Prepared for the unforeseeable

The Norwegian Institute of Public Health (FHI) and its director-general, Camilla Stoltenberg, never know what infection may break out – or when. All they can be sure of is that it will come. And that they need to be ready for every eventuality.

No activity can be pursued without risk, but the latter can and must be managed. That recognition is well established in the petroleum industry.

But what if the risk does not clearly relate to a specific activity which can be planned? What if the hazard is contagious and takes the form of a potentially fatal disease?

The FHI is one of the agencies mobilised when influenza and other infectious maladies threaten Norway. It monitors national and international epidemiological conditions and advises the health service, other agencies and the public at large.

“Good risk management systems are crucial for preventing a public health crisis,” says Stoltenberg. “Mapping, planning, emergency preparedness and training are major elements here.

“Our problem is that we never know what the next big outbreak will involve. That means we must prepare on a broad basis, because no epidemic is the same.”

Key

As in the oil industry, the precautionary principle occupies a key place at the FHI. Stoltenberg regards it as crucial in seeking to combat infectious diseases.

“We never sit and wait while wondering whether to do something,” she says. “We always respond, and the threshold for allocating staff resources is low to stay on the safe side.

The most important consideration is to determine quickly that an outbreak is happening. This means we mobilise large parts of our organisation even if the risk is relatively low. That also gives us the best training.

Following the swine flu scare in 2009, the FHI’s decision to recommend vaccination of the whole Norwegian population came in for criticism from several quarters.

Stoltenberg emphasises the importance of taking quick decisions, even though a lot remains uncertain – and even if you get castigated for doing so.

“It obviously wasn’t possible in those circumstances to be certain about the right course of action, and it’s not given that we’d choose the same response again – since we now know more.

“Nevertheless, when summing up the swine flu pandemic, I still believe our standpoint was right at the time.

“The UK, for instance, opted to vaccinate only a modest proportion of the population. It experienced serious outbreaks for many seasons thereafter, with a number of deaths.

“Adding up how many were actually killed or injured by swine flu over the five years from 2009 shows that this epidemic took many more lives than was predictable after the first round.”

She says that this has helped to give people a more nuanced view of the matter, and that the FHI has experienced little criticism of late.

Warning

Infection control is organised internationally through a number of warning systems run by such bodies as the EU and the World Health Organisation (WHO).

All member states are required to use these systems if they think an outbreak could have an international impact. Several major epidemics have occurred on a global basis in recent years.

These include severe acute respiratory syndrome (Sars) in 2002 and Middle East respiratory syndrome (Mers) in 2012, as well as swine flu – which actually reached Norway.

Ebola fever has been the big concern over the past year and, although Norway remains unaffected, its anti-infection organisation has been on high alert.

“We must always assume that infection can develop quickly,” says Stoltenberg. “So we plan for various scenarios. We can envisage, for example, that an illegal immigrant from west Africa could bring Ebola here.

“Were we to discover a sick person under such circumstance, the country would find itself facing a very acute condition.”

Challenging

Learning lessons is important for being equipped to cope with challenging new disease outbreaks in the future, and the FHI establishes dedicated strategic groups to analyse such incidents.

Intended to build up more experience with and capacity for continuous analysis of crises, these provide advice and assessments to the operational personnel directly involved.

“We try to envisage scenarios which look completely different, since we never know when a new epidemic will occur,” says Stoltenberg. “We only know they’ll certainly turn up.”