Pandemic Influenza Top of Mind for CDC Director

It may not make for the hottest of headlines in the mainstream press, but Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC) was right to cite pandemic influenza as the infectious disease that “worries [him] the most”—at least if you go by the statistics.

Dr. Frieden made the statement in response to questions that had been asked for a recent feature in The Wall Street Journal on how governments and business organizations should prepare for pandemics. The conversation also included Susan Desmond-Hellmann, MD, chief executive of the Bill and Melinda Gates Foundation.

In light of all the headlines this summer regarding the Zika virus epidemic in Brazil, the Caribbean, and Florida—and now with new locally transmitted cases of the mosquito-borne virus confirmed in Texas—both public health leaders could be forgiven for perhaps focusing on the “infection-of-the-moment.” However, while Dr. Frieden acknowledged that the CDC “start[s] a new investigation that could identify a new pathogen” essentially every day; it is the age-old challenge posed by influenza that continues to, pardon the pun, plague him and his colleagues.

“Bill Gates has said there are really only two things that could kill 10 million people around the world: Nuclear war and a biological event, either intentional or natural,” he told the paper. “It has happened before—in 1918 and 1919, 50 million to 100 million people were killed. Even the 1957 influenza pandemic, which most people haven’t heard of, cost 3% of the world’s gross domestic product … We don’t know when the next one will come, where it will come from or what it will be. But we’re certain there will be a next one.”

Although the United States is not currently experiencing an influenza pandemic—in fact, seasonal flu cases confirmed since early October number only in the hundreds rather than the thousands or higher, according to the CDC—Dr. Frieden’s agency does have a “National Pandemic Strategy” in place should one occur. The World Health Organization (WHO) reports that as many as 10% of all adults and 30% of all children worldwide are diagnosed with influenza A (H1N1 or H3N2) annually; the virus causes as many as 500,000 deaths a year. The more severe avian influenza, H5N1, has caused hundreds of infections since it first emerged in 1997, and has resulted in many deaths over that time, according to WHO.

In comparison, Zika virus has, to date, been confirmed in less than 180,000 people globally, and caused just 15 deaths, according to WHO, which is not to diminish the effects of Zika on those infected.

Speaking to The Wall Street Journal regarding another threat of global proportion, Dr. Desmond-Hellman stated, “What we learned from Ebola is that there are a couple things that are underutilized and not ready. One is governance. Who makes the call when things happen? The second thing is having the right tools, which is why global health research-and-development is a big focus of our foundation. And the last thing is, even though the world is worried about something really super scary … we all saw last summer how something like Zika, which wasn’t thought to be a big threat, actually is a particular threat for women who can get pregnant because it causes a catastrophic birth defect … So understanding these new pathogens, understanding what we need to do from a governance standpoint, and having tools, starting with diagnostics so we can spot new pathogens, are a big focus.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.