Grist: A New Type of Threat
by Jeffrey Staples
No one knows whether avian flu will evolve into a human pandemic. It could, possibly, remain largely confined to bird populations and be remembered years hence as a scare that didn’t materialize. But little stands between the best- and worst-case scenarios.
So far, the H5N1 strain of avian flu has infected millions of birds, mostly in Asia, but now increasingly in Europe and Africa; it has spread, with difficulty, to fewer than 200 people—although it has killed more than half of them. And it is evolving in ways that appear to allow it to infect a greater number of species, including pigs, wild and domestic cats, and dogs. From its origin in southern China in 1997, H5N1 has spread to almost 50 countries (at the time of this writing) and is now circulating through Asia, Europe, the Middle East, and Africa. This advance, coupled with the emergence of mutations that may facilitate the infection across species, increases the risk of a global pandemic.
If the virus does mutate into a form that transmits easily from person to person—and this is the pivotal unknown—in the best case, the World Health Organization (WHO) says, 2 million people could die. In the worst case, according to some experts’ projections, up to 30% of the world’s population could be stricken over the course of roughly a year, resulting in as many as 150 million deaths and perhaps more than a billion people requiring medical care. It takes little imagination to envision the impact this could have on global business as employees fall ill, supply chains fragment, and services fail.
Should a pandemic emerge, it would become the single greatest threat to business continuity and could remain so for up to 18 months. Companies need to develop rigorous contingency plans to slow the progress of a pandemic and limit its impact on employees, shareholders, partners, consumers, and communities. This will require more than simply double-checking the soundness of existing business continuity plans.
As companies start to address pandemic preparedness, they are discovering that a pandemic is fundamentally different from other, more traditional business continuity threats and is outside the scope of issues typically considered by continuity planners. Plans are usually designed to help companies respond to localized threats—like fires, bombs, riots, earthquakes, and hurricanes—that affect infrastructure. Once the event has occurred, it is over and, while the effects may linger, recovery can begin. However, a pandemic isn’t an isolated incident. It is, by definition, an unfolding global event. Because of air travel, many cities around the world could be infected almost simultaneously.
Current models suggest that the next pandemic is likely to come in three waves, with each wave sweeping across the globe in a matter of weeks and lasting as long as three months. So there needs to be a shift in the nature of continuity planning, away from strategies that protect infrastructure and toward those that protect employees and their ability to conduct business during a sustained crisis.
When companies first began to wake up to the threat of avian flu, such strategies often revolved around trying to stockpile antiviral medication as a stopgap measure, with the expectation that in a pandemic a vaccine would soon become available. It is now clear that antivirals would be in short supply and that viral drug resistance would be likely to develop. What’s more, an effective vaccine may not be available in appreciable quantities for many months after a pandemic is under way, and then shortages and distribution problems could limit use. Contingency planning by forward-looking companies, therefore, is becoming more coordinated, headed by pandemic or crisis teams that tap principal functions, including human resources, operations, security, legal counsel, and communications. This planning focuses on nonmedical risk-mitigation strategies to reduce infection and maintain business continuity.
In doing their planning, businesses should look to the WHO’s six-phase pandemic-tracking model, which indicates the WHO’s assessment of the threat. We are now at phase three and have been for more than two years. (See “Tracking a Potential Pandemic” below.)
Tracking a Potential Pandemic
We will probably see larger and more frequent outbreaks and rapid progress through phases four through six if the virus becomes more easily transmissible among humans. Phase three is the point at which companies should develop risk mitigation plans, testing them with tabletop scenarios and site-level drills, which need to be updated regularly. By phase four, the time for planning has passed, since any plans need to be implemented by then. By phase five, it is far too late to start planning—it is time for intensive strategy execution.
Any preparedness plan must address human factors, such as employee education, hygiene, staff movement and evacuation, sick leave policies, and absenteeism. It must also focus on operational issues—managing supply chain and distribution-network disruptions, for instance, and minimizing the interruption of essential services such as electricity, water, telecommunications, transportation, and security. In response to the appearance of avian flu cases in Turkey, the government actually called on law enforcement to protect some hospitals in affected areas from anxious locals who were seeking medical treatment. Such public fear is an underappreciated part of the threat, and companies should anticipate that this type of scenario may occur on a progressively larger scale in pandemic phases four, five, and six.
If the flu becomes a true pandemic, much of the impact on business will derive directly or indirectly from unprecedented absenteeism. Experts believe that infected people will be contagious for up to two days before symptoms develop, ill for five to eight days (in the absence of complications), and contagious for seven days or more after symptoms go away. During the peak periods, or waves, of a pandemic, companies could experience absentee rates between 15% and 30%, due to sickness, quarantines, travel restrictions, family care responsibilities, and fear of contagion.
