Updates & Alerts

A Lesson on PREPARE-ing

the midst of the 2009 H1N1 (“swine flu”) outbreak, International Medical Corps launched the USAID-supported PREPARE project, partnering with local and national government authorities in low-resourced countries in Africa and Asia for disaster management and pandemic preparedness planning. PREPARE aims to “strengthen multisectoral whole-of-society pandemic preparedness and response.”

If you understand what that means, you’ll probably survive the clearly imminent zombie apocalypse. But since I don’t—and probably won’t—I decided to check in with PREPARE Project Officer Jacob Schafer in an effort to better understand his work. Admittedly, I had low expectations for our conversation, based on photos of PREPARE depicting conference participants sitting stiffly in front of PowerPoint presentations. But to my surprise, I found myself fascinated by Jacob—a self-proclaimed fatalist—and what he’s doing to save the world from his own worst-case scenarios.

Jacob begins by telling me the background of PREPARE, which came out of USAID’s Emerging Pandemic Threats initiative to complement activities on zoonotic disease (ie. those transmitted from animals to humans) identification and prevention. When PREPARE was launched two years ago, International Medical Corps implemented the concept of a “whole-of-society” approach to pandemic preparedness and response planning. I learn that this means exactly what it sounds like: PREPARE works on the regional, national, municipal, business, sectoral, and—recently piloted in the Philippines—community level to facilitate planning for pandemic outbreaks.

According to Jacob, “Almost every country has a pandemic preparedness plan at the national level, but this is usually a  health-centric plan that is not filtering down. Historically, we have found that health systems quickly become overwhelmed during a pandemic. So we want to make sure that the rest of society is prepared by deleoping plans to mitigate the non-health impacts of a pandemic.”

I stare at him blankly, unable to picture how a pandemic—possibly one of the scariest words in the English language—gets “mitigated.”

“But what does that mean?” I ask in frustration.

“Ok…” Jacob sighs, “Think of ATMs, for example. People get money from ATMs, but people also stock ATMs. If there were a high level of bank employee absenteeism due to a pandemic, ATMs would quickly run out of money.  An overwhelming amount of people would show up in person at banks, which would both spread the infection further and potentially cause a run on the banks.  Public fear, panic, and civil unrest could soon follow.”

I nod, wide-eyed and riveted now. Jacob smiles, “So we make a plan to keep that from happening.” My mind flashes to the chaotic mob scenes of the movie “Contagion” and I imagine myself savagely fighting with a hockey stick for the last almond milk smoothie at Whole Foods. A “plan”? “So you plan to survive an apocalypse with pieces of paper and PowerPoint presentations?” I ask. I plan to survive by joining a gym… which I swear I’ll get around to one of these days.

Jacob replies, “Well, we’re not developing a vaccine, which is often regarded as the silver bullet. Even in the best circumstances, it could take several months for a vaccine to be developed, produced, and distributed following an outbreak.  Instead, PREPARE strives to stop society from collapsing by making sure that essential societal sectors and key service providers can deal with pandemic impacts, such as high employee absenteeism, disruptions in supply lines, and shifts in public demand.  In other words, making sure that money is available and food prices don’t inflate; people can continue to take public transportation, work, go to school; air traffic control, airports, and customs still operate; and so forth. Basically, ‘business as usual’ during a pandemic.”

Still emotionally scarred from watching “Outbreak” as a young child, I would never have guessed “business as usual” and “pandemic” could be used in the same sentence. But Jacob reminds me there’s a science to it: “In real life, it doesn’t happen overnight. And things need to keep functioning in the meantime.”

Plus, Jacob continues, PREPARE really serves as “All Hazard Preparedness,” readying nations for any type of major disaster by using pandemics as the model scenario. He tells me, “It’s like having an earthquake survival kit. You live in California, so you have one of those, right?” I grimace, silently berating myself for failing to prepare a backpack of granola bars and freeze-dried ice cream for the inevitable BIG ONE.

But ok, I’m starting to see Jacob’s point. Still, how do you convince nations—specifically the eight African and Asian countries that PREPARE targets—to prioritize prepping for a future no one can predict over all of the things killing people today? Jacob acknowledges that global “pandemic fatigue” has set in since the bird flu, swine flu and SARS scares a couple years ago. His is an uphill battle. But, I learn, it shouldn’t be.

In 1918, around one-fifth of the world’s population (50 million) died from an influenza pandemic (“Spanish flu”). If a pandemic of that nature were to hit the globe today, it is estimated that at least 62 million would die (Scientific American). Further, in the past 70 years, a number of new diseases have “jumped” from animals to humans. For example, H1N5 (“bird flu”) is super deadly, but doesn’t yet spread person-to-person. H1N1 (“swine flu”) is not particularly deadly, but it spreads very easily. If these two viruses were to mutate, we’d have a fast and deadly strain spreading far more rapidly than the science needed to develop a vaccine.

Predictably, developing countries would be hit hardest, mostly because they lack the resources to respond. But contagious diseases don’t respect borders. As Jacob says, “Every single person would be at risk.”

My stomach sinks with the gravity of this.

“Yeah…” Jacob trails off as my face goes white. “We can’t really eradicate the risk. But we’re trying to minimize the impact.”

I fish for the silver lining, suddenly feeling like PREPARE’s most passionate advocate: “But minimizing the impact would in turn save lives, right? By keeping us from descending into barbaric chaos?”

Jacob nods, “That’s the hope.”

“So you are driven by hope,” I tell Jacob, who breaks into sheepish laughter. “I don’t think you’re a fatalist after all!” I exclaim excitedly. “If you were, you would just throw up your hands—or not bother to pack an earthquake survival kit.”

“Who knows,” I continue, “You and your PREPAREdness may even save the world one day.”

The U.S. Agency for International Development (USAID) PREPARE project is implemented by International Medical Corps. In 2012, International Medical Corps’ PREPARE team has been implementing preparedness initiatives in Cambodia, Indonesia, Lao People’s Democratic Republic, and the Philippines in Southeast Asia, as well as in Tanzania, Uganda, Kenya and Ghana in Africa.