In February 2006, CNA convened a conference of public health and government officials, medical experts and regional specialists to discuss the science and politics of pandemics, particularly as pertains to Asia. Two public health crises tied to Asia provided the impetus for hosting the event. The first was the 2003 outbreak of severe acute respiratory syndrome coronavirus, or SARS-CoV. The second was the global public health crisis resulting from the 2005 reemergence of avian influenza, or H5N1, sometimes referred to as “bird flu.”
The conference was a sobering event. At the time, there was great concern that avian influenza had high potential to become the source of a global pandemic if it transformed to sustain human-to-human transmission. Consequently, a lot of discussion at the event focused on H5N1. In 2020, it is a SARS coronavirus (SARS-CoV-2) that we are confronting, not avian influenza, but some of the observations from that conference a decade and a half ago are equally valid — and unnerving — in today’s context.
The ability to develop vaccines for a novel virus strain will generally lag behind the spread of the pandemic.
At our 2006 conference, great concern was evinced about the challenges associated with developing an effective vaccine for a novel virus. As one medical specialist pointed out, “Vaccine research … can only occur for viruses that exist, not for viruses that we fear have the potential to emerge. Therefore, efforts to develop a vaccine cannot even begin until after (the strain) has already mutated and an influenza pandemic has begun.” This is certainly the case at the moment. U.S. government health officials have publicly cautioned that a safe, effective, and clinically tested vaccine for COVID-19 may not be ready for as many as eighteen months. The fears expressed at our 2006 event have been validated by the current absence of a vaccine for COVID-19, the lack of human immunity to this novel virus, and its easy human-to-human transmissibility in a hyper-globalized world.
Political challenges posed by pandemics can hamper the ability of governments to deal with global health security emergencies.
During our 2006 conference, one of the major non-medical takeaways was that domestic and international politics will be highly significant factors in determining how effective the early warning, containment, and response to future global pandemics will be. As summarized in the conference report, “…the emergence of human pandemic flu is a question not just of biology and demography but also a question of transparency and international will.” Transparency, cooperation, communication as well as public trust in government institutions were all cited in 2006 by conferees as critical.
Unfortunately, in 2020 it is painfully apparent that domestic and international political factors early on constrained effective responses within and among many countries around the globe. Future histories of the political and international dimensions of “the great pandemic of 2020” will unquestionably convey some unpleasant findings as regards domestic governance, preparedness and responses within many countries, as well as cooperation among them.
Asia in general — and China in particular — has high potential as a source of pandemics.
Pandemics can emerge from many parts of the world. For example, according to the U.S. Centers for Disease Control and Prevention, the swine flu pandemic of 2009 was first detected in the United States before spreading globally. Ebola and its 2014–2016 outbreak emerged from West Africa. CNA’s event focused on Asia; the source of SARS and avian influenza. Asia was considered potentially problematic for a few reasons. First was the high population of domestically farmed ducks and pigs. (Pigs act as mixing vessels for strains of human and avian influenza.) Second, Asia is home to various migratory routes across which wild birds transit, with the potential to infect domestic flocks. Third, Asia has dense rural human populations that live in close contact with domestic poultry and pigs due to backyard farming. Specialists at the conference offered that these factors, while generic to Asia, are especially prevalent in China.
At the conference, Professor Yanzhong Huang of Seton Hall University — a ubiquitous commentator in the current crisis — highlighted that China’s floating population of more than 200 million, by some approximations, would make disease control difficult should an outbreak occur. As it turned out, China’s COVID-19 crisis took place in the lead-up to Spring Festival, starting January 25 and usually lasting about two weeks. This is the most important Chinese holiday, during which hundreds of millions travel. Before Beijing’s January 23 ban on all travel to and from Wuhan, almost 5 million people are thought to have already left the city. Professor Huang also focused on political factors in China. He presciently opined back in 2006 that the combination of a lack of public accountability and oversight, as well as disincentives for local officials to report bad news, would hinder timely responses to a future notional pandemic centered in China.
2006 Conference: Right prediction, wrong pathogen
At the conference in 2006, experts were in strong agreement that sooner or later there would be another major pandemic. No one who attended that conference could possibly have left it without being more attuned to — or intimidated by — the prospect of what a major global health crisis would wreak in an age of increasing globalization. Most attendees also viewed H5N1 as a prime candidate for that next pandemic should it become more easily transmitted among humans. As we now know, that next great outbreak, the most disastrous since 1918, came from a SARS coronavirus.
In October 2007, not long after the CNA event, specialists in microbiology and infectious diseases at the University of Hong Kong published an article in Clinical Microbiology Review, a journal of the American Society for Microbiology. Focused on the propensity of SARS to keep remerging, and looking back at the SARS epidemic of 2003, the authors wrote the following: “Severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) is a novel virus that caused the first major pandemic of the new millennium… the resumption of the wildlife market in southern China and the recent discovery of a very similar virus in horseshoe bats, bat SARS-CoV, suggested that SARS can return if conditions are fit for the introduction, mutation, amplification, and transmission of this dangerous virus…The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”