Humanitarian Resource Institute:  A U.S. & International Resource on the Scope of Humanitarian Assistance

April 4, 2003 

Stephen M. Apatow
Director of Research and Development 
Humanitarian Resource Institute Biodefense Reference Library
Eastern USA: (203) 668-0282   Western USA: (775) 884-4680


The outbreak of Severe Acute Respiratory Syndrome (SARS) has spanned a period of 5 months (WHO reporting: From: 1 Nov 2002 To: 4 Apr 2003) yielding 2353 cumulative cases and 84 deaths, crossing international boundaries within a matter of weeks (SARS: Epidemiological Tracking: The seriousness of this outbreak is underscored by the fact that transmission and case contact to date is based on clinical/epidemiologic case definitions without a definitive laboratory test to prove or disprove infection by a definitive etiologic agent. 

As outlined CDC Influenza Pandemics: How They Start, How They Spread, and Their Potential Impact 
(,  we are at a phase 2 level of this current pandemic: 

"The Pandemic phase occurs when the novel virus is causing outbreaks and epidemics in multiple countries around the world. If a community has not prepared itself well before this phase, it may be suddenly facing some very serious public health, social, and economic problems. Fortunately, it is extremely rare for a novel virus to progress to the Pandemic phase. It hasn't happened since the Hong Kong flu of 1968." 

Fortunately, in the case of an influenza outbreak, a vaccination strategy would be a key variable for containment and control. At this juncture, our inability to define the etiologic agent is directly associated with our inability to implement a vaccination strategy, which is a major component of  Phase 3 (End of First Pandemic Wave): 

"Influenza activity in initially affected countries/regions has stopped while outbreaks of the new viruses are continuing elsewhere. During this "downtime," it is important to maintain enthusiasm for the pandemic response by continuing vaccination campaigns and other response efforts. This may be the time when we have a chance to "catch up" to the virus." 

Which leads to Phase 4 (Second or Later Waves of the Pandemic): 

"Based on past experiences, at least a second wave of outbreaks caused by the novel virus would be expected to occur within 3-9 months of the initial epidemic in a particular country or region." 

This outbreak paints a clear picture, even if SARS is a natural evolutionary challenge encompassing a virus that has jumped species, the global public health infrastructure is currently not prepared for rapid containment, control and eradication of such an infectious agent.  It is in the context of this reality that the threat of bioterrorism must be comprehended and perhaps the realization that: 

"Weapons of Mass destruction threaten the very fabric of civilization itself, presenting the need for a proportional emphasis on open dialogue, conflict resolution and negotiations that will provide a lasting solution for sustainable peace." - International Interfaith Peace Declaration (

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