It will be our next global pandemic | Science

If a bookmaker were to estimate the odds that an apocalyptic event is most likely to eliminate the human race, a pandemic would be more likely than any nuclear attack, any robot uplift or any asteroid. Epidemiologists and health professionals around the world agree that, despite the efforts of governments and agencies to prepare for the worst, the world is not prepared for a global epidemic of contagious disease deadly. In February 2017, Bill Gates warned that unless drastic measures are taken quickly, an airborne pathogen that moves quickly "could kill more than 30 million people in less than 30 years. ;a year".

Of all the emerging threats of disease, an influenza epidemic is the most worrisome, mainly because of the speed with which it can spread and the virulence with which it can kill. Recent research has proven beyond a reasonable doubt that the 1918 Spanish flu, which killed between 50 and 100 million people and was the deadliest in human history, was caused by birds. Today, the new avian influenza strains have unprecedented mortality rates, such as the H5N1 strain that appeared in Hong Kong in 1997, and are appearing more regularly than ever before.

The main new threat is H7N9, an influenza strain initially found in a Chinese hen that Centers for Disease Control and Prevention (CDC) currently considers most likely to cause a deadly pandemic in case of mute and be transmitted by air. The virus was first detected in a human victim in 2013. Figures released last month indicate that the most recent H7N9 outbreak in October 2016 killed more people in China than the previous four influenza outbreaks. bird. produces a variant less sensitive to vaccines.

Although the main suspect is clearly identified, there is a problem in preparing for the treatment of H7N9 on a global scale. As Dr. Keiji Fukuda, former head of epidemiology at the CDC, says, humanity has "dodged a bullet" in the face of pandemics in recent years. Thanks to a combination of preparedness, quick action and luck, neither SARS in 2002, nor the swine flu in 2009, nor the Ebola virus in 2014 ended up being complete pandemics. We have few benchmarks for providing clues or models about how a world could be at the heart of a deadly epidemic and how we could, within our connected society, prepare for the future. worst.

Irwin Redlener is director of the National Disaster Preparedness Center at Columbia University. With his team, he has spent the last 14 years studying disasters caused by climate change, terrorism or sick birds. Using data and computer models, they explored the different scenarios that may arise after the emergence of a new lethal and virulent strain of bird flu. The results of these highly prophetic models are read as a zombie fiction.

Like the trenches and hospices in canvas of the 1918 Spanish flu outbreak, an aircraft is used as an incubator for a virus and infects passengers who, after disembarking and dispersing, effectively distribute the virus. As Ed Yong recently declared in L & # 39; Atlanticwhen it comes to spreading diseases, "crossing the sky in countless planes, we turn small fires into big global fires".

The airport closure comes too late to stop the spread of the pandemic. In today's connected world, a disease can be transported from a rural village to any major city in 36 hours, faster than a government could apply. a policy of prohibition of theft. The first cases are reported in Europe and shortly thereafter in the United States. During these first few weeks, misinformation is plentiful, as during the Ebola outbreak in 2014, when false reports spread the spread of the virus. In cable news channels, some experts suggest that the outbreak is the result of irresponsible genetic research in China. Others suggest that this is part of a terrorist plot.

While the CDC issues recommendations every day (stay home, shut your mouth if you cough), President Trump responds with extravagant rhetoric. This time, however, rhetoric leads to even stronger measures. US borders with Canada and Mexico have been closed, martial law declared and Americans sick quarantined (and placed in detention camps as it turns out they have violated the curfew). Based on public opinion about these epidemic conspiracies, Trump begins a trade war with China.

As the pandemic continues, we begin to see the inability of countries to respond. Hospitals, medical staff and drugs are tested using unprecedented methods. "The United States has done little to improve its ability to medically treat people affected by a pandemic," said Redlener. "We do not have enough antivirals, we do not have enough mechanical ventilators, it is very risky to know if we will take care of people who need to be hospitalized in case of a pandemic and how we would simply feel overwhelmed by the patients. "

It is here that reveals the great complexity of a pandemic scenario: think about the ethical issues that will arise at the heart of a disaster. What happens, for example, when hospitals lack mechanical fans? Can a doctor tell a parent that since their child's chances of survival are lower than those of a young adult, will the respirator be confiscated? "There is simply no guidance on how to deal with the huge shortages we will find in the health system in the event of a pandemic," Redlener said.

Regardless of whether these hypothetical situations are plausible or exaggerated, Redlener believes that the consequences of a pandemic are beyond the current considerations of many disaster planners. The models can show how quickly a virus can travel the world, but they do not explain in detail the consequences of the collapse of society in the midst of a deadly pandemic. The whole world, says Redlener, is "completely unprepared".

Redlener and his colleagues are not the only ones to draw these apocalyptic conclusions. In 2011, the World Health Organization presented a global initiative called Pandemic Influenza Preparedness (PGP), a program designed to stop or delay the onset of pandemic influenza. influenza and avoid the type of global disaster described above.

As part of the PGP, a network of more than 150 laboratories worldwide, known as the Global Influenza Surveillance and Response System, controls influenza outbreaks, examines blood samples from newly diagnosed patients. infected and monitors pharmacy sales of drugs used. treat the symptoms of the disease. This research reports on the creation of the seasonal influenza vaccine, new versions of which are developed twice a year, and serves as a basis for the World Health Organization's advice to governments to help them prepare for pandemic.

