Throughout history there have been many outbreaks of disease that have resulted in high numbers of deaths. These epidemics have had and will continue to have very different impacts on particular health systems and societies. There are crisis management difficulties that are common to emergencies and disasters, whatever their origin.
Once again, experience has shown that in this type of health crisis, the number of cases may be less relevant than the presence of the disease itself. Some years ago, the Region of the Americas and the rest of the world mobilized to respond to six deaths resulting from Anthrax in the United States and 44 deaths from severe acute respiratory syndrome (SARS) in Canada. Both events had enormous social and economic consequences beyond the health sector.
The emergence of a new type of influenza in humans caused by a virus of avian origin (avian influenza A H5N1), and confirmation of human cases with mortality approaching 60%, prompted almost all countries to begin efforts to improve their capacity to respond to an imminent pandemic.
The terminology applied to this process was similar to that used for emergency and disaster management, including “preparedness” and “contingency planning.” However, in most cases progress was made only in developing preparedness plans that were known to a limited group of health officials. In a very few cases, operational plans were both developed and tested that involved all the key components of health and other sectors. In even fewer cases were personnel trained in tasks envisaged in the plan, or supplies and resources provided that would be needed to respond to a crisis.
With the confirmation of the pandemic (H1N1) 2009 virus that was easily transmissible among humans and that had potentially serious effects, response mechanisms were activated that were in direct proportion to the level of preparedness.
It was necessary to immediately take urgent steps to contain the disease at a time when there were many more questions than answers about its clinical features, transmissibility, the attack rate, effective treatment, the risk for health personnel, and effective control measures. However, prioritizing the health and lives of the population above other considerations was not without major social and economic impacts. These impacts were greater in sectors such as tourism, trade, and transport than in the health sector, and affected Mexico more severely than other countries.
In such a situation, it is not surprising that there were issues common to other health crises. Of note were decisions based on fear, the emergence of rumors and conspiracy theories, the intrusion of political and economic factors, and insufficient official information. These problems were multiplied by the press and electronic media, which were sometimes much more difficult to control than the disease itself.
Counting confirmed cases became the highest priority, and the media demanded this from health authorities. Suspected cases were not as important, even when they were serious or caused more deaths than the new virus.
Other national priorities and more pressing public health needs were put aside, and sometimes the pandemic was used for purposes that had nothing to do with control of the disease. In such a context, the public expects and often demands authorities to carry out visible and urgent actions to demonstrate their concern for protecting the health of citizens. Among the most common are closing airports and using extreme measures to control foreign borders. Such actions require a major investment of resources and personnel, and have proven time and again to have little value in preventing a disease from entering a country.
The health sector took the lead in responding to the outbreak in almost all countries, but in many cases, they also took charge of actions that should have been dealt with by other sectors and actors, were unrelated to surveillance and diagnosis of disease, and were only marginally relevant to the response, if at all. A major weakness was the lack of more active involvement from the health services network, precisely those who were treating the sick.
Why all the actors who were involved in preparing for the pandemic did not take action during the response phase is an important question. There are still major challenges in combating this disease, which is here to stay, and whose future behavior may be more severe than what we have seen thus far. It is imperative that the health sector, where it has not done so, be open, strengthen coordination with other sectors, and share responsibility. Institutions and countries as a whole must recognize and make better use of their national potential.
It is still possible to strengthen information management, improve how institutions build capacity, use a multisectoral approach to solving problems, and to make the most of regional solidarity. We must remember that new problems require new resources. It is necessary to maintain a balance between responding to the pandemic and other public health priorities.