Kampala, Uganda — A 9-year-old Congolese girl who tested positive for Ebola in neighboring Uganda has died, officials said Friday, as the World Health Organization said that the outbreak has neared 3,000 cases.
The young girl’s body will be repatriated with her mother back to Congo for a funeral, according to Dr. Eddy Kasenda, Ebola representative in the Congolese border town of Kasindi.
“We are finalizing the administrative formalities so that the body is repatriated and buried here in Congo, her native country,” said Kasenda. “We are collaborating with the health services of neighboring Uganda and we will strengthen the sanitary measures here in Kasindi.”
A Ugandan official at the hospital where the girl had been in isolation confirmed her death overnight. He spoke on condition of anonymity because he was not authorized to speak to reporters.
The girl, who was traveling with her mother, was identified at a border screening Wednesday as a possible Ebola patient and isolated.
Although cases of cross-border contamination have been rare, this case highlights the risk of Ebola spreading across the border into neighboring Uganda and Rwanda. Borders in the region are often porous, and many people traveling at night use bush paths to cross over.
Because the 9-year-old Ebola victim passed through an official entry point, Ugandan health authorities believe she had no contact with any Ugandan.
Ebola has killed nearly 2,000 people in eastern Congo since August 2018. The disease is spread through contact with the bodily fluids of an infected person.
WHO said Friday that cases have reached 3,000 in Congo, with 1,893 confirmed deaths and some 900 survivors. An average of 80 people per week are sickened by the virus, which has infected most people in Congo’s North Kivu province.
ted from the epicenter of the outbreak, the fight against it has been hugely complicated by a raging conflict in the region between rebel groups and the government, and resistance from wary residents who don’t trust the vaccine or public health workers.
Some in these communities have even staged attacks against health workers.
In June, a family of Congolese with some sick family members crossed into Uganda via a bush path.
Two of them later died of Ebola, and the others were transferred back to Congo.
Uganda has had multiple outbreaks of Ebola and hemorrhagic fevers since 2000.
WHO Director-General Tedros Adhanom Ghebreyesus will travel this weekend to Congo with United Nations Secretary-General Antonio Guterres and senior officials, including Dr. Matshidiso Moeti, WHO Regional Director for Africa.
On Friday he called on partners to increase their presence in the field.
“Our commitment to the people of the Democratic Republic of the Congo is that we will work alongside them to stop the Ebola outbreak,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Our commitment also means strengthening the health systems to give them all the other things they need. Building strong systems is what will protect people, communities and the world.”
Medical experts have attributed the re-occurrence of Emerging Infectious diseases (EIDs) to the inability of the government to control the disruption of the eco system through human activities.
According to them, inadequate funding of health care research and environmental impact studies together with government’s inability to regulate the way people destroy the environment have led to the increasing cases of outbreaks caused by dangerous pathogens.
The experts stated this during the 5th African Conference on Emerging Infectious Diseases and Biosecurity in Abuja organized by Global Emerging Pathogens Treatment Consortium (GET).
The Principal Investigator, GET, Prof Akin Abayomi, noted that Nigeria and Africa in general have been destroying the ecosystem through the destruction of forests, causing animals to move out into human communities.
He said the interaction between animals and humans is increasing due to population expansion and destruction of the ecosystem, thereby forcing animals out of forests.
He said the consequence of this is the increasing frequency and range of EIDs: ebola, lassa, yellow fever, monkey pox, cholera, bird flu and meningitis, adding that shrinking natural resources is creating human competition for water leading to demographic conflict.
The don stressed the need for government to spend more on health care delivery research and the creation of awareness, lamenting that there is a lag between what the government should be spending and what is being spent.
The Chief Operating Officer, GET, Dr Dotun Babadoye, lamented that the impact of changing climate and increasing security challenges in Africa are impacting on the emerging infectious diseases and biosecurity threat on the continent.
The Director General of the Nigeria Centre for Disease Control, Professor Chile Ihekweazu, pointed out that with the nation’s exponential growth rate of 2.8 per cent, including the internal and external migration coupled with poverty and lack of education are all responsible for the spread of infectious diseases.
Mark Gallivan is the Lead Data Scientist at Metabiota, which provides risk monitoring services on global epidemics.
On Wednesday the World Health Organizationdeclared the ongoing — and now year-old — Ebola outbreak a global health emergency.
