Waiting for the next killer

It is forty years since Europe was last hit by a pandemic, yet the threat is ever-present, writes Emily Smith.

The EU has not witnessed a pandemic since the last global influenza outbreak in 1968. Many Europeans thought that rising wealth and living standards, together with a life expectancy in many EU member states of more than 80 years, meant that the days were over when a headache could signal a fatal illness for much of the world.

But chickens and swans have brought the fear of death back to many EU households.

In October 2005, the pathogenic avian flu virus H5N1 was detected on the EU’s doorstep, when poultry carrying the deadly strain were identified in Turkey. The same month, the first EU bird cases were reported in Greece and subsequently across many other EU countries in 2006.

This February more than 160,000 chickens were slaughtered in the UK, after H5N1 - or bird flu - was found on a farm in eastern England, apparently having been transported from Hungary. In July, France confirmed that wild swans, a second common carrier of the disease, had brought bird flu to the east of the country.

A deadly human variant of the disease has so far not reached Europe. Even globally, bird flu cannot be said to have caused a pandemic: a widespread human epidemic.

This does not mean that European officials and politicians have let down their guard. Birds have inspired the European Commission and every EU member state to look for the best way of preventing a new pandemic descending from the skies.

Their work is being co-ordinated from a 120-year-old red-brick building in Sweden.

When governments agreed to set up a European Centre for Disease Prevention and Control in 2004, few expected it to play such a high-profile role in EU policies so quickly. Now known as the ECDC, the Stockholm-based EU advisory body has had its work cut out since opening its doors to national experts on 20 May 2005.

A series of bird flu outbreaks in Asia, followed by human cases in Turkey, had all of Europe wondering if it was ready to handle a twenty-first century pandemic.

Professor Angus Nicoll, responsible for influenza work at the ECDC, believes that the 39-year gap since the last influenza pandemic hit Europe has been a lucky break, rather than a sign that times have changed.

"It would be extraordinary if history had stopped and we did not have any more pandemics," said Nicoll. "No one is seriously suggesting that."

The rising number of elderly people and people with chronic illnesses in the EU makes it more vulnerable to the next pandemic than ever before, he said. And many conventions of modern life, such as the short-term supplies of food delivered to shops to guarantee optimum freshness, rely on having steady transport links and healthy staff.

Many European pandemic plans project that up to 20% of the population could be incapacitated in the event of a pandemic. Though this might sound, said Nicoll "no worse than Brussels in August, when almost everyone is on holiday" a pandemic would hit vital energy supply or food transport staff indiscriminately.

The ECDC is therefore working to make sure the EU countries and Iceland, Liechtenstein and Norway are fully prepared for whatever hits them.

Liechtenstein in October became the last of the 31 countries to have its national pandemic preparedness plans assessed by the ECDC. Each assessment takes three months, starting with a questionnaire asking what countries have done and not done to prepare for a pandemic, and what they would like to focus on. ECDC staff spend four days with the national authorities in the middle of each assessment, looking at the different sectors affected.

Nicoll said it made more sense to co-ordinate pandemic preparedness programmes at EU level than to let each country tackle the problem in its own way.

"To start with, we can make sure everyone is working from the same template," he said. "It is very easy to miss things when there is so much to be looked at. We can make it much more likely everyone covers the same areas."

Having the ECDC keeping an eye on things had also encouraged member states to commit themselves to strong action and follow things through, said Nicoll. "It is relatively easy to publish a polished plan and to buy some anti-viral drugs," he said. "But unless you decide what you are actually going to do at a local level in the event of a pandemic, you will not be prepared."

"Where would people get medication in the event of a pandemic, when the doctors will be overwhelmed?" he said. "How will hospitals cope with 20% of their staff out of action?" ECDC has published a set of local ‘acid tests’ to assist in this.

Perhaps most importantly, ECDC co-ordination means that countries can benefit from each other’s work, said Nicoll. This had been the case for Sweden, which will be basing some of its future preparedness work on similar work already carried out in the Netherlands. A UK video to teach people about pandemic influenza has also been made available around Europe.

A report on lessons learnt from the 31 pandemic preparedness plans is expected from the ECDC before the end of the year. But the agency will not be offering EU-wide ‘one-size-fits-all’ advice on issues such as schools closures in the event of a pandemic, saying that it is better to take the action most suited to the region in question.

Nicoll said no one in Europe could afford to take their eyes off the threat, or to forget that infections will always be there. To make his point, he quotes the late American bacteriologist Hans Zinsser: "Infectious disease is one of the great tragedies of living things, the struggle for existence between two different forms of life. Incessantly the pitiless war goes on, without quarter or armistice."

It is forty years since Europe was last hit by a pandemic, yet the threat is ever-present, writes Emily Smith.