Preparing for a pandemic: public health experts say the occurrence of another worldwide influenza outbreak is not in doubt. Internal auditors need to help ensure organizations have a plan in place to deal with such an eventuality

Internal Auditor, June, 2007 by Jane Ying, Alan D. Ash, Tim Sly

IN SLIGHTLY MORE THAN A CENTURY, the world has experienced four influenza pandemics. The most severe was the 1918 pandemic, with as many as 50 million deaths reported worldwide. In the United States alone, it is estimated that 25 percent of the population was infected, and more than 650,000 people died. The world population at the time was 1.75 billion; today it has grown to more than 6 billion.

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There is every reason to assume such events will surface again; only their timing and severity are unknown (see "Past Pandemics," this page). Currently, the World Health Organization (WHO) considers a particular strain of influenza virus, type A/H5N1, to be the most likely candidate for the next pandemic. H5N1, dubbed the "bird flu," has proven to be the most severe influenza among birds ever recorded, causing the death so far of hundreds of millions of wild and domestic fowl on three continents.

This particular strain, which normally infects only birds and pigs, was observed to infect humans for the first time in 1997. At the time of this writing, 291 people in 10 countries are known to have contracted the H5N1 virus, and 172 have died. While the human death toll from H5N1 so far is comparatively small, public health experts warn that if the virus mutates and becomes easily transmissible from human to human, it could cause a worldwide public health disaster of unprecedented proportions (see "The Influenza Virus" on page 67).

The effects of such a pandemic would pose a significant threat to business operations. Threats to both public- and private-sector organizations include employee health, potential long-term adverse effects on production and service delivery, and a significant shift in demand for products and services. Different organizations will be affected in different ways. Businesses and organizations providing essential products for day-to-day living may experience an extremely high demand, while those providing nonessential services and products may see a severe downturn in demand. Management should address the risk, to the extent possible, by ensuring that adequate control and mitigation measures are in place through a pandemic preparedness plan. Internal auditors can contribute to the process by providing an independent and objective assessment of the plan.

ASSESSING PREPAREDNESS

Most large businesses have extensive continuity plans for managing natural and man-made disasters. However, these plans are developed to respond to localized and short-term disasters such as an earthquake, flood, or power outage, and as such they have not accounted for the significant health, social, and economic impacts resulting from a severe pandemic. To be effective, management should develop a specific pandemic preparedness plan in conjunction with emergency planners. Where an extensive continuity plan already exists, certain adaptations and changes should be made to address specific issues and challenges arising from an influenza pandemic.

The goal of any pandemic planning for businesses is to protect employee health, mitigate adverse impacts on business, and speed business recovery. Several business pandemic preparedness tools and guidelines are available from government agencies such as the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Homeland Security, the Public Safety and Emergency Preparedness Canada, and the New Zealand Ministry of Economic Development as well as local public health agencies and financial institutions. Organizations should choose the planning process and model most suitable to their size and business functions.

Certain critical issues must be thoroughly examined and addressed in any influenza pandemic plan, regardless of the organization's size or the extent of its preparedness planning. When reviewing their organization's efforts in preparing for the possible avian pandemic, internal auditors should ensure that plans are effective and adequately address several specific issues.

THE PLAN SHOULD BE BASED ON SPECIFIC HEALTH IMPACT ASSUMPTIONS DEVELOPED BY LEADING PUBLIC HEALTH EXPERTS. Although it is impossible to predict the exact impact on human health before the pandemic strikes, the development of any pandemic plan must be based on certain health assumptions for the plan to be useful. These assumptions are provided by leading public health agencies such as the WHO, the CDC, and the U.K. Department of Health.

One of the major health assumptions associated with the avian influenza is the unusually high infection and mortality rates. Many experts suggest that about a third of the population would become ill, with the mortality rate for the whole population as high as 1 percent. In terms of the current U.S. population, that would translate to 3 million deaths. This calculation is based on 2 percent to 3 percent of infected individuals dying (as in 1918). In fact, the H5N1 death rate among human cases to date has remained consistently above 50 percent. A common belief holds that the virus will lose some of its potency as it mutates and becomes more easily transmissible from person to person, but to date this remains unsubstantiated.