Analysis: Asian game flu pandemic response

By SHAUN WATERMAN, UPI Homeland and National Security Editor   |   March 19, 2007 at 1:07 PM
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WASHINGTON, March 19 (UPI) -- Senior officials from six Southeast Asian nations this week war-gamed their handling of a bird flu pandemic in a table-top exercise prepared by a group of specialists from U.S. think tanks -- the region's first ever multi-national flu response simulation.

The exercise is the latest in a series of efforts to promote regional co-operation in planning responses to a possible pandemic -- and boost the capacity of governments around the world to mitigate and deal with the huge population displacements and economic chaos that could ensue.

Cambodia, China, Vietnam, Laos, Myanmar and Thailand all sent health ministry officials "at the undersecretary or (agency) director level," to participate in the two-day exercise said Terrence Taylor, director of biological programs at the Washington-based Nuclear Threat Initiative, and one of the exercise's organizers.

Participating nations also sent officials from their ministries of foreign affairs, agriculture, tourism and internal security, as well, Taylor told United Press International by telephone from Siem Reap, Cambodia.

Their participation was essential, he said, because the kind of influenza pandemic envisaged by the exercise scenario, with millions infected and survival rates low, would be much more than just a health crisis.

"If you're going to deal with this properly, you have to address questions of population movement, border controls, of how to quarantine a population that feels threatened," he said.

One of the biggest problems, he said was dealing with professionals call "risk communication," how to assess and explain the risks of, for instance, staying indoors and avoiding contact with other people versus attempting to flee.

The problem, he said, is that people generally have a very poor understanding of risk, and their perceptions, even if inaccurate, have a profound impact on their behavior.

"You have to factor the public perception of the risk in at the very heart of your analysis," he said.

Representatives of the six nations -- all members of the Mekong Basin Disease Surveillance Network, a program run by Taylor's non-profit -- joined observers from the United Nations, the World Health Organization and regional institutions.

The participants were "very practical and down to earth," he said. "There is obviously a political background to what we're doing, but when the entry point is public health, people tend to be very pragmatic."

The exercise was designed and run by the participants, working with health specialists from the RAND Corporation, a think tank based in Santa Monica, Calif., that was originally founded by the U.S. Air Force and maintains close ties with the military.

Taylor said the game was the culmination of a series of similar, national-level exercises in each country over the past year, organized by the Mekong Basin Disease Surveillance Network, a Rockefeller Foundation and WHO, funded program set up in 1999 to promote sharing of information on disease outbreaks and build response capacity.

In the past few years, the region has emerged as one of the possible epicenters of a future avian flu pandemic.

Taylor said a similar program was already underway in the Middle East between Israel, Jordan and the Palestinian Authority, and that he hoped to establish a third soon in South Asia.

Using techniques similar to those in modern war-gaming, the tabletop exercise envisaged a three-stage pandemic influenza emergency unfolding over a six month period after the mutation of the deadly bird flu virus H5N1 enabled it to be transmitted easily between humans.

In the first stage, a small number of cases of human to human transmission were confirmed in a neighboring country, Malaysia. In the second stage, infected travelers had brought the new virus across the border to Thailand. By the end of the third stage, six months later, all six countries had confirmed cases of the deadly disease, with half of them experiencing pandemic-level infection rates of 15-20 percent.

The six countries share thousands of miles of land borders crossed daily by tens of thousands of people, making the control of infectious disease a major logistical challenge.

The cornerstone of disease control begins with "surveillance" - the close tracking of an influenza threat from the point at which a new virus is detected and the development of an accurate picture of how it could spread.

A statement from the Nuclear Threat Initiative, or NTI, said the exercise had identified "gaps and weaknesses in systems for detecting, monitoring, tracking and containing" pandemic influenza.

The event was sponsored by NTI, with additional funding from the U.S. Centers for Disease Control and Prevention and the Rockefeller Foundation.

"A disease outbreak on one continent can be on another in a day. In a global economy, national borders are no defense against the spread of disease," said former Sen. Sam Nunn, D-Ga., NTI's co-chairman.

"Finding gaps now in disease monitoring and control systems through this exercise will help us save lives in a real crisis."

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