In-Flew-Enza: Pandemic Influenza and Its Security Implications - Innovation in Global Health Governance - page 131

et al. 2005). Moreover, similarities between H5n1 and the 1918 virus (which led
to the death of 20 to 50 million people world-wide) have been suggested in the
gradual adaptation of an avian virus to a human one, the severity of disease, and
its concentration in young and healthy people (wHo 2004). For good Darwinian
reasons, pathogens tend to evolve in less lethal directions when mutations allow
them to spread more effectively. 3 available evidence, however, seems to point to the
spread of a highly transmissible and lethal virus that kills between 80 percent and
100 percent of the birds it infects. by 19 June 2008, it had killed 243 people, with
a case fatality rate (cFr) of more than 60 percent (wHo 2008). while such a high
cFr is obviously deceptive, the prospect of the emergence of a virulent strain has
led at least one public health expert to predict a statistical possibility of as many as
360 million deaths world-wide (osterholm 2005). 4
The potential demographic effects of the pandemic influenza rival a current
pandemic, HIv/aIDS. Since 1981, HIv/aIDS has wiped 25 million people off this
planet (UnaIDS 2008, 31). Yet unlike HIv, which has an incubation period of up to
ten years and spreads gradually from high-risk groups to the general population, a
pandemic influenza virus can make a global impact in a matter of months, if not weeks.
In the words of John barry (2005), the 1918 Spanish influenza 'killed more people
in 24 weeks than aIDS has killed in 24 years'. It is therefore necessary to make a
distinction between two types of epidemics, outbreak events and attrition epidemics
(wHo 1996, 39). the impact of HIv/aIDS as an attrition epidemic is mainly long
term, given its long incubation period and the relatively high certainty about its
morbidity, mortality, and pathways of transmission. by contrast, an outbreak event
like pandemic influenza or severe acute respiratory syndrome (SarS) can generate
significant shocks over a very short period, and this impact can be exacerbated by
the difficulty to control the behaviour that causes the transmission of the disease.
The potential long-term impact of pandemic influenza must not be overlooked,
however. after all, the challenge is going to be much bigger than SarS, which killed
916 people and infected 8422 worldwide. Not only is the influenza virus much more
contagious and virulent than SarS, but asymptomatic carriers can shed the virus as
well, making it difficult to contain its spread through quarantine and isolation.
A Different World
the nature of the pathogen is not the sole factor determining the impact of the future
pandemic. as works of alfred crosby (2003) and John barry (2004) have suggested,
world war I, degree of political commitment, and civil society engagement all
affected how the 1918 influenza was transmitted and felt in U.S. society. To the
extent that contextual variables matter, an analysis of the impact of the pandemic
needs to address the following question: what makes the world of today different
from 1918?
an easy answer is that there is no world war. During world war I, the conditions
of trench warfare on the western front and the american efforts to send troops to the