Post on 20-Jan-2016
Confederation of Health Care Systems
Israel – 2008
Lori Post
Yale University
School of Medicine
By the Year 2020
The next pandemic will have concluded
The UN will send a mandate to the World Health Organization
The WHO will generate a resolution to prevent another pandemic
WHO Request for Proposals
1. Why did it happen?
2. Damage – Mortality, Morbidity, Cost
3. What could we have done?
Why?
Every ~100 years, avian flu sweeps through the world
Large human population without immunity
Densely populated Asymptomatic during transmission Global population exposure Cytokine storms
Damage
TBD
Flu Pandemic Phase 1: No new influenza virus subtypes have been detected
in humans. Phase 2: No new influenza virus subtypes have been detected
in humans, but an animal variant threatens human disease. Pandemic alert period: Phase 3: Human infection with a new subtype but no human-
to-human spread. Phase 4: Small cluster with limited localized human-to-human
transmission Phase 5: Larger cluster but human-to-human spread still
localized. Pandemic period: Phase 6: Increased and sustained transmission in general
population.
Public Health Surveillance
Ongoing, systematic collection, analysis, and interpretation of data (e.g., regarding agent/hazard, risk factor, exposure, health event) essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.
Early Surveillance
1854 John Snow Began with a cholera outbreak in London No technology First example of data collection and
spatial display of health issue Broad Street Water Pump clusters
Solution
Data collection and display Break the chain of transmission Public Health Resolution –
REMOVE the HANDLE Technology sufficient in 1854 but not in
2018
1800s 1900s 2000s
Positive Population MovementRuralSmall Population
Rural ICTKnowledge
Negative Transmission Knowledge
Transmission KnowledgePopulation Movement
ICTPopulation MovementUrbanLarge Population
Risk and Protective Factors for Infectious or Contagious Disease
1918 Flu Pandemic
~100 Million People Died 2 x number killed in WWWI Epicenter in Spain
2015 Flu Epicenter in rural Asia Disparate information and control measures Surveillance – passive, confederation, disparate Poor use of Information Communication Technology Slow response Global transmission before identification Population movement (1000s flights out of Asia every
day) Healthy population affected The technology to prevent the pandemic of 2015 was
developed in 1995
What could we have done?
Standardized data collection and aggregation Active Universal Health Surveillance System Early Identification Public Health Information Dissemination Containment until vaccine developed (2nd and
3rd Waves) Stockpiles of life sustaining medicines Global solution beyond political boundaries
Borders and Health Care Systems
3077 county health care systems Complicated passive system in US: County to
State to CDC to WHO The next avian flu will begin where there is
little to no surveillance Universal Health Care could be used for
primary, secondary, tertiary prevention for number of public health and social issues