The emergency declaration comes after a man became sick and brought the virus to the Congolese city of Goma, a highly populated transit hub with an international airport and next door to Rwanda. As it stands today, the current Ebola outbreak has surpassed 2,500 cases and 1,500 deaths concentrated largely in two provinces in eastern Congo.
The response effort has been hampered by a deadly mix of armed conflict, distrust, and lack of medical resources. Less than half of the affected population trusts the government and Ebola responders; armed groups have even killed responders. Public health experts expect the outbreak to continue into the foreseeable future.
Yet outside the public health community there has been relatively little concern in America about the second largest Ebola outbreak in history. By one crude metric, the President’s tweets, the current outbreak hasn’t even registered. During the 2014-2016 Ebola epidemic, which also generated an emergency declaration, Mr. Trump tweeted nearly a hundred times about Ebola. This outbreak? 0. Unfortunately this lack of public attention has translated into a shortfall in funding particularly in contrast to the 2014-2016 Ebola epidemic.
The contrast in concern between the 2014-2016 Ebola epidemic and current Ebola outbreak can largely be explained by proximity and fear. Interest in the 2014-2016 Ebola epidemic rose when two U.S. nurses contracted the virus from an imported case in Dallas. However, there was considerable public interest in the outbreak even before the infections in Dallas.
This suggests there is an innate fear associated with the Ebola virus itself. Fear from infectious diseases can be quantified by the deadliness of the pathogen, the severity of the symptoms, how much is known about it, how it’s transmitted, and whether treatment or preventive measures are available. Due to the severity of Ebola virus disease, you would expect any abnormally large Ebola outbreak to create a large amount of news coverage.
When determining the amount of attention an event should receive, public health professionals and news editors face a similar question: is this event significantly different from the baseline, or what’s expected? If so, the event can be considered an outbreak and demands the public’s attention. If not, the event would be considered part of the expected baseline and not enter the public consciousness.
After the 2014-2016 Ebola epidemic resulted in nearly 30,000 infections, there is a legitimate concern that the public has reached Ebola fatigue and have shifted our expectations on what constitutes an emergency, leading to a subdued attention and response. Infectious diseases rarely make the news once the disease becomes an endemic, chronic problem (e.g., the HIV/AIDS epidemic).
Fear. What is it good for?
Fear, or lack of fear, is currently making a bad situation worse. In a recent interview, the WHO director-general spelled out two major facts: 1. the current Ebola outbreak is unlikely to end until security concerns are addressed in Congo and 2. donors refrain from funding unless they feel fear and panic.
On the ground, fear is continuing to deepen distrust towards responders occasionally triggering violence and unrest.
For potential donors, the absence of fear and public attention is causing a shortfall in funding needed for response and preparedness efforts (e.g., surveillance, healthcare infrastructure) that can limit an outbreak’s spread.
If fear can be leveraged to contain the current outbreak and fund preparedness efforts, fear can also eliminate future Ebola headlines for the right reasons; because we eliminated the threat, not because it becomes an endemic problem.
Finally, the World Health Organization has declared the world’s latest Ebola outbreak a global health emergency. But what, exactly, does that mean?
The decision this week by the WHO’s director-general, Tedros Adhanom Ghebreyesus, to designate the long-running Ebola outbreak in the Democratic Republic of the Congo a public health emergency of international concern generated a flood of news coverage.
Some global health experts have been vociferously insisting for months now that a PHEIC (pronounced FAKE or PHEEK) needed to be declared. They say it could improve the outbreak response and speed an end to the crisis.
But how might it do that? Read on.
What is a PHEIC?
Sometimes it’s easiest to define something by talking about what it’s not. That’s definitely the case when trying to describe a PHEIC.
Despite the fact the name combines “emergency” and “international,” a PHEIC isn’t necessarily a true global emergency. It can be — say, if a new disease began to spread globally or another flu pandemic started.
But in the case of the latest Ebola outbreak, the reality is people in Indianapolis and Istanbul, Shanghai and Sydney are at no greater risk today than they were before the PHEIC was declared. The declaration is not the WHO’s way of sending up a flare to warn that Ebola will be spreading around the globe from northeastern DRC.
This event is a crisis in the affected region of DRC and a real risk to neighboring countries. Governments around the world need to be paying more attention to it, but the risk of global spread is low
So that’s what it isn’t. But what is it?
