With this post, we’re pleased to welcome Nelson Fabian as a guest blogger. Nelson is the Executive Director of the National Environmental Health Association in Denver, Colorado.
As counterintuitive as this may sound, I believe the swine origin H1N1 outbreak may soon prove to be one of the best things that could have happened to us.
It is true that public and environmental health experts around the world are advising “abundant caution” as we continue to monitor and learn more about this new and novel influenza virus. The issue also continues to command lead story status in our media.
However, as we’ve learned more about this virus, the evidence is mounting that in its present form, it “appears” to be a surprisingly mild strain. It isn’t transmitted quite as easily as we initially feared and, all things considered, it will probably not even compare to the typical seasonal influenza that we all but ignore as we go about our daily routines during the fall and winter.
In view of what we are learning, it’s not surprising that we are beginning to hear the inevitable criticism that the media and even the public and environmental health establishments have blown this outbreak out of proportion. We are being accused of promoting our own agenda of sensationalism and self justification for presumably attempting to demonstrate that our earlier predictions of a dramatic pandemic were correct. Some of this criticism understandably comes from segments of the meetings and travel industry.
We in the public and environmental health community hear you, and we get it. Like you, many of us are also tired of sensationalism in media. In addition, we understand that people in the meetings and travel industries quite rightly see this as the worst possible time to cancel flights and meetings. To add insult to injury, this is all happening because of a virus that appears to be less a threat than a seasonal flu virus!
Coming from a health sector that has seen cutback after cutback for decades, I feel the pain that your industries are now experiencing with these revenue losses.
Notwithstanding these powerful points, I would nonetheless suggest that this scare may have given us just the right dress rehearsal for the far more serious challenges that lurk in our future.
Set aside the factors that make the 2009 H1N1 a new virus to be taken very seriously. Forget for a moment that the whole of humanity has no immunity to this novel virus…that we must face this threat without the protection of vaccines that take six to eight months to manufacture…that this spring’s eruption might be followed by a much more deadly second and even third wave in the months ahead. We’ll also pass over the significance of the virus being transmitted from a human to a herd of pigs in Alberta.
H1N1’s greater significance is that it prompted us to prepare for life in an increasingly dangerous world.
We live in societies that have become unimaginably complex. This complexity reveals itself in the remarkable interdependence of the infrastructures that we’ve built to support the services and conveniences we take for granted. Our very standard of living and quality of life depend on this labyrinth of urban infrastructures: We transport our food over long distances, enjoy a panoply of modern conveniences thanks to electricity that is available to us at the flip of a switch, rely on vehicles that we can quickly and easily fuel, and benefit from prescription drugs made of compounds that we import at will from around the world. And…we hold meetings all over the planet, thanks to a worldwide transportation and energy system to which we scarcely give a second thought…when all goes well.
But these systems are complex and fragile, as we learned when the major, modern, 21st century city of New Orleans became instantly dysfunctional; its systems literally drowned by Hurricane Katrina.
Now couple our vulnerability with the reality that we are living in an increasingly dangerous world. The specter of global warming is causing us to be concerned about a myriad of public health threats ranging from increases in vector-borne diseases, to food and water shortages, to even warfare over dwindling natural resources. We haven’t had a full-scale pandemic since the late 1960s – which makes it increasingly likely that the next one will occur sooner, rather than later.
And then there is the continuing fear of bioterrorism. To add to the growing literature about this, in December, a bipartisan commission of the U.S. Congress released A World at Risk, a report that placed better than even odds that a terrorism event involving weapons of mass destruction will occur by 2013. The report expressed particular concern about a biological attack, and singled out Pakistan as the area of geographic focus – and that was before the Taliban had made it to within 60 miles of Islamabad.
If something truly awful happened, in the midst of the responders, relief workers, police and fire crews, you would see the public and environmental health profession. Our mission to protect the public’s health makes us one of society’s insurance policies against the kind of destruction, havoc, and human suffering that any disaster could cause.
A pandemic is one of the many “disaster” events we plan for. To date, countless plans have been developed and exercised through tabletop exercises and mock drills. But until now, everything has been in the abstract. We’ve done the fire drills, without the scorching reality of a real fire. That all changed when reports began to surface that a new and novel virus had emerged from nature and was killing human beings.
Suddenly, plans were put into effect, across North America and around the world. Real people were forced to work with real issues, in real time, with real consequences. As a result of the incredible response that was mounted, we now know far more about how to deal with this kind of emergency than we could ever have learned from the drill and exercise simulations.
We learned that our response has to be scaled to public expectations that are largely shaped by the media, not by the science of the issue.
We learned about the impact of Twitter on information flow within the community.
We learned how to coordinate in real time with a variety of agencies.
We learned how to make intelligent policy decisions based on the epidemiological course of a pathogen (which includes bioweapons).
And these lessons are just for starters.
As a result, we now stand better prepared for whatever might come our way tomorrow. Our overall preparedness has improved by quantum levels. And, thank goodness, this all seems to have happened in response to a threat that appears to have been weak and mild.
This month has no doubt stressed the meetings and travel industries, and that’s just one of many reasons that none of us would have wished for this outbreak. But the response to the 2009 H1N1 virus led to immeasurable improvements in our ability to confront serious threats to the public’s health – which is to everyone’s benefit.
I can only hope that this experience has also demonstrated how deeply the entire economy depends on a public and environmental health infrastructure that has been eroded by years of chronic underfunding. Everyone will benefit if the visibility of our work during the H1N1 scare generates greater support for the public and environmental health work force.

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