paper to address and propose solutions to the many challenges noted in the preceding paragraph. Efficient and effective management of an outbreak, epidemic or pandemic is essential to mitigate the effects as much as possible. There are four basic resources that must be organized and managed to respond to an emergency: people (technical skills), logistics (appropriate intervention tools), money (adequate financing) and time.
While there are many possible approaches for effective management of the four basic resources, the Incident Management System [IMS] is one recognized best practice for emergency management and successful resolution of the emergency. An IMS saves lives. The United States has one such system, which was initially developed by firefighters during the 1970s. After Hurricane Katrina revealed the government’s serious lack of preparedness, the current system was developed: the “National Incident Management System,” which is meant to respond to all types of disasters and emergencies, including wildfires, floods, riots, the spilling of hazardous materials, hurricanes, tornadoes, earthquakes, tsunamis, collisions of trains, planes, and other traffic, terrorist attacks, and of course health crises such as pandemics. Not all other countries have a similar nation-wide IMS, though these are necessary to allocate resources efficiently, manage information, and facilitate cooperation among the agencies that can respond to disasters.
IMS systems are flexible and scalable; they can be used for small, day-to-day incidents but expand whenever necessary, from local teams to those at the state and national levels. They cover five missions: Prevention, Protection, Mitigation, Response, and Recovery. They train and certify personnel and maintain inventories of technological and medical material.
The Incident Command System [ICS] is the basis of the IMS. The ICS provides command, control, and coordination of a response. It includes the principles to coordinate the efforts of individual agencies for the common goal of stabilizing the incident and protecting life, property, and the environment.ICS uses principles that have been proven to improve efficiency and effectiveness during health emergencies. Every incident has an Incident Commander. During a small crisis, he or she may handle the situation alone, but if it becomes more complex, the Incident Commander will appoint additional team members to roles that are already well-defined.
Much of the value of IMS comes from its capacity to expand an organization rapidly, while retaining clarity about the obligations of all the personnel. For example, because a disaster requires the collaboration of teams from multiple jurisdictions, specialties, and disciplines, everyone is taught a common set of terms and advised to speak in plain language and avoid acronyms.The command system is separate from the agency’s usual hierarchy, and the personnel are intentionally called by quite different titles from the usual staff. Every role is accountable to only one other person, and no one should have more than about five subordinates.For a detailed description of the IMS, please consult: http://www.who.int/health-cluster/about/structure/IMS_structure.pdf
IMS and WHO Member States
Given that the use of the IMS for responding to health emergencies is now standard policy within the World Health Organization (WHO), it is imperative that all Member States establish policies to support on-going emergency planning and preparation. Member states should consider adapting and using the IMS as an approach for responding to local emergencies to prevent them from becoming larger epidemics and pandemics. It is an accepted role for the WHO to provide technical assistance to Member States and WHO’s technical assistance should include the introduction and adaptation of the IMS in all member states.