Pandemic preparedness

Coming, ready or not

Despite progress, the world is still unprepared for a new pandemic disease

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Connect The Dots

We know the power of germs in causing epidemics and plagues.

I wanted to give a plug to the Single Greatest Innovation in Public Health that cost nothing.
And it prevents bacterial, viral, tuberculosis, parasites, and worms. It can impact first world cities or the poorest nations on earth with immediate long lasting benefits.
And it is overlooked and under appreciated by everyone, everyday.


It is simple HANDWASHING.
It is more important than the invention of vaccines or antibiotics. Hands are how we interact with our world. And the primary vector for transmission of infectious disease. We touch our face, nose or mouth twice a minute.

Eliminating these disease vectors was one of the historical purposes of the Bible and Koran: strange prescriptions about using the right hand to eat and the left hand to--er--wipe your bottom. Avoiding pork. Putting menstruating women in red tents and avoiding them for 10 days. Prescriptions on how to prepare halal meat. Separating vegetables, dairy and meats on separate dishes and utensils.
It was just a way of telling nomadic desert dwellers to WASH YOUR HANDS after handling live stock and blood.

We have a disproportional sense of germs and danger.
Toilet seats have less bacteria than computer keyboards.
The computer mouse in a library computer has more bacteria than real mice.
The bathroom floor has less germs than the paper currency in your wallet.
Flesh eating bacteria--a variant of Staph. Aureus and Streptococcus--is found in 20% of normal human nasal sinuses. And it probably is on the ATM keypad you just used.

Simple Handwashing may save the world by preventing rampant epidemics and other plagues.
And permitted congregation of large populations in cities.

Very few Scientific Advancements have benefited Mankind survival as much as Hand Washing-- more of an impact than antibiotics, vaccines, or the Industrial Revolution.
And washing made civilization possible.
And hand washing can save the world from Apocalyptic Plagues.
And keep our food safe.
And keep our children healthy.
Germs are also useful.
Bacteria/Yeasts has played a historic role in developing civilization.
Bread, Beer, Mead and Wine are all the gift of one single microscopic species that is far more important to civilization than gold.

Our bodies exists as a balance of useful and harmful bacteria. Health is cultivating the good bacteria. And eliminating the bad bacteria. And with the importance of any bacterial pathogen, we all need to pay more attention to Hand Washing.

Al Gore wishes he could say he invented hand washing.
Lady MacBeth went a little far, but she was right.

Save humankind by simply washing your hands.
Solutions, in the end, can be simple.


Consider that modern medicine, antibiotics in particular, has kept many of us alive and procreating who would otherwise have died. That preservation and propagation of less healthy people may increase the impact of any major outbreak of disease.
So an apparent blessing may become a curse.


Contagion spreads exponentially. One infects 4 , four infect 16 etc. So what you want is to control contagion EARLY AT ITS SOURCE.

For some reason , none of your recommendations for extra effort or spending calls for early control so as to PREVENT a pandemic from developing.

All pandemic pathogens originated in animals so far. Influenza, plague, AIDS, etc. If a virus is not allowed to spread in cattle, it will not cause a pandemic in people.

If the virus is not allowed to spread in chickens, it will not jump the species barrier to infect people.

Arresting contagion at the source in man-kept livestock is far cheaper and more humane than coping with a pandemic by trying to prevent additional human infections through vaccines and such.

Lack of government accountability allowed AIDS to spread undetected for three decades and undiagnosed for ten more years. Public health authorities should have stopped it much earlier. They did not know about it! Isn't that their job to know and act, a core public function? Everyone knows that diseases know no borders, so taxpayers should expect results, not disease control only up to the border.

The consequences of the dearth of veterinarians in developing countries will hit us with a vengeance. Without vets you cannot diagnose disease and institute contagion control in livestock populations.

If you do not stop contagion at the source in livestock, the pathogens may jump to people and get on planes to all corners of the world.

So you should have said that money should be spent on preventing pandemics from starting at all. The exponential spread makes the cost-Benefit relation strongly in favor of early control of disease.

If only about 50% of the amounts for antiviral stockpiles of unknown utility were spent on public health services in developing countries! If they have no means to do their job, they will not find and stop contagion and render the antiviral stockpiles far less necessary.


