World leaders rehearse for a pandemic that will come ‘sooner than we expect’

Disease disaster simulations inspired by 'horrendously inefficient' response to Ebola
Esther Tokpah, 11, an orphan, weeps before her release from an Ebola treatment center in Monrovia, Liberia, in September 2014.
Esther Tokpah, 11, an orphan, weeps before her release from an Ebola treatment center in Monrovia, Liberia, in September 2014.

The government ministers were facing a new infectious disease outbreak. The mysterious virus was sickening and killing people with alarming speed. Some patients had to be placed on ventilators to help them breathe. The new virus seemed resistant to antibiotics and antiviral medicine.

Within a week, officials had closed a major hospital and schools and quarantined thousands of people. Fear and panic spread quickly as people in neighboring countries became infected and died.

That scenario was part of a pandemic simulation held during the World Bank’s annual meeting in Washington this month. It’s not the kind of event that people would typically associate with the World Bank. But it’s the fourth such exercise the bank has helped organize in the past year, reflecting what experts say is the growing awareness outside the traditional global health sector of the increasing threat and economic disruption posed by a global pandemic.

The chaotic and “horrendously inefficient” early response to the 2014 Ebola epidemic in West Africa was the catalyst for the simulations, said Tim Evans, senior director for health, nutrition and population at the World Bank.

“We realized that people were just making it up as they were going along, including us,” Evans said, referring to the Ebola response. The bank wanted to “move from a history of panic and neglect to one where we’re going to start to prepare much more systematically to be ready for the 100 percent probability we will be dealing with this again,” he said. “Probably sooner than we expect.'”

Outbreaks of life-threatening infectious diseases are spreading faster and with more unpredictability than ever.

An unusually large plague outbreak in Madagascar has killed 106 people since August. About 70 percent of the cases are the more virulent form of pneumonic plague that spreads by coughing, sneezing or spitting and is almost always fatal if untreated with antibiotics.

In Uganda, officials are on high alert because of a recently reported outbreak of the deadly Marburg virus that has killed one person and may have exposed hundreds more at health facilities and during traditional burial ceremonies. Marburg is a highly infectious hemorrhagic fever similar to Ebola and is among the most virulent pathogens known to infect humans.

For the World Bank simulation, organizers looked at the impact on travel and tourism of an outbreak of a mysterious respiratory virus in a hypothetical country. Participants included finance, health and tourism ministers from about a dozen countries, and officials from organizations including the World Health Organization, the Centers for Disease Control and Prevention, and the International Air Transport Association.

Discussions during the 90-minute session were off the record. But in interviews after the event, organizers said the step-by-step scenario made the theoretical possibility seem very real for participants. In particular, it drove home the need for speedy, accurate information-sharing and strong coordination within and across governments and institutions.

In today’s fast-paced world, information flows through unofficial channels much faster than through official ones, said Ron Klain, who was the United States’ Ebola czar during the epidemic and served as the moderator for the simulation.

“Government officials need to be more in sync with that and adjust to that,” Klain said. Officials who rely on once-a-day updates in outbreak situations need to understand the importance of releasing accurate information in real time, he said.

“I think the exercise clearly flagged that, and the ministers and others really focused on that,” he said.

Participants in the simulation were shown hypothetical social media posts. One news story about a cruise ship passenger who worked in a lab researching the virus was seen by thousands of people within minutes of being posted on Instagram.

That part of the simulation was similar to what happened during the Ebola epidemic. A U.S. Coast Guard helicopter and plane were dispatched to a cruise ship off the coast of Mexico to obtain blood samples from a passenger on vacation. She had, 19 days earlier, been working in a lab at a Dallas hospital and possibly had come in contact with a sealed vial of blood belonging to Thomas Eric Duncan, a Liberian who died in October 2014, the first person to die of Ebola in the United States.

She had no symptoms, and blood tests later confirmed what doctors already knew: She did not have Ebola. (The only two people who caught Ebola in the United States were nurses caring for Duncan.)

The World Bank conducted its first pandemic simulation for finance ministers at its annual meeting last year. In January, the bank and the Bill and Melinda Gates Foundation hosted another simulation for chief executives of major companies at the World Economic Forum’s annual meeting in Davos, Switzerland, in January. In July, they worked with German Chancellor Angela Merkel to conduct a pandemic simulation for health ministers at the G-20 governments meeting, which traditionally focus on finance and economics.

In the past, some countries have been reluctant to publicize outbreaks or delayed reporting them because of politics or worries about tourism and trade. In countries dependent on tourism, there is also political and economic pressure to take action that may turn out to be counterproductive for their economies, said Ryan Morhard, project lead for global health security at the World Economic Forum, which helped organize the World Bank simulation.

Imposing quarantines or closing borders may be seen as aggressive action, but those measures wouldn’t necessarily be effective against a disease that spreads without symptoms, and could be “equally devastating to that economy,” Morhard said.

Coordination also requires health ministries to work across the government with the finance and tourism sectors. “But that’s not the way governments are usually set up any place in the world,” Klain said. Most government systems “are really built in silos, nationally and internationally.”

Although there is more awareness about the issue, experts agree that the world is not prepared for the next pandemic.

“We still are not ready for the big one,” Klain said, noting that next year is the centennial of the great influenza pandemic of 1918-1919 that killed at least 50 million people worldwide.

“We’re frankly not ready for a medium-sized one. The threat is still out there.”

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