Getting Ready for the Next Flu Epidemic

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Because influenza viruses routinely mutate, they are a moving target for developing effective vaccines. The world is overdue for another flu pandemic. Public health officials worry that the "bird flu" (influenza A/H5N1) circulating widely in the Eastern hemisphere might spark the next pandemic. That virus has not yet mutated into a form that spreads easily among humans, but if it does, people worldwide would be susceptible. If it were as virulent as the 1918 flu, it could cause 14-71 million deaths. Because the virus is constantly mutating and because producing a flu vaccine is currently a lengthy process, it is nearly impossible to produce enough vaccine in advance to protect everyone.

So far bird flu cases have appeared in East Asia and the Pacific, Europe/Eurasia, the Middle East, and Sub-Saharan Africa. Countries in these regions are partnering to strengthen their capacity to detect and respond to a future flu-related health emergency.

RAND has provided strategic support and technical assistance for two such sub-regional partnerships focused on improving infectious disease surveillance and control:

• The Mekong Basin Disease Surveillance Project (Cambodia, Laos, Myanmar, Thailand, Vietnam and Yunnan and Guangxi Provinces of China)
• The Middle East Consortium on Infectious Disease Surveillance (Jordan, Israel and the Palestinian Authority)

RAND has developed and conducted exercises that involve public health ministries in these countries as well as individuals in other relevant ministries such as agriculture and livestock, public relations, security, immigration, finance, and transportation. The exercises create the decisionmaking environment that would exist in a pandemic influenza emergency. The participants confront the kinds of decisions that would arise by making the decisions during the exercise. They also experience how their decisions interact with the actions and decisions of others. The exercises identify existing strengths as well as areas that need improvement, and the exercises are designed so that the participants begin to plan for those improvements.

These exercise experiences are helping members of the partnerships judge and improve their capabilities in surveillance and information sharing, disease prevention and control, and communications, both nationally and across the region. Closer to home, RAND has conducted similar exercises with 14 states; U.S. federal, state and local governments; and the private sector.

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