12 months on... Thoughts on a pandemic

As I write this, it is exactly one year since the first reported case of H1N1 (swine flu) arising from last year’s pandemic. It seems natural therefore to take a moment and consider what happened, how we responded, what was learned and perhaps even suggest a way forward.
 
The Continuity Forum has been actively researching and assessing the potential for major disruption from a pandemic type event for many years; our interest started on reviewing what happened around the SARS outbreak which impacted in the Far East and Canada. 

One of the first questions we asked ourselves was whether or not Business Continuity Management had any role at all to play in what would be a major Global health event, potentially causing the loss of hundreds of thousands of lives, perhaps even millions internationally.  For most involved in BCM, the day to day job entails, thankfully, the management of far more mundane and less traumatising issues. Extending the scope of Business Continuity Management to the issues around a pandemic had to be considered very carefully - only if there are clear benefits (that can be easily demonstrated) should organisations such as the Continuity Forum become involved.

 

From an early stage of our thinking, there were two key aspects to BCM that we felt were of overwhelming importance to both the business and private sectors that would deliver huge benefits during a pandemic. The first was the ability to maintain core medical and other public services during a period of sustained disruption, when predictions indicated more than a third of staff may not be available to work. This personnel shortfall would cause considerable hardship on many of the vulnerable in our community, as well as potentially disrupting transport and schools.  This would create a cascade effect, impacting on business and the broader economy very quickly indeed.

 

The second aspect we felt relevant to the threat posed by a pandemic is less well defined, but refers generally to the preparations within our society, our reaction during a pandemic and recovery from its effects. The continuity forum felt that organisations of all types could be engaged and informed on a range of practical measures that would enable, as much as possible, business as usual. Very often in our communities, businesses are disengaged from the incident or response management process applied by the authorities during an event. In the context of a pandemic, this is something that poses both an especially personal threat and which in large part is invisible.   It is equally true that many planning in the public sector would benefit from understanding how decisions made would impact on the country’s economic activities - what may at first appear a simple and even straightforward situation can quickly escalate into a far greater problem if there has been insufficient consideration of the consequences across our wider interests.

 

In order to consider how well prepared the UK infrastructure may have been to cope with the threat of a pandemic in 2003, the continuity forum undertook its first research into the topic which included contributions from over 250 public bodies and 300 leading businesses.  

 

At that time, it will come as no surprise that there were only very marginal plans in existence at all, and that these were found only in 6% of organisations. We will not rake over all of the previous evidence covering the likelihood and consequences of pandemic seen during the 20th century, there is sufficient evidence of this already well established on this site and across the net, but what we found particularly interesting was that in discussing the issues with many of those responsible, there was little consideration being given to the need for agencies in government, the medical profession, infrastructure providers and businesses generally to work together to address the challenge they would be facing.

 

The primary threat faced at the time was that of a mutated bird flu, that could infect humans.  The concern was that (probably from Southeast Asia) a virulent virus would emerge that would spread over 6 to 8 months across the globe.  The virus H5N1 had emerged as the favourite candidate, and cases were regularly appearing across many countries in the Far East. The fatality rates were high, often exceeding 60%.  Leading experts across the world became increasingly concerned, and the World Health Organisation and many national governments started to develop their pandemic response plans. Over the course of the next five or six years these plans matured and gave a foundation for both a national and international response.

 

Most of this planning centred purely on health care aspects; identifying drug needs, bed space provision, the use of ventilators and a host of other details including large-scale mortuaries that may prove necessary should a pandemic strike.  The wider considerations of how the impact of a widespread pandemic would affect communities and our national infrastructures was being considered, and even planned for. This was not consistent internationally, and major differences could be seen across even close neighbouring countries. We’re pleased to report that in the UK significant effort, through the Civil Contingencies Secretariat and the Department of Health, meant that there was clear guidance available across the healthcare profession and even into many of the regional and local government bodies.

 

There was a problem though - a lot of people didn’t think, in the 21st century with all our advances in medicine and the sophistication of our society, that a pandemic was really a risk at all.  Time after time the continuity forum and others’ research showed that generally organisations had a pretty low level of capability, and that there was a clear “cloud of doubt” surrounding the whole issue. This severely impacted the ability to develop fully effective plans, but many felt what had been done was sufficient as the likelihood of there actually being a pandemic was so low.

 

In the previous century there were three pandemics, between them killing something over 50 million people at least. Now, it’s not quite as simple as saying that we can expect a pandemic every 33 years, and that 16 or 17 million people will die from it, but with the recent experience of SARS and how much smaller (and considerably more populous) the world had become, it seems rash to say the least to trivialise the risk against the opinion of leading medical thinkers. This, though, is the pretty much what we got. 

 

After the initial rush of reporting that highlighted the threat from Bird Flu which reported every case of a sick chicken, we moved into a period where doubts were expressed, cynicism over the money spent shown and questions about collusion suggested. 

 

Why... Well the pandemic had not happened... Yet.

 

Each year over the past four the continuity forum has held a special risks summit.  These events have taken specific topics that represent a particular challenge for business continuity managers or others involved in responding to significant threats. In each of these Summits, we have held discussions and provided presentations to provide updates and insights to how pandemic threat and responses were evolving. Last year we had scheduled a special pandemic summit to be held in the early summer; we announced this to Members in February and to the wider community in early March. Just a few weeks later news broke from Mexico of the flu outbreak and its potential consequences. Over the following weeks we saw a rapidly developing situation, one where suddenly people were forced to think of how a pandemic may impact in practical, not just theoretical terms. For many, their conclusions were rather sobering.

