Pandemic Influenza

Pandemics have occurred throughout history and appear to be increasing in frequency, particularly because of the increasing emergence of viral disease from animals.
Pandemic risk is driven by the combined effects of spark risk (where a pandemic is likely to arise) and spread risk (how likely it is to diffuse broadly through human populations).
Some geographic regions with high spark risk, including Central and West Africa, lag behind the rest of the globe in pandemic preparedness.
Probabilistic modeling and analytical tools such as exceedance probability (EP) curves are valuable for assessing pandemic risk and estimating the potential burden of pandemics.
Influenza is the most likely pathogen to cause a severe pandemic. EP analysis indicates that in any given year, a 1 percent probability exists of an influenza pandemic that causes nearly 6 million pneumonia and influenza deaths or more globally.

Pandemics can cause significant, widespread increases in morbidity and mortality and have disproportionately higher mortality impacts on LMICs.
Pandemics can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth.
Individual behavioral changes, such as fear-induced aversion to workplaces and other public gathering places, are a primary cause of negative shocks to economic growth during pandemics.
Some pandemic mitigation measures can cause significant social and economic disruption.
In countries with weak institutions and legacies of political instability, pandemics can increase political stresses and tensions. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens.

Pathogens with pandemic potential vary widely in the resources, capacities, and strategies required for mitigation. However, there are also common prerequisites for effective preparedness and response.
The most cost-effective strategies for increasing pandemic preparedness, especially in resource-constrained settings, consist of investing to strengthen core public health infrastructure, including water and sanitation systems; increasing situational awareness; and rapidly extinguishing sparks that could lead to pandemics.
Once a pandemic has started, a coordinated response should be implemented focusing on maintenance of situational awareness, public health messaging, reduction of transmission, and care for and treatment of the ill.
Successful contingency planning and response require surge capacity—the ability to scale up the delivery of health interventions proportionately for the severity of the event, the pathogen, and the population at risk.
For many poorly prepared countries, surge capacity likely will be delivered by foreign aid providers. This is a tenable strategy during localized outbreaks, but global surge capacity has limits that likely will be reached during a full-scale global pandemic as higher-capacity states focus on their own populations.
Risk transfer mechanisms, such as risk pooling and sovereign-level catastrophe insurance, provide a viable option for managing pandemics.

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