Donald G. Ainslie: If I could just interject, you are the expert from a medical standpoint, but my understanding is that they were able to exhume a body that had the 1918 strain, and the analysis in layman's terms is that this strain is a kissing cousin of that strain. I think that being the father of six children and being responsibility for 130 thousand people in my organization from a security standpoint the fact that we are even discussing the percentage of the risk and the impact of this pandemic, we wouldn't be doing ourselves service by not planning. I think the other thing that gets lost is that by planning for a pandemic it will allow you to be in a better position for terrorism attack, natural disasters, or whatever they will be. We need to get past trying to quantify what is the likelihood of a risk and agree that there is a risk. The realization that if it does hit, it is not going to be like anything we have seen before.
Andrew Erickson: I am a political scientist as opposed to a real scientist, so I will try to explain my beliefs of a threat from a political perspective. If this were not indeed a threat that we would have to be concerned about, I don't think we would see the international efforts in this regard. I don't think we see the efforts that I have mentioned from the U.S. side. There are also considerable efforts from such nations as the People's Republic of China [PRC]. For example, in October 2005, PRC Health Minister Gao Qiang and the Department of Health and Human Services in the U.S. signed a very positive cooperative agreement on November 19, 2005. The two countries signed a joint initiative on Avian Influenza. At the ministerial pledging conference that David has referred to—he will have more up-to-date statistics than I will—but my understanding is that the U.S. pledged 334 million dollars. The PRC pledged at least 10 million dollars and that was on top of 247 million dollars that China had already allocated in its domestic budget. These are significant amounts of resources already being put on this. In April 2006, China hosted the APEC symposium on emerging infectious diseases. I think this is recognition of a significant threat. I also want to briefly say that just as I said that the U.S. military is taking this very seriously, I understand that the Chinese military, the People's Liberation Army (PLA), is also taking this seriously. The PLA had considerable experience during the SARS epidemic. In 2004 the PLA published a practical pamphlet on techniques for dealing with Avian Influenza and is drawing on its large network of hospitals and research facilities and even cutting edge research reported at various PLA and civilian institutions. Again, I am not a scientist, but I hope that those who are in this room are closely looking into what China is doing. It appears to be cutting edge. I think it is very positive that the U.S. Pacific Command Commander Admiral William Fallen has invited the PLA to discuss Avian Influenza. Indeed, in March of this year, Pacific Command sent a medical team to meet with leaders in the PLA to discuss pandemic influenza planning efforts. I think this has been positive, but I think it is also testimony to recognition of a very serious threat that we have to face together.
Donald G. Ainslie: I think the other reason that it is very critical that we conduct and initiate our planning activity as soon as possible is that this doom and gloom picture we are painting here is eighteen to twenty-four months. This is going to end at some point and hopefully sooner rather than later whenever it starts. But remember, the people within your organization will remember how you treated them during that episode, that pandemic. Your clients, your costumers are going to remember how you operated and conducted yourself. So it is important that you operate with dignity and there is plan in place so that you are not running down the hall with your hair on fire. That is why it is important that I think you put together a good plan.
Question: My name is Pam Kim Petra and I am with Dahlberg Global Development Advisors. My only question is it seems that everybody might be working in silos. Is there a global coordinating body? It seems that everybody at the table is representing different silos. What happened in Canada with SARS, everybody seemed to piss everyone off. There needs to be global agreements beyond bilateral that also involve private sector because now multinational companies can extract their employees and contribute to the spread of disease. It seems that there needs to be someone who works across the agencies.
Elisabeth Rosenthal: Do you all talk to each other when you make your plans?
David Nabarro: In today's world, by in large, it is not possible to require people to behave in a particular way in a kind of controlling style. For example, I don't think you would ever get companies or governments signing a pledge as to how they would behave when we move from the current phase three of pandemic alert to phase five or six. Instead, what we are trying to do is a little less precise. We try to make sure that there is a shared understanding of what the issues are, shared approaches to how we are going to react, and that there is movement that combines people together so that they try to do the same sort of thing. The case in point of what happens when the pandemic starts is tricky: Many companies have now decided that they will not evacuate their staff immediately. Instead they will have people staying at home with supplies and try to whether the storm for as long as possible. Because of that concern, they try to pull their staff out, and everybody does it together, you will end up contributing to an extremely unsatisfactory situation. For example, the UN's coordinated response, which has been shared with a lot of other organizations and companies through the kind of movement and network I have just described, is we will stay put. We will do basic minimal tasks. So we will have a lot of people at home and we will stay put. Because we know that if we try to get out, the moment there is a rumor that pandemic has started, we will actually endanger our staff and we will also cause problems for others.
Donald G. Ainslie: I think the answer to your question is I have not seen that. Part of the frustration is that I think there is a lot of discussion taking place about if it is going to happen, if it happens, how bad will it be, do we need a plan for it. There is not that form that you are describing where the commercial companies and the government are sitting down and collaboratively working together. There is probably isolated cases of that, but unfortunately I have not seen that. I think it is opportunities like this to discuss with you all and then you all can be the champions to go out there and really educated people. This is something that we need to put at the forefront.
Question: I am Claire Coppell at the National Bureau of Asian Research in the Pacific Health Summit. I have been hearing everyone talk about investing a lot of energy and money into sophisticated surveillance efforts. A lot of them are communication and having supplies on hand, which is obviously critical. I am wondering how much of the same energy and money has gone into strengthening general health infrastructure systems and how important that is in all this.
David Nabarro: There are two infrastructures that are key: one is veterinary infrastructures, which are really very weak in too many countries at the moment. We need to be building them up, and that involves a combination of working with governments and working with people, and non-governmental groups. The second is basic health infrastructures so that they will be able to address the human consequences of not only avian influenza but pandemics, and not just talking about influenza pandemics but others as well. Is enough money going in? I personally remain very disappointed about the general level of investment in health infrastructures in about fifty or sixty countries out of the 192 in our world. These are the countries with relatively low gross domestic product; not very many of them are in Asia. There are some. Most of them are in Africa, and were a pandemic episode to start or even to appear to be transmitted into many sub-Saharan African countries, the consequences would be quite appalling. I think you are absolutely right to stress—as your question implies—that there must be serious investment in building up health infrastructures if we are going to be also serious about dealing with this threat.