 

Many of the initial planning assumptions were proving to be wrong; the outbreak was not centred in Southeast Asia, but in Mexico and the south-western United States; the virus concerned was not H5N1,  but H1N1 instead; the time taken for the virus to spread from its original outbreak area was not months, but instead weeks. The initial reports of the severity of the virus were rather confusing, fatalities initially appeared high and more in line with expectations associated with human cases of bird flu than that of swine flu. During the course of May virus infections spread across the US and Europe far quicker than the developed models had assumed. Through June and July, case rates accelerated rapidly with the World Health Organisation declaring a formal pandemic status in early June.

 

Writing as I am a year after these events, I can report with some relief that what ensued was far from what was expected. The virus itself proved to be relatively mild, and whilst transmission rates were high and far quicker than expected, the general effects were far less severe than anticipated. There certainly was a considerable amount of press and media hype surrounding the flu outbreak, but as it became apparent that its consequences were likely to be far less severe than initially feared, the media turned its attention and criticism to those who had predicted something more traumatic for our societies.

 

Up until April 25, 2010 nearly 18,000 people had died directly from swine flu.  Across Europe this number was close to 5,000.

 

In many ways, we were lucky. We had developed some basic capabilities to sustain services across the country and these proved most useful in the West Midlands and South London, which were UK hotspots. We were lucky that the pharmaceuticals companies were able to rapidly develop vaccines, and we were lucky that they are proved to be sufficient stocks of anti-viral medication available.

 

We were also lucky in the nature of the virus, as in some ways its relative mildness enabled us to get a glimpse of exactly how prepared we really were.

 

Against a backdrop of hype and media headlines, there was another story. This one showed a very different landscape, and one that is it is important to learn from. The Continuity Forum became involved in what was, in effect, a national effort to promote business continuity to huge parts of our infrastructure that had effectively been omitted from the original planning.  In previous years, it has always been rather difficult to get business owners, directors and executives to engage in pandemic planning, but over a four or five month period of last year it became much easier. Advice and support was dispensed, encouragement given, and some of the extremes of press coverage reigned in. Practical measures were shared, discussed and developed.

 

A recurring theme that we saw time and again was that there was a clear reality gap, even in organisations that had developed plans, between the theoretical and practical capabilities of the pandemic processes created. Across both the public and private sectors, we repeatedly we saw examples of what can best be described as partial planning and a realisation that what had been developed just would not do.

 

It is not my intention to point fingers, blame or indeed shame any organisation, but rather share my thoughts on what we can take away from the experience of the past year in dealing with the potential of a pandemic.

 

Firstly, do understand that we are dealing with Nature here; she doesn’t read risk tables or clinical reports, she is not predictable to any great extent, at least in my experience, so it is important for us to understand that what we have just seen occur over the past year may well be just a “warning shot”. The original assumptions that were made for a more severe pandemic are just as valid today as they were last year, and of course next year. What we have learned though, is that we have a long way to go to connect our planning, resources, experience and knowledge into a more effective pandemic approach.

 

I fully expect in the coming months for the World Health Organisation to be criticised pretty heavily in the media for what some think was a too rapid a declaration of their level VI pandemic alert. This is more than a little harsh though; based on the rules agreed by international convention, it could be argued that actually the WHO was late in declaring a pandemic. The issue as I see it was not the declaration itself, but the inability of many of those reporting and managing this complex issue to establish a proper balance between the initial reports and the clinical factors being seen. This comment is primarily aimed at journalists, but it also applies to others who were sometimes inflaming concerns and speaking of worst-case scenarios as if they were certain.

 

A significant part of the problem in establishing a reasonable and balanced approach to pandemic planning is the sheer scope and range of the potential issues that are being addressed. At the milder end of the scale, we see fewer lives lost than in a normal flu season, yet at the most extreme level we see deaths potentially in their hundreds of millions. Those without direct responsibility may feel they are entitled to criticise those with responsibility for planning these situations, but I am sure they do not feel the weight of that responsibility at all. Getting it wrong, failing to take an emerging pandemic seriously could cost us all hugely and those responsible have to exercise extreme caution - some may argue too much caution - but this approach has complete moral integrity. Indeed, with the stakes as high as they are, a reckless or less diligent approach would be criminal in my opinion.

 

What this means to me is that as we dissect the past years experience, we are again faced with an opportunity. Some will argue for an apportionment of blame, doubtless some will rather ludicrously suggest even some kind of conspiracy. I think a less popular view may be that government, international bodies, pharmaceutical companies and business should look in the mirror and ask themselves the question, “How did we do?” 

 

Well, I’m pretty sure the enquiry will go on for a while, but I’m less sure that we’ll get an honest examination of the systems and procedures used more widely in our communities, that did seem once truly tested, to pretty quickly become strained to breaking point. But I do hope that those with the responsibility will not shy from the challenge they face. 

 

From the evidence I have seen if I was asked the question above, I think my conclusion would have to be, “Must try harder”.

 

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