It is tempting to think of pandemic planning as distinct from traditional continuity planning, a one-off exercise requiring one-of-a-kind preparation and response. But because of ever-expanding global trade and the ease and speed of international travel, an avian flu pandemic is one of an emerging class of threats—including those posed by chemical, biological, or nuclear terrorism—that could cause sustained, systemic disruption. Many businesses have yet to factor these nontraditional threats into their continuity plans. As they do, they will find that they are framing a broader, more resilient approach to risk management that can better protect employees, operations, and relationships, even in the face of traditional threats.Jeffrey Staples, MD ( email@example.com) is a senior medical adviser for International SOS, a medical and security assistance company. He is based in Singapore.
The Science: How a Human Pandemic Could Start
by Scott F. Dowell and Joseph S. Bresee
If there is anything predictable about influenza, it’s that it has a propensity for change. That’s why health officials are so anxiously watching the avian influenza A (H5N1) virus. The virus readily infects birds and has spread to some other species but so far has shown a limited ability to infect humans. While rare instances of H5N1 passing from person to person have been documented, there is no indication that it can do so efficiently.
That could change. At irregular intervals—three times in the past century—a new influenza subtype that is highly infectious in people has emerged. Up to 50 million people may have died as a result of the 1918–1919 influenza, and millions more died in the pandemics of 1957 and 1968, each of which resulted from virus mutations. A series of mutations or a single genetic reassortment event (a type of gene swapping among viruses) could enable H5N1 to spread efficiently among humans, triggering a pandemic.
Human illnesses caused by H5N1 follow a particularly aggressive course, often striking children and young adults. Influenza symptoms, including high fever, rapidly develop, often progressing to pneumonia. About half of the people infected with the virus during the past two years have died as a result. The mortality rate has raised widespread concern, although there is no way to know how high the rate would be if a pandemic emerged. For the pandemics mentioned earlier, the mortality rate did not exceed 2%.
Should the virus become easily transmissible between people, containing global spread is likely to be extremely difficult. Like the severe acute respiratory syndrome (SARS) virus, H5N1 may evolve into something that’s easily spread through coughing, sneezing, or contact with contaminated hands. Unlike SARS, it may be very hard to control by quarantine if patients are infectious before developing symptoms. In the event of a pandemic, effective antivirals will certainly be in short supply. And because it is not possible to make a vaccine in advance (we need to have the pandemic version of the virus in hand before beginning development), it could be four to eight months after the start of a pandemic until the first vaccines are ready for distribution.
An important approach to limiting the spread of avian influenza among humans is to provide the public with the information and tools needed to keep it at bay. All things being equal, the difference between a best- and worst-case global scenario may come down to how well governments, organizations, and individuals control people’s exposure. A pharmaceutical panacea is not likely to be an option.
The Organization: Survival of the Adaptive
by Nitin Nohria
Much of the organizational thinking about avian flu, and about crisis management in general, has focused on preparation. Many companies, for example, have created risk management teams to develop detailed contingency plans for responding to a pandemic. This is necessary but not sufficient. In the complex and uncertain environment of a sustained, evolving crisis, the most robust organizations will not be those that simply have plans in place but those that have continuous sensing and response capabilities. As Darwin noted, the most adaptive species are the fittest.
Consider the organizations described below. Which one would fare better in a sustained crisis such as a pandemic?
Organization 2 is clearly better positioned to respond to evolving, unpredictable threats. We know from complexity theory that following a few basic crisis-response principles is more effective than having a detailed a priori plan in place. In fires, for instance, it’s been shown that a single rule—walk slowly toward the exit—saves more lives than complicated escape plans do.
I’m not saying that companies should not have comprehensive risk mitigation plans. They should be asking questions about their supply chains and internal organization like, “What’s our response if one component goes down? What’s our response if two components go down? Do we have redundant computer systems?” But just as important, companies need to ask, “What real-time sensing and coordinating mechanism will we use to respond to events we can never fully anticipate?”
Companies shouldn’t rely solely on a specialized risk management team to see them through a sustained crisis. What if the team gets taken out? Instead, they need to develop the ability to rapidly evaluate ongoing changes in the environment and develop responses based on simple principles. This means that companies need a global network of people drawn from throughout the organization that can coordinate and adapt as events unfold, reacting immediately and appropriately to disruptions such as lapses in communication inside and outside the organization and losses of physical and human resources. (If a main office overseas suddenly drops out of a company’s network, who is going to jump in?) This network needs to quickly cycle through a process of sensing threats, coordinating, responding, and then sensing again. It needs to engage in creative and collaborative yet disciplined problem solving on the fly, even as members of the crisis network move around or drop out.
