Intended for healthcare professionals


Calibrated response to emerging infections

BMJ 2009; 339 doi: (Published 03 September 2009) Cite this as: BMJ 2009;339:b3471
  1. Peter Doshi, doctoral student
  1. 1Program in History, Anthropology, and Science, Technology and Society, E51-070, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
  1. pnd{at}
  • Accepted 22 August 2009

WHO has revised its definition of pandemic flu in response to current experience with A/H1N1. Peter Doshi argues that our plans for pandemics need to take into account more than the worst case scenarios

The current flu pandemic raises a public health policy question that could have been asked after the emergence of severe acute respiratory syndrome (SARS): what is the proper response to clinically mild or epidemiologically limited (small number) outbreaks caused by new viruses? Over the past four years, pandemic preparations have focused on responding to worst case scenarios. As a result, officials responded to the H1N1 outbreak as an unfolding disaster. Measures were taken that in hindsight may be seen as alarmist, overly restrictive, or even unjustified. Assumptions about the nature of emerging infections along with advanced laboratory surveillance have changed the way we understand epidemics and we need a new framework for thinking about epidemic disease.

Predictions that missed the mark

Before the arrival of novel A/H1N1 virus, pandemics were said to occur when a new subtype of influenza virus to which humans have no immunity enters the population, begins spreading widely, and causes severe illness.1 2 Reference was often made to the catastrophic pandemic of 1918 and the ongoing threat of highly pathogenic avian influenza H5N1 that has killed over half of the 456 people with recorded infection since 1997. Without proper preparation, “The loss of human life even in a mild pandemic will be devastating, and the cost of a world economy in shambles for several years can only be imagined,” one highly cited article concluded in 2005.3 The large sums of public money spent on pandemic preparedness (over $7bn (£4bn; €5bn) in the US) underlined the seriousness of the threat, and often repeated phrases such as “not a question of IF a pandemic will happen, but …

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