A PHEIC is defined as “an extraordinary event that poses a public health risk to other countries through international spread and that potentially requires a coordinated international response.” In short, it’s a tool the WHO’s member states have given the global health agency to help it deal with difficult transmissible disease situations.
It was created when the International Health Regulations — a treaty designed to prevent and control the international spread of disease — were updated after the 2003 SARS outbreak.
(If you don’t remember SARS, it was a disease that spread rapidly from China to other parts of Southeast Asia and also to Canada, sickening more than 8,000 people and killing about 800. It was completely unknown and alarming. But scientists and public health authorities figured out quite quickly how to control SARS and, except for a few cases the following year, it hasn’t been seen since.)
The goal of the IHR is to keep the world safe from transmissible diseases like this by requiring countries to report dangerous outbreaks so their neighbors can be on the lookout for cases and prepare to respond if needed.
A PHEIC gives the WHO some temporary powers it can wield in a crisis. For instance, it can share information about what’s happening with other countries, even without the consent of the affected nation.
WHO’s director-general can also issue what are known as temporary recommendations; those typically take the form of instructions to other countries (and indirectly, companies) not to penalize the affected nation by closing borders, restricting airline flights, blocking importation of goods or suspending visas issued to people from the affected countries.
Wouldn’t you want to stop travel and commerce from a disease-affected country to prevent spread?
Here’s the thing: Countries that know they’re going to take a financial hit or be ostracized internationally are less likely to fess up when they’re dealing with a dangerous disease.
You don’t want to penalize a country that’s been forthcoming. But you also don’t want to make it harder to move people and goods into or out of the affected area. The WHO needs to send in teams of experts, of health workers who can assist in an outbreak response. Doctors Without Borders and the other NGOs working on a response need to be able to ship in equipment. If air travel is cut off or reduced during a health emergency, it impedes the world’s ability to control the disease.
Are there any downsides to declaring a PHEIC?
It was designed to help but experience has shown a PHEIC can be a double-edge sword. There have been real concerns that declaring a PHEIC in this case could hurt the economy of the region, which could further inflame the tensions between people in the affected region and the people trying to extinguish this outbreak.
What about those temporary recommendations? Don’t countries have to follow the instructions of the WHO director-general?
In a word: No. The WHO is not the world’s health police. The director-general can advise, urge, exhort, or even condemn countries. But at the end of the day, countries are sovereign and will do what they think is best for their citizens.
During the massive Ebola outbreak in West Africa in 2014-2016, many countries stopped issuing visas to citizens of the affected countries. The WHO publicly challenged a few to explain their actions. In at least one case, that led to an angry call to the director-general at the time, Margaret Chan. The country that made that angry call, Canada, did not change its visa policy.
And most airlines stopped flying to Guinea, Liberia, and Sierra Leone, the countries at the heart of that outbreak. To this day there’s a deep well of gratitude in the global health community for Brussels Airlines and Royal Air Maroc, which heroically maintained flights into the region.
How often have PHEICs been declared?
Far less often than you’d think. For instance, an emergency committee of experts set up to assess the threat posed by Middle East Respiratory Syndrome met 10 times and decided at each meeting that MERS did not warrant declaring a public health emergency of international concern.
Is the disease a threat to some people in a few Arabian Peninsula countries? Yes. More than that? Not so far. The committee held firm even when a South Korean businessman who got sick in the Middle East went home and ignited a major outbreak — nearly 200 cases — in Seoul.
Likewise a large and dangerous yellow fever outbreak in Angola that moved into DRC’s capital, Kinshasa, in 2016 — an outbreak that nearly tapped out the global supply of yellow fever vaccine — was not declared a PHEIC.
There had been four PHEICs declared prior to this week’s addition of the DRC Ebola outbreak. The first time the tool was used was during the 2009 H1N1 flu pandemic, the first flu pandemic in 41 years. The West African Ebola outbreak of 2014-2016 was a PHEIC, as was the 2017 Zika virus outbreak in Latin America.
The other PHEIC was different from all the rest. It wasn’t a response to the emergence of a new disease, or one like Ebola that breaks out of nature occasionally to infect people. In 2014 the polio eradication campaign was floundering, and a decision was made to declare wild polio transmission a public health emergency of international concern. (That PHEIC remains in place five years later.)
The idea was to raise awareness of the issue at higher levels within governments around the world; that is what PHEICs are intended to do.
