PARIS, May 8 — On this quiet holiday in France, nearly 30 public-private sector representatives gather for day two in their exploration of pandemic flu preparedness issues at a meeting co-sponsored by the French government’s health ministry and the Atlanta-based Safe America Foundation.

Twenty-four hours later, following the formal meetings and informal discussions, I leave for the United States more optimistic than I have been over past months of participating in various programs on the potential for a global influenza pandemic. 

Having the opportunity to understand a good deal more these last two days, I am struck by the challenges we face — not only the medical and scientific, economic, social and moral challenges that a pandemic portends — but also by the underlying matters of heart, spirit and culture that would enable us to prevail against awesome obstacles — or not.

The prospect being discussed was the emergence of a person-to-person flu epidemic that is triggered by a virus that humanity has not experienced, and for which we have no immune responses. We are talking about an ultra pandemic like the influenza epidemic of 1918 that took the life of a grandfather I never met, along with 675,000 others in the United States, and millions worldwide. “This is possibly the greatest human security vulnerability today,” said Robert P. Zook, president of World Vision International at the Paris meeting.

Paradigm Shift

Earlier discussions in the public pandemic forums and private working sessions of the Safe America Foundation had been about avoiding the person-to-person spread of the flu virus through isolation of individuals from one another. Various techniques of social distancing would keep healthy people at a distance, and isolate the infected and those closest to them. 

The emerging paradigm calls for people to shift into a self-survival, crisis-management and preventative mode; for example, through stockpiling necessities, working at home as we all ride out the successive waves of a flu pandemic, and by somehow keeping a good sneezing distance apart, if one must be in the office.

By itself, this is a dark place and a grim model. It connotes uncertainty, hopelessness and vulnerability: the ingredients of fear. And it’s not practical. People cannot stay home for extended periods of time. Vulnerable segments of the population cannot be left uncared for. Bob Zook’s group, like UNICEF and other NGO’s, care for the very needy in the poorest countries. Just to stay in the game, these non-government organizations need to protect their staffs and volunteers.

So too must governments protect first responders, medical personnel and people designated as necessary to keep the critical infrastructure going. The same applies to businesses that support the critical infrastructure.

Enter moral issues. Does a critical employee guard themselves with antivirals, respirators and protective gear, leaving her family to fend on their own? How do limited supplies get allocated? It’s a question asked repeatedly as the team sifts the issues.

In listening to deeply knowledgeable people who have been on the front lines recommending and drafting policy, my sense is that even when there are answers in the can, real-life, pragmatic developments will drive the decisions at the time of crisis. Like governments, major companies that have worked through their pandemic plan will also be making adjustments in the reality of the moment.

Human Continuity

Underlying the policies and plans that have been established (by teams of staff supported by consultants) is the fact that these concepts are being refined and improved as more understanding is developed. But, to me, the refinement and evolution is itself strong.

If I heard correctly, this evolution of pandemic planning and policy has moved from the dark and defensive to something far more positive — a commitment to continuity: economic continuity, social continuity or as Lamar McEwen of Delta Airlines said, “We at Delta call it human continuity.”

Through the 16 hours of discussion, the notion of human continuity emerges as the underlying goal for strategies that have been and that are now being developed.

I like this. It reframes the dialogue, inviting strategic creativity, ingenuity, cross-sector, cross-platform interactions. During the Paris conference, Dr. Didier Houssin, director general of health for the French government, welcomed a colleague from agriculture. This department of the French government joined the pandemic task force that Dr. Houssin leads as we were meeting. (Interestingly, Le Figaro reported that the H5N1 virus risk in agriculture dropped to Level 2 of 6. (LeFigaro, May 8, 2007, “H5N1: la France abaisse son niveau de risqué” p 25.)

Claude Wachtel, representing the Minister of National Defense, talked about how chemical, biological and nuclear defense planning relies heavily on contingency planning to enable continuity. He and Dr. Houssin emphasized that preparedness for an influenza epidemic can help with preparedness for other threats.

Opportunities, Observations and Actions

In effect, the discussions can be seen as serving as an agenda-enriching session. With that in mind, following are some of the opportunities, observations and actions that are worth noting.

Simulation offers the opportunity to bring together the multiple players from government, institutions and business to make decisions and communicate when a pandemic crisis unfolds.

Mark Chussil, founder and senior director of Crisis Simulations International LLC, demonstrated his firm’s multi-user computer simulation tool. Crisis, he explained, occurs in an emergency that’s flavored with novelty. A flu pandemic would be akin to the Katrina hurricane response in the New Orleans or the Chernobyl nuclear disaster in the Ukraine.

In both cases a number of experts were called into play, but they had not encountered such problems before and had not been brought together to work in decision making with the multiple agencies that responded to the events.

As an illustration, a simulation scenario in Kansas City involved the death of a university student recently returned from his Asian home, vigil anti-barricade to prevent newcomers from driving into one community and contaminating residents, a mid-day decision as to whether schools should be let out or the children retained, and a nearby airport where the fly/no-fly decision was pending.

