Conference sponsored by:

Center for Biosecurity of UPMC

Deutsche Bank

The Contingency Planning Exchange

Opening Remarks
Tara O'Toole, M.D., M.P.H., CEO and Director, Center for Biosecurity of UPMC

Speaker biography  |  Video

I am going to introduce our first two speakers, but first I want to say a few words about the nature of the problems that we are going to address today. Almost every day we hear news reports and updates of human cases of avian influenza in Asia, or expanding zones of infection among wild birds, or warnings from researchers and public health officials of the potential peril of an influenza pandemic in the next year or two or three.

It's important to understand that the H5N1 strain of influenza is unlike any strain of influenza seen previously. No one has immunity to it. This strain is highly lethal to chickens, but it is also capable of infecting other bird species, as well as pigs, felines, and humans. Over 100 million domestic poultry in Southeast Asia have been culled, but the virus is now understood to be endemic in wild migratory birds, which means that it cannot be eradicated from the planet. It possesses uniquely virulent properties.

More than 100 human cases have been documented, with a death rate ranging from 40% to 70%. The number of human infections so far in 2005 is twice the number observed in 2004. It is possible, indeed it is probable, that some milder cases are not being identified, but the numbers of these unidentified cases are unlikely to be large. Thus far, most human cases have occurred among people who have had close contact with infected chickens. However, the virus is steadily changing genetically, as influenza viruses customarily do. A genetic change in the virus that favors transmission among humans and maintains the virulent properties of this virus could trigger a global pandemic.

Estimates of the numbers of people who would die, were such an event to occur, vary from millions to tens or even hundreds of millions. The 1918 influenza pandemic was, by far, the most furious epidemic to afflict the world in the past two centuries, and it is estimated to have killed somewhere between 20 to 100 million people. In the United States, 675,000 people died in a matter of months during the 1918 influenza pandemic, and this in a population one-third the size of the country now. For our present population, that would represent 1.7 million deaths, again in a matter of months. These numbers pertain to the 1918 strain of the virus that had a mortality rate of 1.0% to 2.0%, not the 40% to 70% mortality rate we are [currently] observing with H5N1.

Now many might suppose that modern medicine would result in more favorable outcomes for patients than was the case in 1918. That expectation, as I stand here, is not likely to be realized.

The world has only a small supply of the one antiviral medicine that is known to be somewhat effective against H5N1, if -- if -- given quickly enough after infection. Countries are rushing to obtain stockpiles of antiviral medicines, and manufacturers are struggling to fill requests. Most of the developing world will be unable to afford these drugs, and the logistical challenges of distributing medicines in time to stop the spread of disease are formidable. An experimental vaccine is now being tested at the National Institutes of Health (NIH), but there is no possibility of manufacturing an adequate supply of vaccine for the 2005-2006 flu season, and unless heroic efforts are undertaken immediately, there is little chance that there will be enough vaccine to cope with a pandemic a year or two years from now. Few hospitals in this country have yet developed any plans for handling the surge of patients who would seek medical care during an epidemic. Indeed most U.S. hospitals are operating at or near maximum capacity on a routine basis, and in recent years have been stressed by the demands of ordinary, mild flu seasons. [Given all of this], there are ample reasons why the financial industry should be concerned about avian influenza.

We are very fortunate, and indeed honored, that many of the planet's leading authorities on influenza are in this room today. They have all graciously agreed to participate in this program, in part because of the importance of this audience.

You are about to hear from the scientists and public health officials and government leaders who are key players in the effort to alert or, if necessary, to respond to a global pandemic. You will also hear from people who have studied past disease outbreaks and their consequences, and who have important lessons to impart. Their willingness to be here today, interrupting horrendously busy schedules -- Dr. Venkayya was up all night dealing with Hurricane Rita, for example -- that people have flown from all over the country as well as from Europe and Asia to be here, is testimony both to the magnitude of the threat, and again, to the importance of this audience and to what you can do.

The organizers of this conference hope to achieve three aims. First, we want to convey the nature and the dimension of the problem of pandemic influenza and the range of activities underway to deal with it. Secondly, the program is intended to give you in the financial community some practical suggestions on how you might prepare to mitigate the effects of a pandemic on your employees, your operations, and the communities in which you work. And thirdly, although this conference is an educational event, we also hope it will serve as a call to engagement and a catalyst for leadership.

If the calamity of the pandemic comes to pass, the world will depend heavily on the talent and the operational capabilities and vision of the private sector, as Seth mentioned.

Epidemics are an ancient scourge of humankind. For almost two generations now the developed world has, for the most part, enjoyed a respite from the large, lethal, fast-moving outbreaks of infectious disease that have visited history, but this period is ending. Population pressures and commercialization are bringing humans into contact with once remote ecosystems and with new viruses and pathogens. Modern travel and globalization mean that a single patient infected with SARS staying in the Metropol Hotel in Hong Kong infected others who moved the virus across four continents in a matter of hours.

Resistance to available antibiotics and antiviral drugs is increasing, and drug companies are increasingly reluctant to create new anti-infective therapy, given other pressing medical needs which offer greater opportunities for profit at less risk. And finally, revolutionary advances in bioscience, which will be a great boon, coupled with the phenomenon of the Internet and catastrophic terrorism, mean that deliberate attacks on civilians using biological weapons are a real and imminent possibility.

But the good news -- and there is good news -- is that advanced planning and preparation for epidemics, whether they be deliberate or naturally occurring, matters. Preparation matters a great deal and can make a big difference. As we witnessed in 9/11, and as we saw after the attacks in Madrid, in London, and in the wake of Hurricane Katrina, the private sector has an extraordinary capacity for situational awareness, for planning and innovation, for rapid, agile response and communications. I think this program today will persuade you that the world now has great need of these abilities in the context of avian influenza.

Please feel free to ask critical questions and to think aloud about how your company and others might protect its people and their interests, and how the talents and capacities of the private sector might work to lessen the deaths, the suffering, and the economic and social disruption that might follow in the wake of a pandemic flu.

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