Two excellent contributions below both, like me, expressing surprise that this article is predicated on pharmaceutical product 'solutions'! Vaccines and Anti-virals. This is way off beam - why?
Vaccines follow the virus - a pandemic virus is new - that's why it is so dangerous because no-one has any antibodies to it!
It takes at least six months to produce a minimally tested new vaccine (and mock-up H7 vaccines were spectacularly useless in trials a few years ago).
Many new viruses are also not affected by anti-virals
Anyway the collapse of delivery/supply infrastructure in a pandemic will not permit distribution and use of these drugs - look at the waste of money spent on Tamiflu in the Swine Flu Pandemic 2009!
So what should governments be doing? Preparedness planning involving everyone! The collapse of our supply network will be more dangerous than a virus that probably kills fewer than 6% of those who contract it - people will die from starvation (eg old people left without care), from lack of heart meds and dialysis, childbirth, waterborne diseases such as cholera and violence (it takes little imagination to guess what paedophiles will do knowing the police are unable to come after them...
Preparedness planning is a big, ongoing task but it is positive and fun - schoolchildren do it in the USA. Post pandemic the people who feel betrayed by their governments will be so angry they will be anarchic and those countries will be plunged into a dystopian post pandemic period and unable to play a part in the new world order!

The handwashing advice is v important BUT is only potent in the context of understanding how viruses operate - so education should be a priority. The only real weapon we humans have against a new virus is our intelligence. They actually use us to infect ourselves and each other - we are always touching things and lifting virus up to our faces - if you watch everyone touched their face surprisingly often effectively placing the virus at the 'front door'. Understanding this tells us what not to do and when handwashing is effective. The much derided face mask is probably most effective in preventing us rubbing our noses or popping a contemplative finger in our mouths! We need non-perishable food - cheap and plentiful now - and a list of other essentials - I would mention baby milk powder (as it is sealed and Mum may get ill or not have milk)multivitamin pills to make up for an unbalanced diet, radio to hear news, and a year's supply of essential medications (the NHS needs to get to grips with this otherwise people will be left facing certain death!).
In the UK civil service mandarins have managed to persuade successive elected governments to allow them to continue doing all Emergency Planning 'in-house' - not involving the public on the grounds that we might 'panic'. We may not have time to rectify this sorry state of affairs but if we duck this bullet - as we seem to have done with Saudi SARS last year - let's hope we have a leader who will champion this so that our country will emerge safely, with minimal loss of life into a new world!
ASAP The PM should ignore the feeble WHO advice not to screen travellers (???) and install Body Temperature Scanners for everyone entering the country - on UK carriers at embarkation too. Virus Shedders must be identified and picked up and every plane ticket must have quarantine consent in the terms and conditions of carriage.
A TV campaign to make people virus aware - the recent BBC programme with Michael Mosley and the infant school children was excellent and Basic Food Hygiene training is also relevant - every schoolchild should do this as well as First Aid.!
Our most effective weapons against whichever virus it turns out to be are our brains and preparedness and the stakes are high.


If a pandemic will only kill tens of millions, then unless we think the odds of a pandemic are very high, it would probably be better to spend our money fighting malaria, which is highly preventable and kills ~650,000 annually as it is.

If you assume the costs per death averted are the same either way, then focusing on a pandemic would only make sense if you expected one in the next 15 years or so. But malaria is known to be preventable with excellent cost-effectiveness, so the real threshold is probably much higher.


While the funds being poured into research are laudable, we must use all our tools, not just the newest.

Despite our advances, by far the most effective public health response to SARS was also the oldest: quarantine.

New drugs and forecasting are all well and good, but quarantine remains the most effective response against a broad disease spectrum for at least the next few years, perhaps decades.

We are woefully unprepared for a major quarantine, yet we will likely need it even more than ever. Given the public health, legal and societal impacts of a mandatory quarantine, this is more a political issue than medical.

We should be asking our governments to be at least as prepared as our scientists are trying to be.

Alex DeLarge

"poor countries, in particular, need reliable access to vaccines"

Having access to vacines is the easy part, if by that you mean getting them to the authorities in-country. But vacinating, for example, 1.4 billion Indians is the hard part.

Health workers must fan out with the vacine to every village and vacinate every individual, and the vacinators must themselves stay healthy. And hope the vacine is effective.

If this disease is human-transmissable and has a 20% fatality rate (as has been the case so far), then I'm sorry, but we should prepare for the worst.

