New UN pandemic czar says survival of "world as we know it" may be at stake
TORONTO (CP)
- A flu pandemic could fundamentally alter the world as we know it, warns the public health veteran charged with co-ordinating UN planning for and response to the threat.
Inadequate - and inequitably shared - global resources and the uncertainties inherent in trying to predict the behaviour of influenza combine to create planning dilemmas that are "monster difficult," Dr. David Nabarro said in an interview describing his new job and the challenges ahead.
Progress will demand appealing "to people's recognition that we're dealing here with world survival issues - or the survival of the world as we know it," Nabarro explains.
"And therefore we just can't go on approaching it with sort of business-as-usual type approaches."
The former head of the World Health Organization's crisis operations was seconded to the UN to co-ordinate world response to both the ongoing avian influenza outbreak in Southeast Asia and preparations for a human flu pandemic.
A native of Britain, Nabarro says the decision to appoint a planning czar reflects surging political concern that the world may be facing a pandemic springing from the H5N1 avian flu strain, which is decimating poultry in Asia and has already killed at least 60 people in Thailand, Vietnam, Cambodia and Indonesia.
"Governments have realized that this is something to be worried about," he says, adding the UN must harness that concern and the resources it frees up.
"It's a rare thing, political commitment to deal with a health issue. And when you've got it, you must use it well," he insists.
"We're not going to have such an excellent window of opportunity to really start moving forward with this for long. And so we must take advantage of it now."
One of the monster dilemmas Nabarro describes relates to antiviral drugs, which may be able to blunt the blow of pandemic flu.
But there are only two drugs which, in laboratory settings, work against all possible pandemic strains, oseltamivir (sold as Tamiflu) and zanamivir (sold as Relenza). Both are expensive and made in limited quantities. And there appears to be no quick or easy way to ramp up production.
In addition, the supplies that exist - as well as most of those that will be made in the foreseeable future - are spoken for. They are either squirreled away in or destined for stockpiles held by the world's wealthy nations.
"So we're going to have very little stuff and it's already stuck away in stockpiles . . . that people will protect with their lives. And yet we're going to have to find some way to ration these things so that they are given to the folk who need them the most," Nabarro says.
That statement may reflect Nabarro's position on the pandemic learning curve. Setting priorities for who will and won't get antiviral drugs is a responsibility of governments, not the UN or the WHO.
Nabarro also made several missteps in his initial news conference at the UN on Thursday, including straying far afield from the WHO's estimate of the number of deaths a new pandemic might exact. He suggested between five million and 150 million people might die.
Less than 24 hours later the Geneva-based WHO reeled back in Nabarro's estimate, saying its own longstanding projection of two million to 7.4 million excess deaths was more likely. The official WHO estimate was calculated using a mathematical model based largely on the Hong Kong flu of 1968, the mildest pandemic of the last century.
If Nabarro is still learning the myriad intricacies of his new subject, he appears to already understand that the eventual death toll is only a portion of the damage a pandemic would wreak.
"It would really disturb many, many systems and our capacity to cope in many countries would not be that great," he says, predicting food supplies in the developed world - where diets are comprised almost exclusively of purchased (not home-grown) food - "would be particularly badly hit."
A leading advocate for pandemic preparedness, Dr. Michael Osterholm, has warned a pandemic would have a substantial and highly disruptive impact on the production and movement of goods, leading to shortages of many products critical to daily life.
He says at this point, planning for ways to keep society functioning must be the priority task.
"We basically are going to have a lot of the world's population who are going to come through this," says Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"But just as we saw, very painfully in the Gulf States (after Hurricane Katrina), a lot of people are going to suffer a great deal who are going to live.
"And we need to plan about how we're going to minimize that suffering and get those people through so they don't die from other collateral damage-related concerns. Like lack of other medications. Lack of food. Water."
Nabarro acknowledges the challenges ahead are enormous.
