Fourthly, once a pandemic gets underway it is extremely difficult, often impossible to control its spread. Quarantine, travel restrictions, closure and isolation have little effect.
Fifthly, we now understand that Influenza is permanently maintained in natural reservoirs among migratory aquatic birds in parts of South Asia and that epizootics or epidemics occur frequently among such hosts often allowing the virus to invade nearby domestic birds and animals. Finally, our search for a vaccine to confront major influenza outbreaks struggles against the ability of flu viruses to adapt, change and mutate.
So how should we prepare for the next pandemic?
In the first place we need to recognise the significance of the biophysical environment and the significance of zoonotic or animal infections.
To this end we need better surveillance of animal diseases at home and abroad.
Secondly, we also need to glance back at the history of how we responded to past epidemics and pandemics and the wrangling and disputes and lack of cooperation that characterised the relationship between the Commonwealth and the States as they struggled with finding a way to address the crisis.
Thirdly, we need to carefully reassess the containment measures advanced to try and control past pandemics, and in particular how successful such measures were and how they impacted upon ordinary people.
Fourthly, there is little doubt that we require a rapid diagnostic and surveillance system that quickly identifies the threatening disease agent and what might be done to contain it. To this end we need to stockpile relevant anti-viral and antibiotic drugs always recognising the ability of the flu virus to mutate and change every year.
Fifthly we need to have in place an emergency hospital and healthcare arrangement that can be activated in times of crisis. A continuing problem which marks all epidemic and pandemic encounters in Australia is the failure of Governments and medical authorities to recognise that epidemics and pandemics have a significant human dimension and are as much psycho-social events as epidemiological ones.
Critically we need to acknowledge the importance of understanding how ordinary people regard risk in their lives. There is a failure to recognise the dissonance that exists between how "experts" and "ordinary" people view risk. Risk for "experts" and governments is a definable measurable phenomenon.
For most of us, however, risk is, the way we view the world and the people around us. It is a social phenomenon, emotionally constructed. People harbour deep-seated fears about contagion which are a mix of rational and irrational fears about exposure, infection and "outsiders". Fear is also highly contagious and considerably influenced by the way governments respond to pandemics as well as by the way the media often presents sensational stories and imagery. We need to understand that containment and management procedures such as quarantine, isolation, surveillance, restrictions on movement and closures of public places may aggravate fear, hysteria and panic and that during times of pandemic crisis people have little confidence in the Government and medical profession's power to protect them.
Finally we also need to encourage people to embrace "old fashioned" concepts of personal hygiene and preventive strategies as well as show concern for vaccinating their children against common childhood infections.
In the final analysis if we do not learn from the past we run the risk of repeating the mistakes made. As Ashburton-Thompson, possibly Australia's greatest Public Health practitioner remarked in 1899 - "The brilliancy of modern discoveries blinds incautious eyes to old truths and often endangers sound practice".
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