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| Facing a crisis: globalisation has helped spread infection far and wide |
“An
external event strikes. Fear grips the system, which, in consequence,
seizes. The resulting collateral damage is wide and deep.”
A
description of the coming flu pandemic, or the events of the past 18
months in the world of finance? As the World Health Organisation on
Wednesday night raised its level of alert and instructed countries
around the world to “immediately activate their pandemic preparedness
plans” following the spread of an aggressive flu virus from Mexico,
intriguing parallels between ways to address a public health crisis and
a shock to the financial system are becoming increasingly apparent to
officials and policymakers.
The lessons from these could prove
critical to the success of efforts to minimise the impact of H1N1. The
decisions taken in coming months by international agencies, national
governments, local authorities, employers and individuals alike will be
the first real “stress test” of an unprecedented and still fragile
structure of pandemic preparations built up in recent years.
Much of the architecture of today’s system dates from the 2003
outbreak of severe acute respiratory syndrome. This was swiftly
followed by fears of a widespread outbreak of the “bird flu” H5N1
virus. Both helped mobilise a sharp rise in worldwide funding for
pandemic preparations. The WHO was assigned the role of choirmaster,
conducting the tracking of disease, the speedy dissemination of
information and the co-ordination of the response by governments and
agencies.
Yet
the lack of any immediate outbreak led to “flu fatigue”. Public concern
gave way to a sense that sufficient preparations were in place and
alarmists were crying wolf.
Similarly, in finance, continued
economic expansion generated a sense of hubris that militated against
tougher regulation. “The parallels between finance and medicine or
other branches of science are very thought-provoking – it is something
which is being talked about seriously now,” observes one senior
European central banker.
In a further link, the financial crisis
itself – and efforts to rein in public expenditure even before the
credit crunch began in summer 2007 – may have helped slow pandemic
preparations and squeezed the ability of medical systems to respond. In
the UK, Treasury scepticism over the past two years delayed the
purchase of extra supplies of antiviral drugs and antibiotics, leaving
the government scurrying to place fresh orders this week.
Looking
to the future, the pandemic may slow down tentative signs of global
economic recovery, as declining travel, falling productivity and rising
healthcare costs add to the pressures on companies, consumers and
markets already struggling and deeply sensitive to further
psychological setbacks.
TRIPLE TEST IS THE LATEST CHALLENGE FOR THE GLOBAL HEALTH BODY
The
response to the H1N1 flu outbreak now spreading from Mexico around the
globe is a high-profile triple test for a recently appointed boss, a
young set of rules and a well-established institution.
For the
World Health Organisation, founded just over 60 years ago, it is the
latest in a series of important contributions to public health, which
have included the elimination of smallpox, the introduction of the
Tobacco Convention to spur tougher anti-smoking measures, and efforts
to accelerate treatment for HIV patients across the developing world.
The
challenges it faces include politics, bureaucracy and several failed
public health campaigns including an attempt to eradicate malaria and a
lengthy effort to fight polio that remains incomplete.
Its
preparations for a pandemic have been reinforced by the adoption in
2007 of the International Health Regulations, which theoretically give
it greater powers including certain rights to encroach on national
sovereignty in fighting disease.
But the biggest test is perhaps
a personal one for Margaret Chan (pictured), the discrete Hong
Kong-raised civil servant who took over as director-general of the WHO
in 2006 after a tough election campaign triggered by the sudden death
of her predecessor. She must mobilise her own staff and delicately
negotiate with top politicians around the world to work for the common
good.
Olivier Blanchard, chief
economist at the International Monetary Fund, warned on Thursday that
the impact of the pandemic could be “quite drastic” in some countries.
The
rise in globalisation that drove the expansion in international finance
in recent years has also helped frame the conditions for the pandemic.
Increased air travel, for example, has helped spread infection far and
wide, illustrated in the initial outbreaks of H1N1 outside Mexico: from
a honeymooning couple in Scotland to school-children returning home to
New York and New Zealand.
Distinctions between the financial
crisis and the flu pandemic include the fact that, with the former,
there was – with no over-arching international organisation – little
planning for a severe downturn, and the more alarmist warnings of a few
critics were brushed aside by the majority.
In
recent years, by contrast, there has been general consensus in the
public health community, co-ordinated by the WHO, that a pandemic was a
matter of “when, not if”, and plans – albeit of variable quality – were
being put in place for an event seen as inevitable.
Now, as those
plans are activated around the world for the first time, the question
is how far they will prove effective, given that the responses of
individuals and institutions as the threat of infection begins to
affect daily life are unpredictable.
Just
as the flu virus itself is constantly evolving genetically, so the
financial services sector is continually inventing instruments. In
health, too, there has been frenetic and complex innovation in recent
years that is poorly understood by the vast majority of the population,
creating a gulf between them and the tiny minority with understanding.
That requires considerable trust, which can swiftly crumble and trigger
panic when faith in the few collapses.
As a senior accountant
says: “Most people don’t know how modern medicine works – all that
stuff about DNA and what is inside pills. They have to trust their
doctor. There are parallels there with finance. So much relies on
trust.”
The dangers of the lag after widespread unofficial
information and before any official response were starkly demonstrated
by the saga of Northern Rock, the UK bank. A media leak on the BBC of
its problems in mid- September 2007 caught the authorities on the hop.
They presented no convincing explanation of the scale of its problems,
triggering a run on deposits.
When Sir Callum McCarthy, former
head of the UK’s financial regulator, tried to tell consumers any panic
was “irrational”, it simply sparked greater fears. By the time the
government finally stepped in four days later to guarantee deposits,
customers had lost faith in almost anything it said, sparking deep
cynicism about the health of other banks including many small British
building societies.