That, it’s hoped, is what will result from declaring the North Kivu-Ituri Ebola outbreak a PHEIC — that governments around the world, with their purses and emergency response expertise, will start paying more attention to this long-running crisis.
This week the Ebola virus crossed from the Democratic Republic of Congo into Uganda, but there are reasons to hope it can be contained on that side of the border, reports Olivia Acland.
On Monday morning, a family was heading from the Democratic Republic of Congo back home to Uganda, after a funeral. The grandfather had died from Ebola and his daughter had gone to the country a few weeks earlier, to try and nurse him back to health.
By the time the family got near the Ugandan border, most of them were suffering from high fever and diarrhoea. They stopped in a health clinic and were put in isolation, awaiting tests. But after dark, six members of the family, including a five-year-old boy, slipped out of the clinic and set off down a desolate and poorly policed road crossing into Uganda. A few days later both the boy and his grandmother had died.
Health officials have long feared that this outbreak of Ebola virus could pass over the porous border into Uganda. The border is over 500 miles long and many of the crossings are informal – sometimes just a couple of planks laid across a shallow river. An endless stream of traders, some balancing baskets of eggs on their heads or swinging chickens by their feet, moves back and forth across the border each day.
One of the main reasons it has been so difficult to contain the disease in DR Congo itself is because it is spreading in a conflict zone. Some 120 armed groups hide in the jungle-matted hills in the east of the country and regularly spring out of the bush to abduct or rape civilians. They make money smuggling minerals like gold and coltan, used in mobile phone batteries, or by plundering villages and stealing livestock.
Complicating things further, the local population has little trust in the authorities and their ability to respond. Health workers often move around with armed escorts, which arouses suspicion. And when impoverished villagers see fleets of four-by-fours tearing down their roads they talk about “Ebola business” and are jealous of the money being poured into the response.
From Our Own Correspondent has insight and analysis from BBC journalists, correspondents and writers from around the world
Last month, I visited Butembo in the north-east of DR Congo – the disease-ridden region has become known as the “Ebola zone”. People there told me they believe the disease was bought to the region on purpose so that foreigners could make money from them.
Since the start of the outbreak, there have been over 100 attacks on health workers and Ebola treatment centres. Some have been spontaneous, fuelled by distrust and jealousy. Others, like the burning down of treatment centres, were premeditated and organised by rebel groups. Their aim and agenda is unknown.
While I was in Butembo, I visited an Ebola treatment centre and spoke to a patient from the other side of a plastic window. She told me that she was there, hooked up to a drip, when rebels attacked but was too weak to flee. She said that she’d heard them shouting “Get the matches!” and had then felt heat from the blaze. She lay there thinking she would die until a nurse, who had fled, came back to rescue her some 40 minutes later. Luckily the tents where patients stay were spared and most of the centre has since been salvaged.
At the moment one in four Ebola sufferers in DR Congo are not turning up at treatment centres. In part, this is down to distrust and in part, fear – both of the disease and rebel attacks.
DR Congo may be struggling to manage the spread of disease, but when the dreaded announcement came that the virus had spread across the border, Uganda was quick to act – 4,700 health workers in 165 hospitals have already been vaccinated. Marketplaces near the border have been closed down. Religious gatherings have been suspended. People are making an effort not to touch one another and handshakes have morphed into elbow nudges or waves.
In reality, it tends to take more than a sweaty handshake for the disease to spread. An Ebola patient can only pass on the virus if their fluids enter someone else’s body through broken skin, their mouth, nose, eyes or other orifices. As the disease causes diarrhoea as well as making you sweat, bleed and vomit, those most at risk – by far – are the ones caring for the sick.
In Uganda, the battle against Ebola will be determined by the government’s ability to win the confidence of the people. The country is not strife-torn like its volatile neighbour, and has a more robust health system. For the time being, at least, there is hope the disease will be contained in Uganda.
Olivia Acland is DR Congo correspondent for the Economist
The grandmother had lived in DR Congo, where her husband recently died of Ebola. Her daughter had travelled from Uganda, where she lives with her Ugandan husband, to the Congolese town of Beni with her children to help care for him.
After the grandfather died they all travelled on Sunday to Uganda’s Kasese district, where the five-year-old son and his grandmother then subsequently became sick and later died.
The three-year-old son is now confirmed to have Ebola. He, his parents and two of his siblings have been repatriated at their request to DR Congo, Uganda’s health ministry says.
