H1N1 Influenza: A Harbinger of Things to Come by Michael T. Osterholm

H1N1 Influenza:A Harbinger of Things to Come

Michael T. Osterholm, PhD, MPHDirector, Center for Infectious Disease

Research & PolicyDirector, Minnesota Center of Excellence for Influenza

Research and SurveillanceProfessor, Division of Environmental Health Sciences,

School of Public HealthAdjunct Professor, Medical School

University of Minnesota

Human Influenza Pandemics

• Human influenza pandemics are a part of our history● 11 in the past 300 years

• Novel influenza virus subtype emerges in humans with:● little or no human immunity● transmission of the virus to humans by

humans● moderate to severe disease occurrence

Novel Influenza A (H1N1) Virus Outbreak

• Caused by a novel influenza A virus that likely made the “animal to human jump” in Mexico in the late winter/early spring of 2009

• Human-to-human transmission is well established (worldwide distribution)

• Severity of illness spectrum varies by age and risk factor

• The virus is largely sensitive to Tamiflu and Relenza

WHO Phases Of Pandemic Alert

The Critical Concepts for Pandemic Preparedness That Are Largely Absent

in Our Current Planning Efforts

• The global just-in-time economy• Critical products and services

Global Just-in-time Economy

• Globalization of the world’s economy results from the movement of manufacturing and services to developing world countries due to reduced costs for labor and natural resources and less government regulation

• Just-in-time (JIT) is an inventory strategy implemented to improve the return on investment of a business by reducing in-process inventory and its associated carrying costs. Quick communication of the consumption of old stock which triggers new stock to be ordered is key to JIT and inventory reduction. This saves warehouse space and costs. However, because stock levels are determined by historical demand, if any sudden demand rises above the historical average demand, the firm will deplete inventory faster than usual and cause customer service issues.

Critical Products and Services

• Products and services on which we depend for our immediate health and safety – Water– Food– Basic prescription drugs– Safety– Protection against the elements (heat or cold)

• These products and services are often taken for granted and it is assumed they will “always be available”

50 Largest Container Ports and Major Sea Lanes, 2004

Dubai

Tacoma

Santos

Jeddah

Durban

Seattle

Salalah

Oakland

Colombo

Melbourne

Long Beach

Charleston

Nhava Sheva

Los Angeles

New York/New Jersey

Kobe

TokyoOsaka

BusanNingbo

Nagoya

Manila

Dalian

Yanti an

Tianjin

Keelung

Yokohama

ShenzhenShanghai

Quingdao

Singapore

KaohsiungHong Kong

GuangzhouPort Kalang

Laem Chabang

Tanjung Priok

Tanjung Pelepas

LeHavre

Hamburg

Antwerp

Valencia

Rotterdam

Barcel ona

Algeciras

Felixstowe

Gioia Tauro

Bremen/BremerhafenPacific Asia Europe

Traffic 2004 (TEU)

Less than 2 million

2 to 4 million

4 to 7 million

7 to 10 million

More than 10 million

Weather-Watch Ships at Sea: Tuesday, February 12, 2008, 1:00 PM

(ships participating in a voluntary global weather watch system,of 40,000 ships at sea today)

World container ship traffic has doubled since 1997

The Integrated Freight Transportation Network

• Little planning has been done on how we will maintain critical international, national, regional or local transportation

• One million highly skilled workers on 50,000 maritime freighters that move the global supply chain: they are not on any country’s priority plan for pandemic vaccine or antivirals

• No plans for how to prioritize fuel for critical transportation needs

Transportation and SupplyChain Integrity During the Next Pandemic

A Modern World View of Pandemic Influenza

Chicken Little “We’re All Going to Die”

The Truth

“Plans are useless, but planning is invaluable.”

Sir Winston Churchill