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USA 1 Kelsey Slader and Alex Gray RUMUN 2008 United States Edison High School World Health Organization: Topic 1 Pandemic Preparedness Background: A pandemic takes place when a virus is rapidly mutating rendering most medications ineffective, all the while spreading itself more and more around the globe. Pandemics transpire for multiple reasons including rapidly mutating viruses, lack of education about the virus, lack of resources available, and sanitary conditions within regions. Viruses are capable of learning which causes them to mutate. They mutate because people begin and stop taking their medications, evolution, and genetic mutations. Lack of education refers to a deficiency in medical knowledge and not being able to create new vaccines quickly enough. With fewer resources, there is a much lower knowledge of how viruses spread and work, and regions afflicted often have the least of all these as well as low sanitation. For example, the Bubonic Plague, otherwise known as the Black Death, rose up maliciously in the mid 1300’s. This pandemic was most likely one of the deadliest and most well-known. Its transmission to Italy was on the backs of rats through both animal to human and human to human contact, as it slowly progressed through Europe in 1348. The virus made a mockery of those living in Europe by taking advantage of the poor sanitation and wiping out millions of people. Six hundred years later the Spanish Flu is walking in the foot steps of the Bubonic Plague. Since this occurred in 1918 during World War I, troops were carrying it with them back home to their families. Only a USA 2 few dozen years later, the Asian Flu takes its toll. The Asian Flu occurred in 1957 and is classified as a “second wave” pandemic because of the way it progressed. This pandemic hit children first; however, the symptoms were minor; but when the disease was passed on to their older relatives, the death rates began to increase. Fortunately, the Asian Flu was not a very strong strain and was only able to have drastic affects on those with already weakened immune systems. No political borders can stop a virus from spreading once it has reached the pandemic state. The key factor is not financial but the efficiency at which aid is distributed. Although money is a blatant issue, the main problem is stopping the pandemic globally, not just within one’s country. The virus’ that are predicted to be the next pandemic are Ebola, HIV/AIDS, Avian Flu, influenza, and SARS (Severe Acute Respiratory Syndrome). At the turn of the millennium to 2005, it was predicted that approximately seven hundred and fifty cases of Ebola appeared in Africa with only one third surviving. Between 2002 and 2003, roughly eight thousand five hundred and fifty people contracted Severe Acute Respiratory Syndrome. Throughout the world, other possible pandemics have broken out which leads to questions about whether or not the global community can take the hit. Therefore, with the aid of the United Nations and the World Health Organization we can combat the future pandemics and save millions of lives. UN Involvement: The United Nations is part of the Epidemic and Pandemic Alert and Response System (EPR) which is part of the WHO’s preparedness plan. This system includes public access with information on an influenza tracking system. The four diseases that are required to be reported to the EPR System are smallpox, SARS, polio, and any new kind of influenza. Hopefully, this system will help prevent a pandemic from occurring. The World Bank estimates that USA 3 approximately three trillion dollars will go into the next pandemic from economic loss. Clearly, this is a vital issue that should possibly have more UN interest. The World Health Organization provided a mass vaccination in 1978 in order to eliminate smallpox. Smallpox is contracted on a human to human contact basis, often from air particles. This disease had infected nearly 50 million people every year killing multiple people and everyone else were permanently blinded or scarred. It was extremely expensive for the WHO to launch this vaccination campaign and it received the largest donations from the United States of America. Cost became a little easier with donations and the WHO was able to receive one thousand needles for a mere five US dollars. Also, the Center for Global Development (CGD) was able to make several estimates and concluded that one billion dollars a year went into smallpox deaths. The WHO was capable of providing mass vaccination because each country had one person responsible who connected the vaccines to the people, each program was created to be a perfect fit for the region of which it pertained, and there were already healthcare facilities in tact. A published identification chart consisting of multiple phases was put out by the World Health Organization in 1999. Each phase is a different criterion the world has reached determining the progress of a virus over certain periods of time. The definitions of the six possible phases were amended in 2005. Phase one is basically a non-existent virus. Phase two is a virus found in animals that has not been contracted from humans. Phase three is what the world is considered to be at currently, with a new strain of a virus found in animals which infects human from animal to human contact. Phase four is when there is limited transmission between human to human, but is still possible. Phase five is easy transmission from person to person in USA 4 single regions and phase six is pandemic. The purpose of these phases is to track how pandemics are begun and their rapid mutations. In March of 2004, A/RES/58/179 makes reference to pandemic preparedness through access to medication. The main focus of this United Nations resolution is for current possible pandemics and how to perform another mass vaccination, similar to that of the 1978 smallpox one. Mainly, A/RES/58/179 refers to the World Health Organization to work with international community. The most plausible solution is in operative five, calling “upon States to establish or strengthen national health and social infrastructures and health-care systems, with the assistance of the international community as necessary, for the effective delivery of prevention, treatment, care and support to respond to pandemics.” Therefore, it stresses several crucial points and should be looked upon for reform to ensure that everything is done that can be done. United States Policy: The United States of America has been home to multiple viruses over the years including Meningitis, Ebola, and influenza. The USA is considered an endemic state because it is susceptible to uncontrollable disease within the nation. When the Spanish Flu infected a quarter of the percentage of the United States population in 1918, it killed numerous Americans. The government had no plan to counter-act this pandemic leaving them with little to no help. There was also a small outbreak of the Asian Flu in the mid nineteen hundreds, but it was quickly eliminated since it was a second wave pandemic. The U.S. International Avian and Pandemic Influenza Assistance has donated an approximate total of $949 Million USD. This money has gone towards research of avian and pandemic influenza and has made the United States the largest single donor. The idea is to control outbreaks of these diseases and to prepare for an overwhelming pandemic. USA 5 The state of Pennsylvania within the United States borders has established the PA Pandemic Preparedness Plan, also known as the IPRP. This document gives specific jobs to different areas within their state. For example, the Emergency Medical Service Officer (EMSO) is in charge of instituting a means of