1 Oct 2015

Planning for a pandemic

From Our Changing World, 9:10 pm on 1 October 2015

Recently the community on Great Barrier Island came together to discuss a frightening prospect – what would happen if a pandemic wiped out the world’s population and left the inhabitants of the island as the sole survivors?

University of Auckland microbiologist Siouxsie Wiles (middle) chairs a panel discussion with virologist Lance Jennings, emergency planner John Titmus, science fiction author Karen Healey and David Johnston, at Massey University.

University of Auckland microbiologist Siouxsie Wiles (middle) chairs a panel discussion with virologist Lance Jennings, emergency planner John Titmus, science fiction author Karen Healey and David Johnston, from Massey University. Photo: Richard Somerville-Ryan

This question was posed in a panel discussion called No Barriers – Small Island, Big Ideas – Exploring Pandemics, hosted by the Great Barrier Island Branch of Awana Rural Women. The scenario was simple but chilling; a novel Type A influenza virus, called Mortenza, develops in a small village on the other side of the world and quickly spreads across the globe, killing everyone it infects. Soon, the 900 people on the island are the only ones left alive.

On the panel was Lance Jennings, a clinical virologist at Canterbury District Health Board and the director of New Zealand’s National Measles Laboratory for the World Health Organisation: WHO. He says that a pandemic like Mortenza is a realistic prospect.

There is always the possibility that a novel virus… could evolve at any time.
Lance Jennings, Canterbury District Health Board

Lance Jennings

Lance Jennings Photo: Richard Somerville-Ryan.

Lance Jennings points to the ability of the influenza virus to evolve across the species barrier, allowing it to be transmitted from its animal host to humans, as one reason for concern. An example is the avian influenza H7N9 virus in southern China, which causes serious respiratory illness in humans and kills approximately 20 per cent of those it infects. At present, transmission between people is rare but as the virus evolves, this could change.

One key message from Lance and the rest of the panel is pandemic preparedness; having a plan in place to deal with an outbreak. New Zealand has the National Health Emergency Plan  which includes the New Zealand Influenza Pandemic Plan: A Framework for Action. Topics range from planning for individual and community recovery in an emergency event to disability issues and ethical values in a pandemic situation. 

Should an outbreak occur, the Ministry of Health will take the lead role in a response that will involve the whole of Government. But the Emergency Plan is specifically designed to devolve downward so all local bodies and District Health Boards will be able to continue to implement it if central government collapses. And like a virus, the plan frequently adapts to changing circumstances.

The National Plan was used in 2003 to respond to SARS and then subsequently for the H5N1 avian flu outbreak. It’s an evolutionary document.

New Zealand’s ethnically diverse population means that in the event of a pandemic there will likely be a range of responses to sickness, death and the disposal of bodies. Some may involve close and intimate contact with the infected, allowing the further transmission of the virus and tragically, potentially helping it to kill entire family groups. But there are plans to deal with this, too. Ongoing dialogue with community leaders educates all parties to potential risks, while more pragmatically, consultation with funeral directors hopefully means that an adequate supply of body bags will be available and the necessary protocols will be in place to deal with the dead.

A second key to combating a killer virus is the continuing emphasis on the importance of annual flu vaccinations and promoting uptake among those most vulnerable. According to Lance Jennings this not only improves the health of those individuals but also builds capacity to effectively distribute vaccines and improves communications lines within both the community and the media that could prove to be critical in a pandemic.

But unlike your favourite disaster movie, there is no possibility of a super vaccine being quickly developed. Current technology requires first a specific virus to respond to. Control reagents are then developed and should they prove to be successful, it may then be possible to manufacture the vaccine in large amounts. Unfortunately, the likely time frame for this is at least four to six months - too slow for a swift and unusually deadly virus like Mortenza. 

But although a Mortenza-like illness, which kills everyone it infects, is possible, is it really likely to occur?

The Influenza Pandemic of 1918-1919 killed between 20-40 million people or roughly 3 per cent of the population. The Great Plague in Europe and Central Asia possibly accounted for around a third of the world's population. But while we have yet to see anything as deadly as Mortenza, Lance Jennings says conditions around the planet mean that a virus like this has to be planned for. He cites contributory factors like increasing population growth and the dense concentration of people in large cities as well as the vast increase in both chicken and pig production. In short, a perfect storm scenario for the creation of the kind of deadly diseases.

Viruses are getting agitated. We’re starting to see lots of novel Influenza A viruses emerging … there are things going on that we don’t understand at this point in time … I think it is inevitable that we will certainly have more emergence of these viruses and the chances for one devastating virus occurring must be in our planning.

In the meantime, planning, preparation and public discussion are the best forms of prevention. And if a pandemic does occur, trying to take refuge on Great Barrier Island may not be the best plan. It is highly unlikely that the virus would not reach the island. And almost everyone there owns a gun.