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The 1918 Global Flu Pandemic Killed 50 Million People. Could it Happen Again?

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This year is the 100th
anniversary of the year 500 million people became infected with the flu,
resulting in 50 million deaths worldwide. The 1918 Flu Pandemic devastated the
world and was exacerbated by close living conditions and massive troop
migration during World War I. The absence of effective countermeasures and limited
knowledge about disease transmission made responding to the pandemic almost
impossible. This month, NTI Communications Manager Caitlyn Collett sat down with
Beth Cameron, NTI’s Vice President of Global Biological Policy and Programs, to
discuss how the world has changed since 1918 and what should be done globally
to prevent a similar pandemic and to reduce global catastrophic biological

Caitlyn Collett: One
hundred years ago, 50 million people died in a global flu pandemic. Could a
pandemic of that magnitude happen again, and if it could, do you think it would
be as bad as it was 100 years ago?

Elizabeth Cameron:
Yes, and it’s not a question of whether a pandemic could happen, it’s really a
question of being prepared for when it will happen. If a flu pandemic like the
1918 flu were to happen again, it would travel even more quickly around the
world because we’re increasingly connected. Additionally, since we still don’t
have universal flu vaccine capabilities, in the first several months there wouldn’t
be a vaccine against the emerging outbreak.

Collett: So we’re
even more at risk in some ways than we were 100 years ago. Do you see a
particular existing disease or virus that biosecurity experts should keep an
eye on?

Cameron: I
think most experts in health security are keeping their eye on new flu viruses that
have pandemic potential as they emerge. H7N9, which emerged in 2013, is a flu
that experts are definitely keeping an eye on to track potential human-to-human

we also worry about the growing ability to create and modify viruses like flu in
a laboratory setting, which could lead to the emergence and spread of a new
virus or one developed maliciously to evade countermeasures. 

In fact, NTI just launched a new effort – the Biosecurity
Innovation and Risk Reduction Initiative – to develop novel mechanisms for
reducing biological risks associated with advances in technology.

Collett: That’s
definitely motivation to get your flu shot. What’s changed since 1918 – both things that increase global
catastrophic biological risks and those increase capacity to prevent, detect,
and respond?

Cameron: The world is increasingly
connected. Travel, trade, increase in urbanization, people living in denser
populations, the rise in technology, the ability to create and modify pathogens
… all of those things can increase global catastrophic biological risks. The
world is better prepared to deal with some disease threats – for example, we now
have capabilities to make drugs and vaccines, but it still takes much too long
make an effective vaccine or therapeutic for a disease threat – like a new
pandemic strain of flu – that the world has never seen. We also know that most
countries in the world are not prepared to prevent, detect, and respond to a
disease outbreak of this magnitude. The good news is we have new tools to
understand exactly what the gaps are through the World Health
Organization (WHO) Joint External Evaluation
. Some countries have already
conducted these evaluations, but unfortunately not all countries have taken the
time to do so. Furthermore, most that have conducted evaluations identified a
number of very large gaps in their biosecurity capabilities. Political will and
resources must be mobilized so that all countries are better prepared for pandemic

Collett: What do countries need to
do to decrease the risk of a similar pandemic?

Cameron: One thing that all countries can and should do
is undergo an external peer evaluation to identify and address their vulnerabilities.
They should prioritize specific actions that can be taken to fill those gaps
and then provide resources to keep those gaps filled over time.

month, NTI is heading to the Global Health
Security Agenda Ministerial hosed by Indonesia
to encourage more action –
especially on the components of the GHSA that focus on catastrophic risks,
including intentional misuse and accidental release.

Collett: What are some examples of
those gaps that countries could be looking for?

Cameron: I’ll give you a few
examples under the headings of “Prevent,” “Detect,” and “Respond”.  To “Prevent,” we’re focused at NTI on all
countries knowing where their especially dangerous pathogens are located and
taking steps to consolidate and prevent theft or misuse of them. As I mentioned
previously, we know that almost no country in the world is fully prepared to
accomplish this based on the external evaluations that have been conducted.
Even well-developed countries fall short in this area.  It’s also critical to improve accountability and
oversight for research and technology development that can increase risk,
including research that enhances virulence or transmissibility for pathogens
that have pandemic potential.  We’re
working to do our part to reduce those risks through NTI’s Global Biosecurity
Dialogue, Biosecurity Innovation and Risk Reduction Initiative, and Next
Generation for Biosecurity Competition.