Events flow forward based on decisions made by the players — governor, state police commander, and public health director, for starters. Each decision results in an outcome based on the simulated decision-maker’s choice. Meanwhile, in the background, the noise of news commentators, talk show hosts, and emergency radios can be heard. These messages also change depending on decisions made in the simulation.

The tool could be employed in a simulation of the current pandemic plans in France and the United States. It may well be used on a multinational scale, possibly the health meeting of G7 + Mexico or within the E.C., said Dr. Didier Houssin, director general of health in France.

As suggested by the quality of the responses, simulation offers much promise. It not only can provide real-world training experiences, and from them the opportunity to learn and improve, but it also generates a way to help keep the issue of preparedness top of mind.

If simulation moves further, I believe that, among other things, the Safe America Foundation can play a unique role by monitoring the process and generating third-party reports on best practices and learnings. These would provide a stream of improvements in preparedness, which as noted above, can be useful in many other threats.

Cross–Platform Planning and Development

In general, participants said they value the opportunity to consider a common issue and learn across sectors. Robert W. Dry, a counselor with the U.S. embassy in Paris, said corporations collectively bring valuable experience from their continuity planning. He said they could be a resource for instruction, training and workshops.

Looking to the future, Dr. Jeffrey Levi, executive director of Trust for America’s Health, said the pool of businesses involved should be broadened, reflecting the larger, general economy as well as major not-for-profit organizations.

Global corporations might (can and should) be engaged two ways: (1) on a business basis with those that have direct experience in health, pharmaceuticals, vaccine and other members of the health care channel who have much to offer as commercial suppliers; and (2) from the corporate viewpoint of corporate social responsibility — the emerging opportunities to further debate open a role that several companies ought to embrace.

Define the Issue | Brand the Initiative

The issue is not really clear among medical, governmental and business people. Without delving into reasons why, Jadranka Bozja, with Emory University’s Department of Microbiology and Immunology, called for clearly defining terms and — once done — branding the issue as was done with Y2K. “People …don’t understand,” said Ms. Jadranka.

The situation and technical issues require clarity. Once details of what is being addressed are defined, the pandemic challenge should be given a brand identity, as with Y2K, she argued.

Throughout much of the discussion, participants asked, “How do we sustain interest?” Many following the matter closely say that the occurance of a pandemic is a matter of statistical certainty, though we don’t know when it will occur nor whether it would be the H5NI, some future mutation of that or another virus altogether.

Privately after the session, one colleague exclaims, “With this doom and gloom — this is not an appealing topic by any means — how can you keep people interested? I mean, is this even going to happen?”

Communicators Needed

Calling for clarity, definition of terms, and a brand identity to facilitate consumer-level communications, it is clear to me that public relations and professional communications are needed to facilitate both preparedness and the “inevitable” dealing with the issue. Interestingly, The Safe America Foundation has a number of PR and ad agencies involved as well as media organizations themselves. In the weeks ahead, I think we can reach out to these groups and explore how they could contribute today in the preparedness phase, and potentially during a multi-phase occurrence of a pandemic.

Dr. Houssin questioned whether it’s a matter of “popularity” of pandemic as a product. On the contrary, he said, it is “extremely popular” even with the up-and-down amount of media coverage. He noted that society manages preparedness and awareness of other major threats, for example, fire and national defense.

The flu pandemic issue is not limited as a health matter, Dr. Houssin said. It is more like defense (involving multi sectors) so the challenge is what methods should be employed to sustain preparedness. Another participant recalled a story of a South Pacific island that had a tradition of posting a watch on its highest peak to scan the horizon for a tsunami.

Conclusion? Communications, as mentioned in an earlier post, will be a powerful ally in preparing for and living through a pandemic, but the public institutions need to be organized and equipped on a multi-sector level to sustain preparedness.

Emotional Care

Oscar Morgan spoke to the emotional and mental health issues that will arise during a pandemic. Key points from the discussion:

•    Accurate, consistent information will be required to help reduce fear and anxiety

•    How will the emotional needs of people who are affected by deaths and illness be addressed? There will be a need to engage a community of healers, understanding that sometimes people who have been traumatized can be the best resources for this

•    Funeral directors will be confronted with multiple cultural issues related to death and dying

•    Prisoners and the homeless need to be considered

•    Overall, the issues will be one of trust. There is a legacy of distrust (of authority) to be overcome in the United States. Faith-based and community organizations must be engaged, and we need to be having an honest conversation about how government can and cannot respond. There is value in the idea of starting citizen groups that could augment the public sector

What Does it Mean?

Whether France or the United States, the discussions drew the conclusion that despite all that has been accomplished, much more lies ahead. The more time that passes between the present and the time when a pandemic arises, the better prepared society will be.

The options we have are as varied as the participants. Should we confront pandemic as a war using a civil defense model and marshalling command, control and communications. Or should we flip the horrifying aspects of pandemic and look at it as a new project, perhaps even with an aspect of fun?

Though there is no single course of action, there seemed to be consensus that business and governments need to collaborate further, and that both had gained from what Dr. Houssin calls “ the magic of gatherings.”