Many countries have developed their own specific plans. The United Kingdom, for example, has created the identifiable bird disease control strategy, which sets out the procedures to be followed in the event of an outbreak of a disease that could turn into a pandemic on the island. However, the World Health Organization is striving to better coordinate efforts and strategies of countries based on the experience of the 1918 Spanish flu: you can not fight a pandemic by treating each patient individually. They believe that a modern pandemic can only be conquered by treating the world in an interconnected way and not by nations separately.

"A pandemic is a global event," said Sylvie Briand, director of the Contagion Risk Management Department under the emergency program recently created by the World Health Organization. "It must be managed nationally and internationally, a disease has no borders." Pardis Sabeti, one of the leading researchers on infectious diseases at Harvard University, said the same thing L & # 39; Atlantic at the beginning of the year: "Viruses are a global threat to humanity, they are a common problem, they are somehow the only threat that unites."

Nevertheless, the type of flu threat is different depending on the country of origin. "The problem is that up to now, the flu was perceived as a disease of rich and temperate countries," said Briand. "This is not the case, the flu is present everywhere, but in many tropical countries, where the mortality rate due to respiratory diseases is high, most of the time, they do not even know that this is due has the flu."

In 2014, the Obama administration pledged $ 1 million to a newly created association known as the Global Health Security Agenda. The program aims to help prevent the spread of deadly epidemics by strengthening basic public health systems in less developed countries whose goal is to combat epidemics. For example, he provided epidemiology training to health professionals in Mali and helped governments develop emergency plans to deal with an avian influenza epidemic. More than 30 countries have participated in assessments to determine their ability to detect and prevent epidemics (results, even negative ones, are made public). Progress, however, is "still fragile" and "requires ongoing funding," according to an internal analysis by the CDC.

Currently, efforts to improve international collaboration are encouraging. However, we can not predict how countries would react if they were asked for mutual support in the midst of a hypothetical pandemic.

"When, for example, there is a big coastal storm in the northeastern United States or something similar to Katrina in the Gulf region, help usually comes from other cities and regions. of the disaster area, "says Redlener. In other words, those who are not affected normally support those who are. "But a pandemic threatens everyone, no matter where, Boston can not expect to receive other fans from New York, Washington or Chicago, as these cities will need everything they have . " Resources are limited and, at every level, from neighborhood to city and nation, the human instinct to take care of oneself is inevitably activated.

"It takes a lot of work to ensure collaboration in a crisis," said Briand. "The tendency is for each country to accumulate vaccines and run its own preparedness plan, but we need to add a level of supranational readiness to ensure that the first hit does not monopolize all resources – a global event – the richest country. will have access to vaccines and not the rest. "

Part of the problem for anyone involved in this difficult situation is that it is very difficult to anticipate problems. Vaccination is by far the most effective way to defend against a pandemic. However, as Redlener says, the wheels of capitalism go against the research, development, manufacture and storage of vaccines (some of which expire in 12 months). "In a private manufacturing, development and research system," he says, "pharmaceutical companies may not have the capacity or the willingness to invest large sums of money. money in something that will not happen and can not be expected to come back. "

At the same time, World Health Organization laboratories are continuing their efforts to speed up the drug preparation process in the hope of reducing the time to develop a new vaccine for at least six to four months. The speed at which flu can be transmitted is fundamental: the 1918 flu, in particular, killed more people in 24 weeks than AIDS in 24 years.

Today, the World Health Organization has secured 500 million doses of general influenza vaccines, but these may not be effective against a new strain of avian influenza. According to Mr. Briand, these reserves will allow the world to face the first wave of a pandemic. But Redlener, on the contrary, remains firm and says that the reserves will be quite inadequate. "We do not have enough vaccines to stop a major pandemic influenza and less a deadly pandemic extremely contagious."

During the 2014 Ebola outbreak, Trump tweeted that US aid workers should not return to North America ("GO OUT OF HERE!" wrote), so that they do not spread the disease. This is a way of thinking that suggests that Trump would be reluctant to send American help to help cope with epidemics in other countries. "Fragmenting our countries only increases the threat posed by a pandemic," Redlener said.

For the World Health Organization, the need to continue international collaboration is crucial not only in the case of a pandemic, but also during the exercises and building defenses for such an event . "The preparation requires a continuous effort," explains Briand. "The mechanisms are strong only if you use them frequently, people change, the guidelines change, so you have to constantly do simulation exercises to make sure that the plan is up to date and really ready for the unexpected."

When can we expect the appearance of another bird flu? All the experts interviewed for these articles said that not only was a major pandemic likely to appear, but that it was dangerously imminent.

The World Health Organization is currently monitoring several avian influenza viruses which, according to Briand, "have pandemic potential". Among them is the recently discovered H10N8, a disease of unknown origin that killed its first human victim in China four years ago. Since then, the CDC has monitored more than 300 outbreaks in 160 countries and monitored 37 dangerous pathogens in the past year.

Clearly we are not prepared. How would we be? You can not do a simulation of the company's collapse. Health systems around the world are already struggling to meet the needs of our populations in terms of growth and aging, as well as to address those that may arise after a pandemic disaster. Meanwhile, xenophobia and other nationalistic and introspective positions run counter to international politics and the necessary collaboration to prevent a local epidemic from becoming a pandemic.

In his January article, Bill Gates wrote that he was optimistic and that with a little effort, humanity could always avoid the worst. "In a decade we will be much better prepared for a deadly epidemic if we are willing to devote a fraction of what we spend to defense budgets and new weapons systems in anticipation of the epidemic. "

But as Redlener says, this will is "still to manifest". Until that happens, we will continue to live under the threatening shadow of flying birds in the gray sky.