controlling the pandemic. Also, the Department is to determine to the sensible ways to control and minimize the pandemic. Moreover, this document supplies estimated time periods and dead lines by which certain goals need to be met. This will coerce a state to make these dead lines and provide better access to the necessary materials within an area. The HHS Pandemic Influenza Plan was created by the United States from the U.S. Department of Health and Human Services. This plan is a basic blueprint of what needs to be done in the case of a pandemic. This plan consists of over three hundred measures for the state and each government to take. Mike Leavitt is a secretary at the US Department of Health and Human Services and talks about this plan and past conflicts that have caused the creation of this document. For example, the Great Influenza occurred in 1918 and killed nearly fifty million people globally. This document’s goal is to be prepared for the next pandemic and prevent the millions upon millions of deaths that are caused from pandemics. With this, the plan incorporates the six different phases set up in the World Health Organization’s guide lines defining a true pandemic. It consists of three main parts and is still under revision. The first part is the Strategic Plan which includes medical support and public health. The second stage is Public Health Guidance for State and Local Partners which specifies guidance and residential health departments with eleven key sub-sections. Part three is called the HHS Agencies’ Operational Plans. This section will specify roles for each section of the HHS and create individual plans for all. Also, it stresses the need for global preparation, national strategy, and the regional Influenza USA 6 plans. Overall, this document supplies one of the most comprehensive and detailed analysis of what is to come in the case of a pandemic and is the basis for all agencies and Federal departments to be looked upon as a reliance for if the situation was to occur. Although this document is not completed yet, it is definitely a work in progress that will be looked upon globally to determine what is to be done in a situation. Solutions: Pandemic Awareness is an issue that occurs on a global scale. If or when the next pandemic occurs, it could wipe out an extremely high percentage of the population; however, very few resolutions have been passed by the United Nations, the last one being in 2004. Therefore, the World Health Organization is one of the main contributors to pandemic awareness. With the help of the World Health Organization, the United States hopes to enact multiple solutions to prepare to world for a sudden pandemic. First, we suggest the creation of a branch off of the World Health Organization that is to be based solely on Pandemic Awareness called the PPO (Pandemic Preparedness Organization). Second, we propose the combination of historical records to determine areas more prone to pandemics and under what cause. Third, we stress the need to determine regional boundaries in which quarantine will be necessary to prevent a pandemic. Fourth, we need to understand what is to be done once the pandemic has escalated past all other precautions. Lastly, the United Nations needs to stress education upon all of its members so that everyone understands the severity of this problem. The Pandemic Preparedness Organization (PPO) will be a branch off of the World Health Organization that can focus solely on the issue of pandemics. This organization will encompass all of the other solutions that have been brought up. Also, it will work with the documents and resolutions which have already been implemented. However, the main goal of this branch will be USA 7 to establish an understanding between countries. The idea is to have a strong base and extensive knowledge on what is to be done in case of emergency. With all historical records in tact, the United Nations or World Health Organization will be able to look through it and establish where sustainable development is necessary. Sustainable development will be constructed in different regions, properly suited for each one. Using the history of that region as a guideline, we can go back through and determine the strengths and weaknesses of pandemics. Once this is determined, the necessary precautions will be set up and be established within the actual country before any pandemic even occurs. The difficulty here is in the case of a country under conflict. The hope is that all countries, at least under the United Nations, understand how disastrous another global pandemic could be. In order to get all of the countries on the same page, we suggest a conference in March of 2009 to specify the prerequisites of protection from a pandemic. At this conference, all prior agreements will be available for amending. For instance, some countries may not want sustainable development from the United Nations within their county, in which case, we can establish their history but not take the extra step and provide the sustainable development. Many countries are extremely large and in the case of a pandemic, even if the borders were sealed, there is still a large amount of room for spread of the virus. Therefore, by establishing regions within larger countries, the spread will be minimized within that region. These regions will basically be under quarantine. Air travel spreads viruses very easily and transportation now a days can take one anywhere in the world. Consequently, when a region has gone into lock-down mode, it will be required to have proof of cleanliness before exiting the region. Also, the individuals will be completely decontaminated as an extra precaution. Furthermore, air conditioners can spread disease within regions from viruses located near and USA 8 around the central A/C or one’s car A/C because they are spewed around unsystematically often causing illness like the head cold. When any virus gets out, it spreads rapidly and efficiently, the goal is to stop its spread before it get to this extent but to be prepared in the case of an emergency. The goal for once a pandemic has occurred within a nation is to stop it all costs. In this case, the quarantines would still be in place and the regions with the worst cases of the virus would get treated. With all of the preparedness from before, this should not be that difficult as long as we can assimilate the same way the World Health Organization did in their mass vaccinations of small pox. Ideally, there will be vaccinations available that work and kill the virus. If there were to be no known medications working because of the virus’ rapid mutations, the goal would be to stop the random mutations. The only way for this to be done is drastic, but the only possibility left. Those who were infected with the virus would not be able to have the chance to pass on the virus to other individuals in hopes of stopping the growth and evolving of the virus. Education for all of the countries is vital in order to make sure that each country is satisfied with the way a pandemic will be handled. By making other countries aware, the United States hope to gain support and understanding for when a pandemic finally occurs. Furthermore, if countries understand an extensive background of the topic, they will more willing to provide financial aid. The United States feels that we have done some of the best research and have put millions of dollars into it, and we hope other countries will help us when it comes to financial issues. All in all, the United States can only hope that other countries understand the severity of this problem and that no solution can be created quickly, but rather that a lot of time and money is going to be spent on research and preparedness.