1. Confederation of Health Care Systems Israel – 2008 Lori Post Yale University School of Medicine

2. By the Year 2020 The next pandemic will have concluded The UN will send a mandate to the World Health Organization The WHO will generate a resolution to prevent another pandemic

3. WHO Request for Proposals 1. Why did it happen? 2. Damage – Mortality, Morbidity, Cost 3. What could we have done?

4. Why? Every ~100 years, avian flu sweeps through the world Large human population without immunity Densely populated Asymptomatic during transmission Global population exposure Cytokine storms

5. Damage TBD

6. Flu Pandemic Phase 1: No new influenza virus subtypes have been detected in humans. Phase 2: No new influenza virus subtypes have been detected in humans, but an animal variant threatens human disease. Pandemic alert period: Phase 3: Human infection with a new subtype but no human- to-human spread. Phase 4: Small cluster with limited localized human-to-human transmission Phase 5: Larger cluster but human-to-human spread still localized. Pandemic period: Phase 6: Increased and sustained transmission in general population.

7. Public Health Surveillance Ongoing, systematic collection, analysis, and interpretation of data (e.g., regarding agent/hazard, risk factor, exposure, health event) essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.

8. Early Surveillance 1854 John Snow Began with a cholera outbreak in London No technology First example of data collection and spatial display of health issue Broad Street Water Pump clusters

10. Solution Data collection and display Break the chain of transmission Public Health Resolution – REMOVE the HANDLE Technology sufficient in 1854 but not in 2018

11. 1800s1900s2000s Positive Population Movement Rural Small Population Rural ICT Knowledge Negative Transmission Knowledge Population Movement ICT Population Movement Urban Large Population Risk and Protective Factors for Infectious or Contagious Disease

12. 1918 Flu Pandemic ~100 Million People Died 2 x number killed in WWWI Epicenter in Spain

13. 2015 Flu Epicenter in rural Asia Disparate information and control measures Surveillance – passive, confederation, disparate Poor use of Information Communication Technology Slow response Global transmission before identification Population movement (1000s flights out of Asia every day) Healthy population affected The technology to prevent the pandemic of 2015 was developed in 1995

14. What could we have done? Standardized data collection and aggregation Active Universal Health Surveillance System Early Identification Public Health Information Dissemination Containment until vaccine developed (2 nd and 3 rd Waves) Stockpiles of life sustaining medicines Global solution beyond political boundaries

17. Borders and Health Care Systems 3077 county health care systems Complicated passive system in US: County to State to CDC to WHO The next avian flu will begin where there is little to no surveillance Universal Health Care could be used for primary, secondary, tertiary prevention for number of public health and social issues