In-Flew-Enza: Pandemic Influenza and Its Security Implications - Innovation in Global Health Governance - page 148

• balancing the need to fight an impending influenza with other infectious
diseases, such as HIv/aIDS, to minimise the cost of the interaction of different
pathogens.

ninety years ago, when the Spanish influenza was wiping out populations across
the globe, children in the United States used to sing:

I had a little bird
And its name was Enza
I opened the window
And in-flew-enza.

today, the window is open again. the difference is that by acting now and
working together, it is possible to turn it into a window of opportunity to strengthen
the global public health infrastructure and emergency response capabilities. It is
in the interest of all states, particularly those in the developed countries, to give up
the fortress mentality and develop effective strategies for international cooperation
if the macabre tales of dreadful death and disease are to be avoided.

Notes

1 Ullman (1983, 133) deines a threat to national security as 'an action or sequence of events
that (1) threatens drastically and over a relatively brief span of time to degrade the quality
of life for the inhabitants of a state, or (2) threatens significantly to narrow the range
of policy choices available to the government of a state or to private, nongovernmental
entities (persons, groups, corporations) within the state'.

2 the intervals between pandemics have ranged from 10 to 55 years over the last two

centuries. with only three incidents per century, however, there is no statistical basis for
a firm prediction (Weiner 2006).

3 this is what happened to the 1918 inluenza after the western front was abandoned in

world war I. In a little more than a year, the virus lost its virulence and evolved into
an ordinary influenza (see Orent 2005).

4 even the 1918 inluenza, 'the mother of all pandemics', had a CFR of a bit more than

2.5 percent (taubenberger and Morens 2006). the WHO data counted only lab-confirmed
cases, and milder, non-fatal cases were likely not included. this is particularly a problem
in many affected countries, where surveillance and healthcare facilities remain inadequate
and only the very sickest cases go to the hospital. In vietnam the reported mortality rate fell
from 70 percent to 35 percent as more people learned about the disease (weiner 2006).

5 this is suggested by research conducted by the University of Hong Kong (see chan et al.

2005). For the distribution of mortality among different ages, see crosby (2003, 24).

6 See also personal communication.

7 Renmin ribao , 14 May 2003, p. 11.