There is a confirmed case in Taiwan who claims he had no contact with live chickens or raw eggs, which means it probably IS human-transmissable:

ondatra in reply to vectro

I think you are missing crucial differences. Not all diseases are the same. Malaria persists over many years. Influenza pandemic would sweep through the world in less than two years. Other pandemics would be in between.

Suppose the next bad influenza pandemic kills only 1% of the population. That's 70 million.

Suppose the probability of such a pandemic is just 1% in any year - that is, it is very unlikely to happen, 99:1.

The expected annual death toll is 700,000, every year (1% times 1% times 7 billion).

Somewhat more than malaria.

Except, in addition, the economic impact of a pandemic would be far, far greater.

Malaria depresses incomes of very low-income communities. But a bad flu pandemic would quickly undo functioning of security, food supplies, transport, financial systems, health care and other sectors everywhere, in all countries, rich and poor. Poor people would suffer the most.

vectro in reply to ondatra

Hi Ondatra,

Thanks for the response. However, I believe there are some problems with this analysis.

Using your own figures, of an expected annual death toll from pandemics of 700,000, yields a number very comparable to malaria (as I noted, malaria is thought to kill around 650,000 each year). So the human impact in terms of deaths is equivalent. However, we know that malaria can be eliminated cheaply and effectively, so even if the death toll is comparable, malaria would still come out on top. For the same cost as the actions proposed in this article to reduce (not eliminate) the impact of a pandemic, you could nearly eliminate malaria deaths.

Also, it's not clear to me why you think the impact of the death of 1% of the human population would undo civilization. During the regular influenza season, a much higher percentage of people are unable to work, but society continues to function just fine.

J. Kemp

Political correctness is already slowly strangling the Western world, and might, through a pandemic, ultimately be its end.

One worries that this PC force, which springs from wealth and abundance, may also prevent the swift use of the most effective anti-pandemic tool already cited by posters here: quarantine.

It would be sad, but not surprising, if the Western world's obsession with political correctness brought about the loss of many millions of its people. At least the survivors might be cured of their chronic plague of political correctness by that experience.


Global vaccine propaganda is certainly rising - again. In 2009 the WHO changed the definition of pandemic from what you would expect and what it should be - high mortality rates in many nations - to a few people being ill in six countries, a ridiculous definition. The real progress being made is the rise in awareness of the nature and extent of vaccine damage, the consistent statistical manipulations of, and outright disinformation released by, our so-called public health entities, and the terribly bloated fear of disease as portrayed by the vaccine industry.

You can't eliminate risk from life, but the risk of damage from vaccines far outweighs the risk of damage from disease.

guest-leilnwn in reply to Alex DeLarge

In 1918 one doctor reportedly lost not a patient to the pandemic Spanish Flu, while in clinics all around him people were dying. He would immediately put new patients on a fast, keep them well hydrated, and administer an enema daily, and they would begin recovering within a few days. Homeopathic hospitals reportedly had a very low percentage of mortality, compared to allopathic.

Closer to home, mid-twentieth century one physician, Dr. Fred Klenner, was recovering sufferers from paralytic polio by administering massive injections of vitamin C. There's an excellent video available of a New Zealand man who in 2010 became so violently ill from swine flu, hospital staff had urged the family to take him off life support, for there was no hope. They managed to have him administered massive injections of vitamin C, and he began recovering within hours.

Part of the manipulation of information I mentioned in the previous comment is a litany of suppression of information. Dr. Klenner announced his success in treating polio victims with C at an AMA conference, but no one followed up. No other doctors questioned him about it, and no newspaper alerted the public of the success of the treatment.

So I would ask what treatments were administered to the sufferers from the bubonic plague; what were their living conditions - the quality of the water and the diet; what kept those who were exposed to the plague yet survived, alive. One thing's for sure - injecting neurotoxins into them as children - vaccines - would have compounded the problem, not alleviated it.

free wheelie

In times of penny-pinching, governments would be more prepared if the global pandemic scare was raised more tactfully, first of all by the WHO. There are 6 phases in its pandemic alert that can be played with the right mix of caution and urgency.
The experience with H1N1 left many with the impression that the vaccine industry was in cahoots with this authoritative and supposedly reliable organization (the WHO itself seems to have some misgivings after that, even on the definition of flu, as its site suggests:
Big pharma, which derived an increasing share of overall profits from vaccines until FY 2010, is giving a welcome contribution to the new campaign for pandemic preparedness. This is a first step and should be stepped up in order to provide the best evidence that there are no hidden goals behind it.



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