Swedish researchers are trying to find out how to prepare the country for potential pandemics. Photo: Hans Bjurling / www.imagebank.sweden.se

Over the past 300 years, severe pandemics have swept the world around a dozen times, striking down great swathes of population. The question is not whether a new pandemic is coming, but when. To reduce the impact of such a disaster, and to ensure that societies continue functioning come what may, there must be a high level of emergency preparedness, based on solid scientific knowledge.

Interdisciplinary hunt for clues
With this in mind, Fredrik Elgh, an assistant professor and senior consultant in pathology and virology at Umeå University’s Department of Medical Biosciences and Centre for Population Studies, has launched a research project that will involve studying the four latest pandemics – Russian, Spanish, Asian and Hong Kong flu – from an interdisciplinary perspective.

Researchers in the social sciences, humanities and medical sciences are taking part in the project, entitled “Historical influenza pandemics as a source of information in emergency preparedness planning.” Starting with the wealth of Swedish source material available to them, the researchers are examining the pandemics from a socio-historical, epidemiological and demographic perspective.


Assistant professor Fredrik Elgh is one of the key researchers in the pandemics project in Umeå in the north of Sweden. Photo: Private

“We’ll be looking at demographic databases, church records, media material and correspondence between doctors who were active at the time of the pandemics,” Elgh says.

Conclusions for the future
The idea is that by studying what preparations were made and what actions people took in those days, and what rules and regulations were in force, the team will gain an idea of the best way to respond next time a pandemic occurs.

The aim is to learn how the outbreaks affected society and the people in it. What happens if schools are closed down? What parts of the community cease to function when sickness is widespread? Which social groups are hardest hit, and should they be given special protection?

“Sweden today is a fairly homogeneous society in socioeconomic terms,” Elgh says. “If a bad pandemic such as Spanish flu were to break out again, the consequences would be more severe in poor countries than here. In developing countries that have problems with malnutrition, tuberculosis and HIV/AIDS, such an epidemic would have a much stronger impact.”


How did outbreaks in the past affect people in the Swedish society? What happens if schools are closed down? Photo: Maskot

Elgh also points out: “An important part of this work is toning down the apocalyptic talk you often hear in the media when pandemics are discussed.”

National and international coordination
In Sweden, the National Board of Health and Welfare has overall responsibility for providing the country’s inhabitants with adequate protection against infectious diseases. The agency coordinates the measures undertaken in this respect.

A report recently published by the European Centre for Disease Prevention and Control (ECDC) concludes that the EU and its member states have made substantial progress in preparing against an influenza pandemic, but that there is still at least two more years of work to be done. Additional efforts need to be made in areas such as consistency of planning across all government departments, implementation at local level, coordination at European level, research on influenza and response to seasonal influenza.

The mission of the ECDC, which is located in Stockholm’s Karolinska Institute’s campus, is to identify, assess and communicate current and emerging threats to health posed by infectious diseases. The ECDC works in partnership with national health protection bodies across Europe to strengthen and develop disease surveillance and early warning systems.

Quarantine ineffective
Professor Johan Giesecke is Head of Unit and Chief Scientist of the ECDC. He thinks the Umeå study is a good idea. “I believe you can learn from what happened previously,” he says. “For instance, the introduction of quarantine proved to be fairly ineffective during earlier pandemics.”

Giesecke says that when the Spanish flu swept the world in 1918–19, a number of cities in the US and Canada tried to seal off their boundaries to prevent the disease from spreading. This proved fruitless. “Our infrastructures and our travel habits have changed considerably since then, but even in those days the Spanish flu spread across the globe in a matter of months,” Giesecke says.

FACTS

The four most recent flu pandemics:

• Russian flu, 1889–1890: Approximately one million dead.
• Spanish flu, 1918–1919: An estimated 20–50 million dead.
• Asian flu, 1957–1958: Up to four million dead.
• Hong Kong flu, 1968–1969: Almost one million dead.

Swedish contingency planning for pandemic influenza

• Information/communication: Establish an organization with a clear division of responsibilities.
• Control measures based on legislation: Examples include quarantine and/or the closure of workplaces.
• Voluntary measures to limit the spread of infectious disease: The closure of schools and pre-schools, use of protective masks.
• Surveillance: Monitoring systems that provide information about the spread of the disease in the community. In Sweden this is the responsibility of the Institute for Infectious Disease Control. In the EU it is the remit of the ECDC.
• Vaccination: Today certain vulnerable groups are vaccinated against influenza. In the event of a pandemic other groups would also be considered.
• Antiviral drugs: The National Board of Health and Welfare is responsible for stocking emergency supplies of antiviral drugs.
• Preparedness in other community sectors: All employers should have a contingency plan for how their operation is to work in the event of a pandemic.

Who does what?

The National Board of Health and Welfare (Socialstyrelsen) is responsible for the national coordination of activities in this field via the Unit for Communicable Disease Prevention and Control. www.socialstyrelsen.se

The Swedish Institute for Infectious Disease Control (Smittskyddsinstitutet) is a national body of experts charged with monitoring the epidemiological situation regarding infectious diseases in the population. www.smittskyddsinstitutet.se

The Swedish Emergency Management Agency (Krisberedskapsmyndigheten) coordinates the work of improving emergency preparedness in the community. www.krisberedskapsmyndigheten.se

The National Pandemic Group (Nationella Pandemigruppen) comprises representatives of the above three bodies, with the National Board of Health and Welfare as group leader, together with representatives of the Medical Products Agency (Läkemedelsverket), the Swedish Work Environment Authority (Arbetsmiljöverket) and the Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Landsting).
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Charlotte Celsing is a freelance journalist who has lived and worked in Indonesia, Fiji and Australia. She currently writes for both the daily press and monthly publications, and recently published her first book.

The author alone is responsible for the opinions expressed in this article.

Translation: Stephen Croall

Classification: A189EN

© Photo 1: Hans Bjurling / www.imagebank.sweden.se
© Photo 2: Private
© Photo 3: Maskot
© Photo 4: Jack Mikrut / Scanpix