Pandemics, Severity, and Context—Some Loose Ends

Simonsen, Lone; Viboud, Cecile

For decades, pandemic planning has been synonymous with influenza preparedness, with severe scenarios modeled after the experience of the 1918 pandemic. 1 Meanwhile, other zoonoses have presented themselves as credible pandemic threats. For example, while we were concerned about the rise of avian A/H5N1 influenza in China in 2003, it was the SARS coronavirus that emerged and spread globally that year. And more recently, pathogens that had previously been causing sporadic and localized outbreaks, such as Ebola and Zika, have reemerged in urban settings and new regions to pose a global pandemic threat. Further, historic epidemiologic records are ripe with mortality events of pandemic proportions caused by a variety of pathogens, indicating it is critical to think beyond influenza in pandemic preparedness plans. The GCBR definition outlined by Schoch-Spana et al is broad thinking in this respect, echoing the World Bank's $500 million investment on pandemic insurance for 6 viruses (influenza A, SARS, MERS, Ebola, Marburg, Crimean Congo, Rift Valley, and Lassa fever) or CEPI's focus on noninfluenza viruses (MERS, Nipah, Lassa fever).