This is exactly what marine expeditionary forces do, to great effect. One reason the marines are so nimble is that they practice. Companies should do likewise. A firm could establish a globally dispersed group with shifting membership that would devote, say, half a day every other month to engaging in crisis simulations. What would the group do, for instance, if 30% of the company’s factory workforce in Asia dropped out? What if the United States closed its borders? How would the team respond to an “unthinkable” scenario? The goal is not to create specific rules for responding to specific threats but to practice new ways of problem solving in an unpredictable and fast-changing environment.
As for the two organizations described in the table, advantage in a crisis will go to the one that can leverage its capabilities and cooperate with other members of the community—even competitors. Companies should think about applying an open-source model to crisis response. Just as they invite partners and competitors to codevelop innovative products, they should look at whether codeveloped crisis responses would be better than proprietary ones. If they’d lose certain capabilities in a crisis and competitors would lose others, are there mutually beneficial opportunities for trade and collaboration?
Finally, many leaders think crisis management is not their job. That’s why they hired risk mitigation and security experts. But creating organizations that are strong in the face of uncertainty requires a new mind-set—and that must be driven from the top down. By developing a culture and mechanisms that support superior adaptive capability, companies will inoculate themselves against a range of threats, not just pandemics. They’ll become more resilient and competitive in the complex and uncertain business of business.
The Leader: Leading for the Long Run
by Warren G. Bennis
In a short-lived crisis, followers may be willing to overlook character flaws and settle for a leader who acts quickly and makes the right choices. They may tolerate a leader who acts unilaterally or doesn’t communicate stirringly, as long as he seems motivated by the common good.
In a continuing crisis—a war or a pandemic—people want a great deal more. They want leaders who strive to unify their followers. They want leaders with Winston Churchill’s ability to articulate the common threat and inspire people to overcome it together. During a long siege, people look to their leaders for hope. Above all, they want those leaders to be individuals who are capable of greatness and who aspire to it.
If a worst-case scenario unfolds as a result of avian flu, organizations will be stressed in ways that can’t be fully anticipated. As the pressure mounts, people will scrutinize their leaders relentlessly. They will expect their leaders to make smart decisions, yes, but they will also want leaders who have the ability, as Franklin Delano Roosevelt did, to comfort and galvanize them. In operational terms, leaders will need to share power as never before. No organization can afford to be without a succession plan during a pandemic. Some organizations may want to name co-CEOs or copresidents. And every CEO will want to build a team of top-notch people to share responsibility for solving the novel, complex problems that will inevitably arise. This leadership team will be better equipped to solve problems than any individual, and it will provide the organization with bench strength in case the leader becomes ill.
Abraham Lincoln is the great American model for this collaborative approach to crisis leadership. As Doris Kearns Goodwin describes in her biography Team of Rivals: The Political Genius of Abraham Lincoln, Lincoln drafted a wartime brain trust of former political rivals. He knew that Edwin M. Stanton had dismissed him as a country bumpkin, but he also believed that Stanton was the secretary of war the nation needed.
Widespread avian flu would introduce a new level of uncertainty into our already unsettled lives. If the threat escalates, people may be quarantined involuntarily. Whatever their organizational affiliation, people will feel they are losing control. The situation will require tireless, persuasive, optimistic—but factual—communication on the part of leaders. The medium of communication won’t matter much. In some organizations, leaders or their designees may want to start blogging regularly on flu-related matters. The tone of these communications will be critical, however. One of the insidious qualities of a health threat is that it destroys social cohesion. In the face of a deadly disease, people will become fearful of one another. Individuals who have amicably shared office space will begin recoiling every time a colleague sneezes. Genuine leaders will find the words to ameliorate those fears and enable people to remain connected and productive.
If the flu becomes a plague, employees must be assured that no organizational function is as important as their well-being. A pandemic would be an economic disaster, but it would also be an opportunity for organizations to repair the perception (often sadly true) that institutions no longer care about individual members. In the workplace, loyalty is increasingly seen as a fool’s game. But in the emotionally charged atmosphere of a pandemic, business as usual won’t be possible.
When I travel, I have a growing sense that people worldwide are frightened, hunkering down, worried about grotesque threats—terrorism, environmental degradation—that they can barely articulate. The threat to physical health presented by avian flu could be a chance for leaders to forge a new contract with members of their organizations, acknowledging each member as an asset and, in the process, making it so.