Twenty-seven people are said to have been in contact with the three confirmed cases in Uganda. They have been restricted to their homes and will be vaccinated against Ebola.
The people who fled from a hospital isolation unit had been found to have high temperatures when they crossed the border from DR Congo to the Ugandan district of Kanungu, which is about 150km (93 miles) south of Kasese. Medical workers did not get a chance to take samples of their blood to send for testing before their escape.
How prepared is Uganda?
Analysis by Patricia Oyella, BBC Africa, Kampala
This isn’t the first time the virus has struck the country. Outbreaks in 2012, 2007 and 2000 have prompted the health ministry to build capacity, says Director of Clinical Services Dr Charles Olaro.
Public health information campaigns broadcast to at-risk areas have been key in preventing the spread since the first case of Ebola was reported over the border in DR Congo last August. Mass gatherings, including market days and prayers, have been cancelled. Market days in the town of Kasese attract an estimated 20,000 people at the border area.
Uganda’s health ministry and the WHO said a rapid response team had been dispatched to identify others at risk. The country has already vaccinated about 4,700 health workers against the disease, according to a joint statement by WHO and Ugandan health officials. Ebola screening centres are in operation along the border with DR Congo as well as other major entry and exit points.
Authorities have identified 22 high-risk districts – places that are close to the border and have high levels of movement – and deployed medical monitors to spot and manage any cases they find.
A database of experts is on hand to deal with different scenarios, the health ministry says, and Uganda also benefits from the expertise of health workers it deployed to contain previous outbreaks in West Africa.
What’s the situation in DR Congo?
Nearly 1,400 people have died over the last 10 months – around 70% of all those infected.
The outbreak is the second-largest in the history of the disease, with a significant spike in new cases in recent weeks.
Some have predicted it could take up to two more years to bring to an end. The WHO has twice ruled that this Ebola outbreak is not a yet global emergency. I
Efforts to contain the spread have been hindered by militia group violence and by suspicion towards foreign medical assistance.
Nearly 200 health facilities have been attacked in DR Congo this year, forcing health workers to suspend or delay vaccinations and treatments. In February, medical charity Médecins Sans Frontières (MSF) put its activities on hold in Butembo and Katwa – two eastern cities in the outbreak’s epicentre.
In the West, virtually unnoticed, spreading in Africa, one of the most insidious diseases in the world: Ebola. Anyone who is infected with the Virus suffers from high fever, pain and internal or external bleeding. According to statistics, two-thirds of the sick die.
Seriously, the extent in the Democratic Republic of the Congo currently In the Region of Nord-Kivu, most recently, 1600 people have been infected and already over 1000 have died – mostly women and children.
the disease is Transmitted through contact with body fluids of infected people or animals. Family members and nursing staff are exposed to a great risk of infection, even at funerals, where the dead are washed, spreading the disease.
propagation due to rebels
experts say: The Situation in the Congo gets out of control and could take on similar dimensions as the Ebola epidemic of 2014, as in Guinea, Sierre Leone and Liberia over 28’000 people became ill and 11’000 people died.
Peter Kremsner (58), Director of the Institute for tropical medicine at the University of Tübingen (D), says in the “süddeutsche Zeitung”: “You currently can not estimate at all of how it goes.” The current outbreak is unique and don’t fit at all into the picture of most of the previous 20 outbreaks.
Although there is now a vaccine that can spread the Virus because of the unstable situation in the North of the Congo river, unhindered. Often helpers of rebels are attacked, in addition, large parts of the population distrust the helpers.
Bern observed exactly
The Federal office of public health in Bern (BAG) observed, the recent Ebola outbreak closely. Patrick Mathys (49), in the division of Communicable diseases, crisis management, and international cooperation is responsible, says: “The situation is alarming, especially because, due to the tense security situation, the control and Monitoring of transmission chains is very difficult.” Critical it would be if the disease would spread to neighboring countries such as South Sudan and Uganda.
Geneva hospital is ready
The BAG is with relief organizations such as Doctors without borders in contact. Since the disease was to focus on an area where there is hardly any Travel to Switzerland have to currently be no measures taken. In the past few years have been recorded in Switzerland, only two patients who had become infected in Africa and were successfully cured.
The BAG would be always ready, just in case. Mathys: “At the Geneva University hospital we could Ebola patients and treat them.”
