Special Issue - Pacific Eclipse

On December 9–10 2019, the 40 year anniversary of the declaration by The World Health Organization of the eradication of smallpox, and while SARS-COV-2 began spreading in China, we ran Pacific Eclipse, a pandemic tabletop exercise, in three cities simultaneously in the United States. Using smallpox as a case study, Pacific Eclipse brought together international stakeholders from health, defence, law enforcement, emergency management and a range of other sectors. The exercise was designed to identify potential gaps in preparedness and modifiable factors which could prevent a pandemic or mitigate the impact of a pandemic. Mathematical modelling of smallpox transmission was used to simulate the epidemic under different conditions and to test the effect of interventions. Live polling was used to gather participant decisions as the scenario unfolded. The scenario is described in detail in Pacific Eclipse – a tabletop exercise on smallpox pandemic response (Page https://doi.org/10.1016/j.vaccine.2021.10.081). A series of recommendations were made on the modifiable determinants of pandemic severity, and how these can be incorporated into pandemic planning. Many issues that subsequently arose during the COVID-19 pandemic were anticipated – testing, tracing, isolation, quarantine, vaccination response, stockpiling, social distancing, masks, border control, protecting critical infrastructure, business continuity and protecting first responders. Pacific Eclipse took a broad, societal view of pandemics, including cascading failures in critical infrastructure due to mass illness and absenteeism, all of which were seen during the subsequent COVID-19 pandemic. We illustrated the impact of a pandemic under different response scenarios, which were validated by the COVID-19 pandemic. The framework developed from the scenario draws out modifiable determinants of pandemic severity, can inform pandemic planning for the ongoing COVID-19 pandemic and for future pandemics. This special issue features an editorial by Rear Admiral Lois Tripoli who supported the involvement of US IndoPacific Command in Pacific Eclipse, and a range of papers on aspects of control of the COVID-19 pandemic. It is a resource for future pandemic planning incorporating lessons from the past and present.