For “Detect,”
we know that it’s really important for countries to have trained “disease
detectives.” These are people that know how to find, stop, and prevent diseases
from spreading. There are programs to train disease detectives all over the
world and some of those disease detectives then go on to stop outbreaks in
their own countries and regions.  Also, the
world is not yet prepared to detect emerging, unusual, and modified agents in
real-time – I equate this to pulling a needle out of a haystack. It’s so vital
to improve our international biosurveillance architecture so that we don’t lose
precious time during a pandemic. 

“Respond,” we know that all countries should have in place the ability to have
an emergency operations center – sort of a national hub for reporting when a
disease is detected and then be able to run an effective outbreak response. The
center should be able to be stood up quickly and it should be able to handle a
report very quickly from anywhere in its territory.
At this time, many countries don’t have an effective emergency operations
center. In addition, there is not enough global attention or investment in
developing the platforms necessary to more quickly develop, distribute, and
dispense drugs and vaccines for emerging threats. New international efforts
like the Coalition for Epidemic Preparedness Innovations (CEPI) are
helping, but additional focus and creative financing mechanisms remain crucial.

Collett: It seems like there’s still
a lot of work to do. How is NTI | bio reducing the risk of a global pandemic in
2019 and beyond?

Cameron: NTI’s biosecurity program,
NTI | bio is working on several things that are important to reducing global
catastrophic biological risks and preventing the next pandemic. I’m really
excited about NTI’s Global
Biosecurity Dialogue
. We know that most countries aren’t prepared to handle
a deliberate or accidental biological event. That’s why we’re working with countries
around the world to spur new actions to fill those biosecurity gaps worldwide. We’re
working to also elevate this issue and build political will and financing to
improve policy and capability gaps, while also addressing emerging risks.  Additionally, I’m delighted to announce a new
effort we recently launched called the Biosecurity
Innovation and Risk Reduction Initiative
. That Initiative is aimed at convening
technical experts, people largely outside of governments, to determine new
actions that can be taken to reduce the risks posed by advances in technology
that make it easier to create and modify pathogens. Scientific advancements
that allow the creation and modification of viruses like flu are outpacing the
ability of national governments to provide effective oversight. This means the
experts that create, use, and invest in new technologies should take additional
and specific steps now to reduce those risks. The group has already agreed to
pursue several novel approaches, which we hope will be piloted and eventually
adopted in the coming years.

year, NTI, in cooperation with our partners at the Economist Intelligence Unit
and the Johns Hopkins Center for Health Security, will also publish the first
Global Health Security (GHS)
. The GHS Index will be a catalog of areas for global attention and improvement
to prevent the next outbreak from becoming a pandemic.

addition, we remain focused on improving disease surveillance for emerging,
unusual, and modified agents – those more likely to be associated with a global
catastrophe but which are unexpected or deliberately created or released. Knowing
what threat you’re dealing with is the first step to saving lives.

Collett: Those all sound so
exciting! How can readers get involved with NTI | bio or just helping with this
effort in general?

Cameron: There are several ways if
you’re interested in becoming involved in pandemic preparedness of biosecurity.
NTI readers come from all over the world, so, wherever you live, you can
advocate for resources for pandemic preparedness. It’s really important that
every country takes action to prevent, detect, and respond to disease outbreaks
before they become epidemics. The US government, for example, has lots of
programs that work nationally and internationally to stop outbreaks from
becoming epidemics and that kind of continued work is really important.

can also check out our Global Health Security Index when it’s published next
year – we’re really excited to put forward the 1st global health
security index with our partners and see how people can use the data to make
the world safer.

if you’re interested in our Global Biosecurity Dialogue, there is a Next
Generation Global Health Security Network, and there’s a growing number of
people in that network that are becoming interested in biosecurity so you could
join that network and link up with biosecurity experts around the world.

you could enter our Next Generation for Biosecurity Competition which we host
annually to encourage young professional to think creatively about biosecurity
and give them an opportunity to present their ideas to health security leaders
from around the world. We will actually be announcing the 2018 competition
winners in early November.


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