"My base point is: How to deal with an issue that's so impossibly difficult that we're bound to end up saying 'We didn't get it right' if there is a pandemic, or, if there isn't a pandemic where people are going to say 'You scared us all for nothing. "
- A flu pandemic could fundamentally alter the world as we know it, warns the public health veteran charged with co-ordinating UN planning for and response to the threat.
Inadequate - and inequitably shared - global resources and the uncertainties inherent in trying to predict the behaviour of influenza combine to create planning dilemmas that are "monster difficult," Dr. David Nabarro said in an interview describing his new job and the challenges ahead.
Progress will demand appealing "to people's recognition that we're dealing here with world survival issues - or the survival of the world as we know it," Nabarro explains.
"And therefore we just can't go on approaching it with sort of business-as-usual type approaches."
The former head of the World Health Organization's crisis operations was seconded to the UN to co-ordinate world response to both the ongoing avian influenza outbreak in Southeast Asia and preparations for a human flu pandemic.
A native of Britain, Nabarro says the decision to appoint a planning czar reflects surging political concern that the world may be facing a pandemic springing from the H5N1 avian flu strain, which is decimating poultry in Asia and has already killed at least 60 people in Thailand, Vietnam, Cambodia and Indonesia.
"Governments have realized that this is something to be worried about," he says, adding the UN must harness that concern and the resources it frees up.
"It's a rare thing, political commitment to deal with a health issue. And when you've got it, you must use it well," he insists.
"We're not going to have such an excellent window of opportunity to really start moving forward with this for long. And so we must take advantage of it now."
One of the monster dilemmas Nabarro describes relates to antiviral drugs, which may be able to blunt the blow of pandemic flu.
But there are only two drugs which, in laboratory settings, work against all possible pandemic strains, oseltamivir (sold as Tamiflu) and zanamivir (sold as Relenza). Both are expensive and made in limited quantities. And there appears to be no quick or easy way to ramp up production.
In addition, the supplies that exist - as well as most of those that will be made in the foreseeable future - are spoken for. They are either squirreled away in or destined for stockpiles held by the world's wealthy nations.
"So we're going to have very little stuff and it's already stuck away in stockpiles . . . that people will protect with their lives. And yet we're going to have to find some way to ration these things so that they are given to the folk who need them the most," Nabarro says.
That statement may reflect Nabarro's position on the pandemic learning curve. Setting priorities for who will and won't get antiviral drugs is a responsibility of governments, not the UN or the WHO.
Nabarro also made several missteps in his initial news conference at the UN on Thursday, including straying far afield from the WHO's estimate of the number of deaths a new pandemic might exact. He suggested between five million and 150 million people might die.
Less than 24 hours later the Geneva-based WHO reeled back in Nabarro's estimate, saying its own longstanding projection of two million to 7.4 million excess deaths was more likely. The official WHO estimate was calculated using a mathematical model based largely on the Hong Kong flu of 1968, the mildest pandemic of the last century.
If Nabarro is still learning the myriad intricacies of his new subject, he appears to already understand that the eventual death toll is only a portion of the damage a pandemic would wreak.
"It would really disturb many, many systems and our capacity to cope in many countries would not be that great," he says, predicting food supplies in the developed world - where diets are comprised almost exclusively of purchased (not home-grown) food - "would be particularly badly hit."
A leading advocate for pandemic preparedness, Dr. Michael Osterholm, has warned a pandemic would have a substantial and highly disruptive impact on the production and movement of goods, leading to shortages of many products critical to daily life.
He says at this point, planning for ways to keep society functioning must be the priority task.
"We basically are going to have a lot of the world's population who are going to come through this," says Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
"But just as we saw, very painfully in the Gulf States (after Hurricane Katrina), a lot of people are going to suffer a great deal who are going to live.
"And we need to plan about how we're going to minimize that suffering and get those people through so they don't die from other collateral damage-related concerns. Like lack of other medications. Lack of food. Water."
Nabarro acknowledges the challenges ahead are enormous.
"My base point is: How to deal with an issue that's so impossibly difficult that we're bound to end up saying 'We didn't get it right' if there is a pandemic, or, if there isn't a pandemic where people are going to say 'You scared us all for nothing. "
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