The lessons include the need to recognise and
respond to the fact that information travels at lightning speed around
the world; and, in the internet era, vague reassurances that the
authorities are in charge no longer work. “A hundred years ago, people
would be reassured by a solemn statement from the Bank of England,”
says a senior European regulator. “That doesn’t work now – people want
evidence. Messages have to be short and clear. People want a website
they can go to, hard facts.”
Embracing the explosion in
information, one critical aspect of pandemic preparations that followed
Sars was the adoption of the International Health Regulations. That,
for the first time, gave the WHO the power to use data from
non-official sources that warned of a potential infection rather than
relying on its member states.
Initial indications suggest that
the agency, as well as regional affiliates and national health
authorities such as the US Centers for Disease Control and Prevention
were relatively slow to react, picking up on warnings in the Mexican
media of outbreaks some days after they were identified by specialist
analytical companies.
“My big question about how things have
developed is around surveillance and warning,” says a senior official
co-ordinating the British pandemic response, who adds that the UK
escalation was triggered by its own observations of activity by the CDC
rather than any formal WHO notification. “If we had had even two more
weeks’ warning, we could have had better efforts to contain the
infection and more time to distribute drugs.”
RESPONSE MEASURES:
Key components of the WHO’s role in tackling the flu pandemic include:
●Track and assess the risk of the virus
●Mobilise countries to plan and react
●Agree public health measures to respond
●Co-ordinate the development of flu vaccines
●Establish medical treatment guidelines
Writing this week of the “striking” similarities between the 2003 Sars outbreak and the collapse of Lehman Brothers,
Andrew Haldane of the Bank of England and author of the scenario
sketched at the top of this article, notes that a modest “triggering
event” is augmented by a media frenzy that transcends borders.
Similarities between crises in public health and finance are “no
coincidence” as both are “manifestations of the behaviour under stress
of a complex adaptive network”.
So far, while struggling with huge media demand, the WHO has
provided regular updates, although the data on its website have often
appeared modest and belated.
While it is early days, the public response around the world to
H1N1 appears calm, despite anecdotal reports of panic-buying of masks
and efforts to obtain antiviral drugs. One risk is that such patterns
escalate as the effects of the virus become widespread.
More
worrying are the cracks appearing in the fragile mechanisms of
solidarity between governments. Just as there was disagreement over
fiscal stimuli and measures for international financial regulation
following the crisis, so there are divergences about how to respond to
a pandemic.
Even before the WHO posted advice this week that
restricting travel was pointless, many countries were imposing a range
of variants that did precisely that. Some countries, such as Egypt,
have diverged even further from the science, with calls to slaughter
pigs despite no evidence that they present a risk of spreading the
infection.
As the pandemic advances, there will be far greater
potential for clashes over different national policies towards vaccine
manufacture, drug stockpiles and distribution, the provision of medical
treatment and so on.
For now, the response has gone largely to plan, and appeared
smoother than the response to the financial crisis. But it is only just
beginning. As Angus Nicoll from the European Centre for Disease
Prevention and Control puts it: “With flu, you have to plan for the
worst, prepare for the worst and hope for the best.” The best laid and
most rational plans for the pandemic are – as in finance – still
grounded in a good deal of faith.
Additional reporting by Gillian Tett
GENETICS: THE HISTORY OF SWINE FLU – AND CLUES TO ITS FUTURE
“Unpredictable” seems to be the word used most often by experts to describe the outbreak of swine flu, writes Clive Cookson.
Scientists now concede that a pandemic is almost certainly imminent but
they insist that they cannot predict its timing or how serious it will
be.
All this talk about uncertainty should not disguise the
astonishing amount that researchers have learnt about the new H1N1
viral strain, using the latest techniques in molecular biology, since
an unusual outbreak of flu in Mexico came to the attention of the
world’s health authorities a couple of weeks ago.
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| An H1N1 culture from a US patient |
By
last weekend, when the general public was becoming aware of the
pandemic threat, the US Centers for Disease Control and Prevention in
Atlanta was already completing the genetic sequences of flu virus
samples taken from patients in California and Texas. (Flu virus genes
are composed of RNA rather than the related DNA that makes up the
genome of almost all other organisms.)
Since Monday, anyone has been able to download the full RNA sequences
from the public GenBank database. For the uninitiated the viral genetic
code is gibberish – “atgaaggcaat” is a typical short stretch – but for
experts it can tell a fascinating tale of infections that have shaped
the virus.
The Mexican strain is a complex mixture of components
from viruses that originated in infections of pigs, people and birds –
but there is no doubt that the dominant contribution comes from pigs,
says Brian Willett, a virologist at Glasgow University.
“This virus almost certainly does originate in pigs,” says Professor
Willett. “Mexican pig farms are a very strong candidate for where it started.”
Hence
the controversial decision by the World Health Organisation to call it
swine flu – to the dismay of pig farmers, who have been hit with a
global slump in pork sales and bans on meat imports from Mexico and the
US in some countries as a result.
A porcine origin does not
mean the current outbreak is circulating among pigs today, experts
insist. Now that the virus is spreading among humans, people face an
immensely greater risk of catching Mexican flu from other people than
from pigs.
Scrutiny of the viral genome – and comparison with
other flu viruses – is also beginning to give scientists clues about
its likely behaviour and effects on people. These seem to be
reassuring.
The Mexican strain currently lacks some of the
molecular characteristics associated with the most virulent viruses –
adding to the emerging epidemiological evidence that it causes mainly
mild illness. Experts believe the apparently high mortality rate in
Mexico is the result of vast under-reporting of less severe cases.
But
that is now. The future is, of course, unpredictable. Flu is a
notoriously fast-changing virus, and it may mutate into a much more
dangerous form. Or it may turn out to be less lethal than normal
seasonal flu, which kills 500,000 people in a bad year.
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