Pity the World Health Organisation. Only a few days after it announced that the H1N1 swine flu had 'largely run its course' worldwide, reports of a superbug gene - NDM-1 - prompted a new outbreak of fear. Cases were reported in Hong Kong and Asian nations including India and Pakistan, while the superbug is becoming a global health threat to North America, Australia and Europe. NDM-1's resistance to antibiotics gives it the potential to be a serious worldwide public health problem. As always, Asia is at risk due to its high population density, increasing migration and regional travel, and underdeveloped health care systems. Haven't we heard all this before? The WHO overreacted in the case of swine flu, avian flu and a variety of other diseases. The past two decades have seen more than 30 outbreaks of new pandemic diseases, and about one-third of those started in Asia. With the media repeatedly warning that every new disease could be a massive global killer, it's easy to dismiss the latest outbreak, whether it's swine flu or a superbug. That would be a mistake. Recent estimates agree that a pandemic or epidemic event over a year could reduce global gross domestic product by more than 2.5 per cent (US$3 trillion approximately). Without tough action, it's a question of when, not if, a pandemic causes death on a scale that makes severe acute respiratory syndrome look mild. A stronger government role and better business involvement should be the key for pandemic preparedness in Asia. While some people are complaining that the danger of many viruses was always exaggerated by the WHO, pandemics, especially flu viruses such as swine flu and avian flu, are notoriously unpredictable and constantly changing. Asia must develop a comprehensive surveillance system and sufficient health care infrastructure. Asia can improve in these three areas: First, due to the high cost of treatment for many pandemic diseases (drugs and vaccines) and growing populations, Asia is challenged by inadequate health care financing and resources. It needs more in the long term. The United States devoted 19.3 per cent of government resources to health care in 2006, considerably more than China, India and Indonesia did - at 9.9 per cent, 3.4 per cent and 6.2 per cent respectively. Per capita, the three Asian countries have fewer than one-fifth of the physicians, nurses and hospital beds that the US has. Because of a shortage of nurses, health care equipment and hospital beds, Hong Kong and mainland China were ill-prepared for the outbreak of Sars in 2003, which led to a failure to even protect nurses and paramedics. Second, research shows that Asian countries are largely ineffective in crafting pandemic and epidemic management plans that go beyond basic WHO recommendations. National vaccination strategies and continuity plans for public services are essential when pandemics strike. Last year, mainland China's attempt to introduce a swine flu vaccine ran into delays because it failed to allay public concerns over the vaccine's safety and effectiveness. In addition, a lack of transparency about pandemic diseases in Asian countries could hamper control efforts. For example, critics said the attempts by the Chinese, Thai and Indonesian governments to hide the Sars and H5N1 outbreaks led to delays in the global surveillance of the viruses. By contrast, the Japanese government provides detailed steps for key stakeholders to take during a pandemic, and guidelines for capacity development over the years. Partly because of those effective measures, Japan had no confirmed cases of Sars, and was unaffected by the avian flu until the end of last year. It also has an adult HIV/Aids prevalence rate of less than 0.1 per cent. Vietnam, too, did well to cope with the Sars outbreak in 2003, even though it lacked resources. It isolated patients and implemented effective infection-control measures early on. As a result, it was the first to be removed from the list of countries with local transmission of Sars. Finally, businesses should co-operate with the government more closely on preparedness. Key industries such as tourism, transport and retail, which are most likely to be affected by pandemic outbreaks, should co-ordinate with governments to identify specific practices to help improve pandemic preparedness. In addition, expanded public-private partnerships with pharmaceutical companies will probably help improve the availability of drugs and vaccines during pandemics. Last year, the Chinese government allocated nearly US$725 million for H1N1 research and vaccine production, which involved 11 Chinese pharmaceutical companies. Production began in June that year and was expected to have a manufacturing capacity of 360 million doses per year, making the Chinese vaccine production one of the biggest and fastest in the world. In short, pandemic diseases affect economic activity in the region and threaten the health and lives of people. Future preparedness is the key. Governments and businesses in the region should collaborate to build effective safeguards against pandemics to ensure rapid action to combat them. Pandemics will continue to kill. The media will continue to be alarmist about the next new bug. But intelligent policies can minimise the inevitable death toll. Alex Zhang is the Asia Business Council's lead researcher on pandemics
