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Preparing for a Pandemic• Stanley M. Bergman • Laurie A. Garrett • Angela McLean • David Nabarro Moderated by • Norbert Lossau Wednesday 28 JanuaryTo put the global financial crisis in perspective, consider a global pandemic: an outbreak of disease could kill millions of people and paralyse systems, resulting in governments, businesses and transportation shutting down, and everything from food to medical supplies becoming unavailable.There was no question raised in the discussion about whether there could be another pandemic, only how serious it would be, when it might strike and how good the response might be. The uncertainties comprise the greatest challenge. However, it is worth bearing in mind, one expert said, that not every pandemic will be as deadly as the 1918 flu that claimed as many as 50 million lives around the world. Discussion leaders outlined a number of specific problems and participants drew from their own knowledge to round out the dimension of the complexities surrounding pandemics. Their sobering observations:• Scientists don’t know how a flu strain becomes a pandemic strain.• Some viral influenza evolve slowly, moving through stages ranging from mild to more serious flu; other viral influenza have the potential to become full-blown pandemics almost overnight.• Hospitals and medical supplies, most vital during disease outbreaks, would be affected as a pandemic interferes with the movement of personnel and medical equipment. Basic systems could shut down.• It is difficult to maintain focus on disease that has not reached a certain level of intensity and where a number of ministries and countries are involved in controlling it, especially in areas of the world that have other pressing problems such as poverty. At the Annual Meeting 2006, after the Bird Flu (H5N1) outbreak, a discussion on pandemics drew more people than could be admitted to the session; this year, a session on the subject was sparsely attended. It is difficult to keep the threat of a pandemic high on the agenda.• Typically, 35,000 Americans die each year as the result of common seasonal flu; about 8,000 people die annually from the flu in Germany. Seasonal flu kills about 5% of the people it affects; the H5N1 strain kills 60-70%.• Vaccines are the only way to protect against infectious diseases. Medications can be ineffective in treating flu. Tamiflu, the medication used to treat seasonal flu, lists as its number one side effect “flu-like symptoms”. This year, there is a Tamiflu-resistant strain of flu in the US.• Prevention must be in place before the pandemic strikes; yet, it is difficult to convince people, businesses and governments to make a sustained investment for an uncertainty.• Political barriers and panic make coordinated and planned responses difficult in a time of crisis. People often do not feel confident they can report diseases to authorities without repercussions.• WHO’s international powers, better control, more vigilance and early alerts will all contribute to keeping disease outbreaks under control. Businesses could play a key role in supporting measures to prepare for a pandemic.Some questions were raised for participants:• What would your government do if it was announced there was an outbreak of an infectious disease?• Have you had your flu shot this season?