The Severe Acute Respiratory syndrome (Sars) has spread in 2003 from China to worldwide, and over 8000 Infected And 800 Deaths. Since then there have been human cases. Uncertain – and troubling – is whether there is in animals, and even the “reservoir”.
in 2005/06, the bird reached flu, Switzerland, in Lucerne infected have been discovered in wild birds. Even today, it is mainly in the Asian region again and again, Transmissions from birds to humans, with death. Only hardly anyone will talk about this anymore today.
in 2009, triggered by a new influenza virus from Mexico is a pandemic, the world died half a Million people in it. Patrick Mathys of the Federal office for health: “approximately every 30 years a flu pandemic. The next one is so determined, the only question is when.”
in 2015, had spread the Zika Virus from Brazil made of solid. The disease, the severity of neurological complications and abnormalities can result in babies, was imported in 1700 cases, to Europe. The situation has calmed down somewhat, the Virus, but especially in the South American region still part of everyday life.
In the 1990s, the sale of beef has been restricted because of the risk of Transmission of BSE (mad cow disease) to humans. In Switzerland, there has never been such a case. Annually there are 10 to 15 classic cases of Creutzfeldt-Jakob disease that breaks out due to a protein error in the people.
Certain environments may make it easier for animals to infect humans with diseases like bird flu and Ebola, according to a recent study from The University of Queensland and Swansea University.
In past studies, researchers have identified the spread of diseases by analyzing species impacted by animal-produced pathogens and their patterns of movement, a press release from the University of Queensland explains. This more recent study builds on that research, confirming that environmental conditions have an impact on whether or not pathogens are given the opportunity to interact with and infect humans.
While the Queensland/Swansea study has not provided concrete data on how specific environments affect diseases, scientists confirmed that environmental factors are among the most important in mapping and modeling the spread of zoonotic, or animal-to-human, illness.
Previous studies have given scientists an idea of the factors that contribute to animal-to-human disease transfer. A 2011 study conducted at Stellenbosch University in South Africa found that variables such as land temperature, sea level and acidity, rainfall patterns and soil conditions are among contributing factors. This study also broke down the contributing human factors, including tourism, trade, the agricultural industry and the popularity of domestic pets.
The Stellenbosch study states that approximately 60% of human pathogens originate in animals, and the spread and severity of these outbreaks can occur in unexpected ways. For example, as the climate changes and animals such as birds are forced to migrate to new locations, they may spread unfamiliar pathogens to native species as they travel.
Even human civil, political and military conflict can contribute to the spread of illness by harming health care infrastructure and weakening human ability to respond to illness when it arises, the Stellenbosch study claims.
The current unpredictability of the environment also makes anticipating how disease will spread more difficult. According to Swansea research team leader Konstans Wells, unpredictability caused by climate change makes it harder to establish a reliable model for making predictions.
In order to draw further conclusions about which environments most directly impact disease transfer, the research team hopes to conduct more studies in order to predict and prevent future outbreaks.
Jasper HamillThursday 21 Feb 2019 12:37 pm Share this article via facebookShare this article via twitterShare this article via messenger You’ve heard of bird flu, but the next epidemic to hit Earth and kill a lot of humans could come from bats. That’s the warning from scientists who fear the creepy flying mammals could be ‘reservoirs for a new type of influenza virus’ which has the potential to ‘attack the cells of humans and livestock’. Researchers from the University of Zurich have warned that bat flu viruses can mutate so they pose a risk of infection to humans. This process is called zoonotic transmission and ‘at worst can lead to a global influenza pandemic with numerous serious illnesses and deaths’. Could bats spark a pandemic which sweeps the world? (Picture: Shutterstock) And in case you’re not scared enough already, bats are already known to be carriers of Ebola. ‘Such an infection has not yet been observed. However, our findings show that the viruses generally have this zoonotic potential,’ said Silke Stertz from the university’s Institute of Medical Virology. In 1918, a Spanish flu epidemic infected 500 million people around the world and killed between 50 and 100 million. If a similar pandemic hit the modern world, millions of people could die. Tedros Adhanom, chief of the World Health Organization, warned in February last year that humanity is ‘vulnerable’ to a pandemic. The Cabinet Office already lists pandemic influenza as the biggest threat on the UK’s Risk Register – placing it ahead of terrorism and cyber-attacks.