Jean-Paul Rodrigue (2013), New York:
Routledge, 416 pages.
Transportation and Pandemics
Authors: Dr. Jean-Paul Rodrigue, Dr. Thomas Luke and Dr. Michael
Dr. Luke: Department of Virology, Naval Medical Research Center.
Dr. Osterholm: Director of the Center for Infectious Disease Research
and Policy (CIDRAP), University of Minnesota.
There are approximately 1,500 microbes that are known to
be a source of disease among the human population. Influenza
can be one the most virulent among them because of its ability to mutate
and be efficiently transmitted through the respiratory route. Under
normal circumstances, influenza's impacts are relatively benign since
populations have developed a level of immunity to its debilitating effects.
Yet, it is estimated that between 1 to 1.5 million people per year die
of influenza or related complications with a distinct
seasonality that runs between October and
March in the northern hemisphere and between May and September in
the southern hemisphere. Influenza pandemics are thus considered to be among the most
significant threats to the welfare of the global population.
Pandemic. An epidemic of infectious disease that spreads
through human populations across a large area, even worldwide.
Over the last 300 years, ten major influenza pandemics have occurred.
The 1918 pandemic (Spanish Flu) is considered to be yet the most severe.
30% of the world’s population became ill and between 50 and 100 million
died. One important factor why the Spanish Flu spread so quickly and
so extensively was through
which at the beginning of the 20th century offered a global coverage.
The virus was spread around the world by infected crews and passengers
of ships and trains and severe epidemics occurred in shipyards and railway
Concerns about the emergence of a new pandemic are salient, particularly
in light of recent outbreaks such as SARS (Severe Acute Respiratory
Syndrome) in 2002-2003 and the Swine Flu in 2009, which quickly spread because of the convenience
and ubiquity of
global air travel. The next influenza pandemic could be equally severe and
widespread illness or absenteeism in freight transportation sectors
can cause cascading disruptions of social and economic systems. The relationships between transportation and pandemics involve two
major sequential dimensions:
2. Vectors and Velocities
The more efficient transportation, the
more efficient is the vector
that can transmit an infectious disease. International and long distance
transport such as air and rail, modes and terminals alike, concentrates
passengers and increase the risk of exposure. In the past, this could
be an advantage as a ship could be quarantined, since there were ample
time during the voyage for an infection to carry its course and the
symptoms to become apparent. Today, it is a different matter as the
velocity conferred by transportation systems for long distance
travel is superior to incubation time of many flu variants (the
period after the infection before symptoms are revealed). Since the
incubation time for the average influenza virus is between 1 and 4 days,
there is ample time for someone being infected to travel to the
other side of the world
before noticing symptoms. This represents the translocation phase and
is the most crucial in a pandemic.
Once symptoms have developed, there is also a "denial phase" where
an infected individual will continue traveling, particularly if going
back to his place of origin. An infected individual beginning to show
symptoms is likely to cancel an outbound travel, but will do the utmost,
even breaking quarantine (or warnings), to go back home. Thus, in a
window of a few days before an outbreak could become apparent to global
health authorities, a virus could have easily been translocated in many
different locations around the world. At this point, the vector and
velocity of modern transport system would insure that an epidemic becomes
a pandemic. In some cases, the velocity of global transportation systems
is higher than at the regional level, which paradoxically implies that
a virus can spread faster at the global level - between major
gateways - than at the regional level.
Once an outbreak becomes apparent, the global passenger transportation
system, such as air travel and passenger rail, can quickly be shut
down in whole or in part, either voluntarily (more likely if the
outbreak is judged to be serious) or by the unwillingness of passengers
to be exposed to risks. The latter is what happened during the SARS outbreak
in 2003. For instance, while the public transportation systems of several
large Chinese cities were still operated, the number of users precipitously
dropped because of risk avoidance. The SARS outbreak also had a substantial
impact on the global airline industry. After the disease hit, flights
in Pacific Asia decreased by 45% from the year before. During the outbreak,
the number of flights between Hong Kong and the United States fell 69%.
It is quite clear that this impact would be pale in comparison to that
of a 12 to 36 month worldwide influenza pandemic.
3. Continuity of Freight Distribution
However dramatic the impacts of modern transportation as a high
velocity vector for a pandemic, a potential greater risk resides
in the geographical and functional structure of supply chains because
the continuity of freight distribution could be compromised.
Up to the mid-20th century, the scale of production, transport and retail
was dominantly local (food) or regional (durable goods such as cars).
Since then, globalization expanded substantially the scale at which
a wide array of goods is distributed. Thus, the interconnectedness
of the global economy, while being a net advantage from a supply chain
standpoint, could make the next influenza pandemic more devastating
than the ones before it. Even the slightest disruption in the availability
of parts, finished goods, workers, electricity, water, and petroleum
could bring many aspects of contemporary life to a halt. The global
economy has been favored by the exploitation of comparative advantages
and a more tight management of supply chains. Inventories are kept to
a minimum. Virtually no production surge capacity exists. As a consequence,
most markets depend on the timely delivery of many critical products
(such as pharmaceuticals, medical supplies, food, and equipment parts)
and services (such as communications support).
