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The Next Pandemic

The Next Pandemic

Right now, in a small corner of Texas A&M University, people are preparing for one of the greatest catastrophes ever to face human civilization. No, there’s not a den of superheroes on campus. The Global Pandemic Policy Program, which goes by the catchy, James-Bond-like acronym GP3, is gearing up for preventing disease outbreak on a global scale. The program was launched by the Scowcroft Institute of International Affairs with a conference held Sept. 15-17 that brought together top minds in the fields of public health, medicine, homeland security, veterinarian medicine, engineering, agriculture, economics, psychology, government and international diplomacy.

Topics discussed included:

  • A report on the World Health Organization’s mishandling of the Ebola crisis last year and its inability to deal with similar epidemics in the future.
  • The slaughter of millions of chickens in the Midwest to combat a new strain of avian flu and the risks of the disease jumping to humans.
  • The spread of Middle East Respiratory Syndrome (MERS) to South Korea.
  • Disease-spreading simulations by the Bill and Melinda Gates Foundation that show how a highly infectious, lethal flu could kill up to 33 million people around the world in 250 days.

Based on papers presented at the three-day conference, the GP3 is preparing a set of major policy recommendations directed at governments and health organizations worldwide, including a plan for reforming pandemic surveillance and response systems.

A Hotbed of Pandemic Experts

The conventional wisdom is that it’s not a matter of “if” a virulent pandemic is going to break out, but a matter of “when.” According to these experts, the world is woefully ill-prepared. The 7-year-old Scowcroft Institute, the international research arm of The Bush School of Government and Public Service, considers the GP3 its signature initiative, with the goal of becoming one of the leading centers for developing strategies to meet the threat. (This is only one of the Scowcroft Institute’s programs; see the sidebar for others.) It turns out that Texas A&M is the ideal place for such a program, since it has a unique combination of expertise and policy research to make effective recommendations on national and international levels.

“I don’t think there’s any other university in the country that has all of the facilities necessary to develop solid policy,” said Andrew Natsios, director of the Scowcroft Institute. “We have world-class programs in veterinary medicine, agriculture, engineering and the health sciences.” Experts in these disciplines already have experience working together through the Texas A&M “One Health” initiative, a multidisciplinary program to promote sustainable health for the ecosystem. “We have a vaccine manufacturing center that can make 50 million vaccines in four months, one of only three in the United States,” Natsios continued. “We have experts in legal, economic and psychological aspects of a pandemic. If we have a worldwide pandemic, College Station is the place you want to be.”

Natsios’ background makes him uniquely qualified to lead the effort. A retired lieutenant colonel in the U.S. Army Reserves and former state legislator, his first job in the federal government was as director of the Office of Foreign Disaster Assistance for President George H.W. Bush. He went on to lead the U.S. Agency for International Development for five years, managing relief, health, development and reconstruction programs throughout the world. Don Bailey ’78 ’80, the institute’s assistant director, adds more experience as a retired Army colonel and former head of biosecurity at the Pentagon.

The GP3’s goal of preparing for a pandemic fits into the Scowcroft Institute’s mission, because any approach to a pandemic must be global. Experts agree that most pandemics arise in developing countries, which have weaker health care systems. “The best way to prevent a pandemic in the U.S. is to stop it overseas. The first line of defense should be in the developing world,” said Natsios. “You cannot build a wall around the U.S. The disease doesn’t stop at the borders, as we found out during the Ebola scare. We also know that if the pandemic is airborne, it will spread through airports.”

Jay Maddock, dean of the School of Public Health, said that if the GP3 had been up and running before the Ebola outbreak last year, it may not have spread to Texas. “It more likely would have been contained in the early days in Africa,” he said. The problem, many experts note, is that much of the international Ebola response was on the fly. “That’s what we’re trying to avoid,” Maddock continued. “The key is to take the expertise of the Scowcroft Institute and everyone at Texas A&M and bring the best minds in the world together when we’re not in a pandemic situation.”

GP3’s advisory board is comprised of leaders in each of these areas of Texas A&M—the College of Veterinary Medicine & Biomedical Sciences, the Health Science Center (including the College of Medicine and School of Public Health), the College of Liberal Arts and the College of Engineering. “This program takes the strengths of Texas A&M and unites them on an important problem,” said Maddock.

The best solutions will come through an integrated approach, Natsios said. “Here at The Bush School, we have social scientists, international relations and national security scholars, and international theory and development experts,” he said. “And if we’re sitting in a room designing policy by ourselves, we’re going to make mistakes and miss important aspects of the challenge. We need medical doctors with us plus public health scholars and other experts. That expertise combined with our knowledge of what’s going on in the federal government and the developing world is what’s necessary for the program to offer comprehensive, non-partisan policy.”

It Could Happen Again

Recalling the year 1918 makes any pandemic expert shiver. That’s when a strain of especially virulent influenza called the Spanish Flu killed 50 to 90 million people, roughly 5 percent of the global population. Fortunately, the world has not seen such a disease-related casualty count since then. Other possible pandemics, including the 2009 outbreak of N1H1, which infected over 1 billion people, were not as lethal as feared. “We’ve dodged a couple of bullets,” said Maddock.

But experts maintain that conditions are ripe for a pandemic that exceeds the destruction of 1918. Many diseases that prove most threatening start in animals and spread to humans. Birds are a common source. Ebola is thought to have originated in bats. MERS could possibly be spread through camel’s milk. With the increase in living standards worldwide, more people are eating meat, which means more animals are kept as livestock. This amplifies opportunities for exposure to zoonotic (animal to human) infections, especially in developing countries, where people live in closer contact with animals. “We have people at our veterinary school that look at these types of diseases,” said Natsios. “Right now, politicians in Washington are not focusing on veterinary schools and their expertise on zoonotic diseases. But they should be.”

Andrew Natsios (left) and Col. Don Bailey ’78 ’80 (right) are striving to make the Scowcroft Institute a world leader in combating global pandemics.

Also problematic is a rapid rise in population and increasing urbanization. Today, 54 percent of the global population is concentrated in cities, versus less than 18 percent in the middle of the 20th century. “Public health risks are much greater in urban areas where people are living close together,” Natsios explained. This is particularly the case in megacities in the developing world where high concentrations of people don’t have reliable water supplies, clean air or proper sewage disposal.

Next, factor in greater mobility. People are 50 times more likely to cross international borders today than they were 100 years ago, according to the Gates Foundation. Air travel is a scarily effective way to spread airborne germs as people are crammed into a small, enclosed tube and then dispersed around the world. This is why the Gates Foundation’s simulations of disease transmission show a highly contagious infection crisscrossing continents within weeks.

Political issues also aid in the spread of pandemics. The leaders of many countries don’t want to tell the world about a disease outbreak for fear of hurting their economy or tourism. This happened with the Severe Acute Respiratory Syndrome outbreak that originated in China in 2003. “The Chinese were very quiet about it,” Maddock said. “We learned that the sooner we can get a global response and awareness, the fewer casualties. The more it stays within a country and people don’t know about it, the worse it gets, and eventually it spirals out of control.”

A social issue was at the heart of the Ebola spread in West Africa last year—the tradition of burying the dead that included touching the bodies. “Once people learned through mass media campaigns to stop this funeral custom, the disease was brought under control,” Natsios said, emphasizing that clear, factual communication—free of misinformation—is key to managing an outbreak and avoiding a panic.

Natsios notes that many institutions responsible for disease control are hampered by political or territorial battles. The GP3 is a neutral body with the sole focus of recommending policy—and, Bailey added, “increasing Texas A&M’s visibility.”