Learning From Past Health Pandemics

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Author Laurie Garrett has written about pandemics in her book The Coming Plague: Newly Emerging Diseases in a World Out of Balance. Garrett, a senior fellow for global health at the Council on Foreign Relations, talks with Renee Montagne about what has been learned from other public health crises.


We turn now to Laurie Garrett. She's written about pandemics in her book, "The Coming Plague: Newly Emerging Diseases in a World Out of Balance." She's a senior fellow for global health at the Council on Foreign Relations, and joins us from New York. Good morning.

Ms. LAURIE GARRETT (Senior Fellow, Council on Foreign Relations; Author, "The Coming Plague: Newly Emerging Diseases in a World Out of Balance"): Good morning.

MONTAGNE: Now as someone who studies epidemics and public health, what information is still missing that you would want to know?

Ms. GARRETT: Well, the big thing we don't know that I would love to know, that we need to know, is how many people in Mexico have been infected. We have a good idea of how many people been hospitalized, and a fair idea of how many may have died, but we don't really know what percentage of the overall epidemic these other two figures represent. So without knowing what the baseline is, what the denominator and the equation is, it's very hard to calculate whether we're looking at something that has a significantly higher potential to kill people than normal flu does, or something that is far more transmissible than normal flu. We don't know.

MONTAGNE: What does the world know, though, both from history and - you know, we've been talking a lot these last few days about the 1918 influenza pandemic and also swine flu in the '70s - and from recent public health crises about, you know, how to respond to an emergency like this?

Ms. GARRETT: The global community in public health, and in particular in the United States, has undergone a pretty good learning curve, a maturation, if you will, over the last, roughly 10 years. This is largely because of our experience with the SARS epidemic. And in addition, in this country, with our experience with the Hurricane Katrina debacle and, of course, 9/11 and anthrax mailings.

All these sobering incidents have forced public-health officials and the infrastructure as a whole to take a hard look at itself; rethink how it was responding to new, suspicious outbreaks; and vastly improve the way that all the various pieces of the machinery of public health interact in a crisis.

MONTAGNE: Well, give us an example. Some states, obviously, here in the U.S., have held formal exercises to test out their emergency preparedness for a public-health crisis. Federal government has a formal response plan in place. How does the response so far in the U.S. compare to these ideal scenarios?

Ms. GARRETT: Well, we have not yet been threatened at the level of any of the flu pandemic plans. So fortunately, they've not been yet been put fully to the test. But we do see that every state, every locality in the United States - and this is true in most European countries, Canada, Mexico and certainly in Hong Kong and parts of Asia that experienced the SARS epidemic - there are now plans that try to solve the biggest problem, the biggest weakness we saw in the past, which is, exactly what is the chain of command? Who's in charge? And at what point are the police involved? What point are other kinds of emergency responders involved in both executing plans to control the spread of disease and the decision-making process? And who, ultimately, does everybody answer to?

Now one thing for our government that's made it a little dicey is that we've not had most of our top positions in the federal government filled, starting with the secretary of Health and Human Services. And I see that Senator Gillibrand has issued a rather strong statement, calling upon her colleagues on the other side of the aisle - she being a Democrat from New York - to stop trying to slow down the confirmation of Sebelius for the position of secretary of Health and Human Services.

MONTAGNE: We just have a few seconds left. But, you know, this threat level that's now gone up to four, how worried should people be?

Ms. GARRETT: Well, it's not something that individually makes much of a difference. The big thing is what it means to governments. The governments clearly need to be on a higher state of vigilance, higher state of surveillance, paying closer attention to what's going on in their populations and being prepared to mobilize, if necessary.

MONTAGNE: Thanks very much for joining us.

Ms. GARRETT: Thank you.

MONTAGNE: Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations. She's also author of the book "The Coming Plague: Newly Emerging Diseases in a World Out of Balance."

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