The transportation industry has also consolidated into a
of global and national mega-players to achieve massive economies
of scale. This is the case for the two most important global freight
maritime shipping and
air cargo. Since the frequency, speed and reliability of shipments are
high under normal circumstances, manufacturers have relocated their
facilities to lower cost locations. Because transportation costs are
lower than inventory management costs, retailers and secondary manufacturers
employ “just-in-time” inventory systems - their “stockpile” is flowing
in the transportation stream as inventory in transit. Most supply chains
are re-stocked on a continuous basis, on par with the demand, which
is labeled pull logistics. The typical
efficiency, and potential non-resiliency, of critical supply chains
as a function of transportation would be placed under stress during
a pandemic. The most important include:
- Transportation as a vector. With ubiquitous and fast
transportation comes a quick and extensive diffusion of a communicable
disease. From an epidemiological perspective, transportation can
thus be considered as a vector, particularly for passenger transportation
systems. The configuration of air transportation networks shapes
the diffusion of pandemics. This issue concerns the early phases
of a pandemic where transportation systems are likely to spread
any outbreak at the global level.
- Continuity of freight distribution. Once a pandemic takes
place or immediately thereafter, the major concerns shift to freight
distribution. Modern economic activities cannot be sustained without
continuous deliveries of food, fuel, electricity and other resources.
However, few events can be more disruptive than a pandemic as
critical supply chains can essentially shut down. Disruptions in
the continuity of distribution are potentially much more damaging
than the pandemic itself.
It is very likely that a pandemic would quickly exhaust available
food, energy and medical resources, replacements will not be forthcoming.
Thus, supply chain issues are expected to seriously compound the impacts
of an influenza pandemic.
4. Possible Mitigation Strategies
Many pandemic preparation plans fail to account the full importance
and ramifications of global supply chains. They are essentially
designed with the assumption that national economies, namely the United
States, are mostly self reliant. The geographic and functional realities
of the global economy are quite different from this assumption. Cascading
disruptions in vulnerable freight transportation systems and strategic
supply chains can compound the difficulties of maintaining social cohesion
and critical infrastructures during a pandemic. Transportation workers
must therefore receive a high priority for support – including vaccine,
prophylactic antivirals, public health interventions and access to health
care. Pandemic planners must cooperatively develop plans and obtain
the agreements and resources necessary to conduct health assurance campaigns
at major transportation chokepoints and corridors.
The basic strategy to protect the transportation system is to provide
the workers with vaccine, prophylactic medications, protective equipment
and physical security under the umbrella of transmission shielding operations
as they move from and into transportation chokepoints and at suitable
points along major corridors (i.e. weigh stations, etc.). Transportation
workers must also have a well-enunciated priority for healthcare
services if they become ill during their work travels. This will require
that some national, state and local pandemic resources and response
activities are reprioritized from traditional influenza priority groups
(elderly, etc.) to insure that all citizens have a reliably adequate
supply of essential supplies and services. Using modern communication
systems, national, state and local licensing and regulatory authorities,
industry and unions can identify, locate, educate and train the transportation
workforce. Governments and transportation stakeholders (industry, unions,
and workers) must create a cooperative plan that identifies roles, resources
Because transportation workers must cross international and local
borders, national and local entities, industry and unions, health agencies
and other stakeholders must provide this support without regard to their
nationality or state of origin. The international maritime domain presents
unique challenges as it plays a fundamental role in supporting the global
distribution of essential commodities (food and energy), parts and finished
goods. The naval services of nations should prepare to establish task
forces in international waters to quickly provide vaccine/antivirals
and other health assistance to the multinational mariners of commercial
vessels as they transit into or out of maritime chokepoints and sea
lanes. International entities such as the North Atlantic Treaty Organization,
the International Maritime Organization, or the Global Maritime Partnership
initiative, can provide the organizational framework to protect global
- Food. Modern food production and distribution relies
on low levels of inventory, particularly to avoid wastes of perishable
products on store shelves. On average, supermarkets have between
2 to 5 days of inventory of perishable goods (dairy, produce, meat)
and about 1 to 2 weeks for other goods (pasta, canned goods, etc.).
It is worth underlining that these figures are for a normal and
stable demand. In the case of a pandemic, available food supplies
could quickly be exhausted through hoarding behavior. Food security
is therefore defined by the ability of the transportation workers
to move food from producers, to the bulk-storage facilities, to
the processor and lastly to the grocer.
- Energy. The provision and distribution of energy is critical
to the functioning of a modern economy and society. For instance,
about 40% of the world's supply of electricity is generated by burning
coal (50% for the United States). Coal power plants maintain a fairly
low stockpile, about 30 days, and rely on a constant supply from
major coal mining regions, which tend to be far away. While a pandemic
would not directly damage energy systems, many energy distribution
systems could be threatened through the removal of essential personnel
from the workplace for weeks or months and impaired transportation
capabilities to supply power plants.
- Medical supplies. A pandemic is obviously associated
with a surge in the use of medical facilities, equipment and pharmaceutical
products. Global drug production is controlled by a few large conglomerates
that maintain a limited number of facilities at selected locations.
Commonly, a single drug is produced at a single plant. If global
distribution systems were impaired during a pandemic, many essential
drugs would have difficulties to reach patients while limited stockpiles
maintained at medical facilities would quickly run out. For instance,
over 95% of all generic drugs used in the United States are made
offshore, primarily in China and India. A similar pattern applies
to critical medical equipment such as ventilators. Even simple respiratory
masks could quickly run out. All these shortages are likely to result
in additional deaths.