Pacific Eclipse: Before the corona dawn

The Pacific Eclipse meeting was based around an immersive tabletop simulation of a multi-threat bioterrorism disaster precipitated by the deliberate release variola virus in the South Pacific. The prescience and timeliness of this meeting, held on December 9th and 10th 2019, was extraordinary. Within a month, those attending the meeting, would be facing the SARS-CoV-2 epidemic, hopefully implementing many of the lessons learnt.

Although the pandemic spread of SARS-CoV-2 was not deliberate, many of the issues addressed in the meeting were and remain highly relevant to effectively managing and limiting the spread of a highly contagious infectious disease. The scenario based interactive meeting attracted academics including epidemiologists, infectious disease experts, immunologists, vaccinologists, public health experts, pathologists, and political scientists, emergency clinicians, senior planners from health authorities, leaders from defence, law enforcement and other first responder organisations, industry representatives and cybersecurity experts. Participants came from the USA, UK, Canada, Australia, New Zealand and the Indo-Pacific region. The exercise was designed to test the responses of local and global systems, at all levels of government and non-government sectors. It was a terrific opportunity for international security leaders to converge on an issue of clear importance.

Pacific Eclipse predicted a range of changes that COVID-19 would bring to the globe.

Firstly, the meeting had a very substantial virtual component. It was held in three different locations in three different time zones: Washington, Arizona and Hawaii, linked by two forms of digital software. Real time video linked the three rooms so that participants could actively participate in reacting to the scenarios in real time, as well hear, see and converse with the presenters and panellists. In addition, one of the industry participants supplied a mobile phone app that allowed secure, real-time commentary and discussion by text between all registered participants. The careful choreography of Pacific Eclipse allowed the stimulus provided by the scenarios to be seamlessly presented to all participants simultaneously resulting vigorous real time discussion, despite the geographical separation of the groups. This demonstrated what we all confirmed in 2020: that virtual meetings, if set up properly, can be highly effective means of communication, even when they extend beyond the didactic, allowing interactive discussion, debate and development of action plans, even when the exchange of ideas is across multiple disciplines.

The scenario-interactive based components of Pacific Eclipse effectively demonstrated the need for preparedness especially with regards the co-ordination of organisations with expertise in highly diverse areas, across multiple sectors. This component of Pacific Eclipse was underpinned by mathematical modelling. This allowed provision of realistic epidemic outcomes under different scenarios. Variable outcomes were determined by the different decisions, interventions and resource allocations made by the participants in the meeting. Pacific Eclipse demonstrated that the determinants of spread of a highly contagious pathogen, with ensuing significant morbidity and mortality, are complex, driven not only by the biology of both host and pathogen, but also by governmental and societal responses. In a globalised world, without coordinated and effective control responses, pathogen spread does not recognise the traditional societal, or geo-political boundaries. Responses need to be integrated not only within countries and but across countries and across all sectors of their societies. Decisions by actors outside a geo-political jurisdiction can affect other jurisdictions profoundly. As we have learnt, the extreme mobility of the modern age means that man-made borders and jurisdictional silos are not recognised by or limiting to pathogenic viruses. Further, the lack of consistent responses may, in fact, be advantageous to their spread. The global interactions we have all come to depend upon, can allow rapid spread of infectious diseases across the globe.

This means that any response has to be co-ordinated mature and responsive to unforeseen consequences of actions. The scenarios depicted within the Pacific Eclipse predicted: the porosity of borders and that cruise liners would pose very significant logistical issues and moral dilemmas caused by the risk of disease amplification on board, while being highly mobile vectors for the spread of disease across borders. As in real life, infections on cruise ships resulted in them becoming ping-pong balls bounced from jurisdiction to jurisdiction. The scenario also highlighted the need for consistent local control measures which are responsive and accommodating to the mores and customs of the societies in which the infection is spreading.

The scenario based discussions were underpinned by expert panel discussion sessions which highlighted the key elements of effective real world responses. Many practical, hard won insights were revealed in the discussions of the 2018 Novichok poisoning in Salisbury, UK and the 2001 Amerithrax attack. These discussions were led by experts directly involved in the multidisciplinary responses to these attacks. These demonstrated impacts well beyond health professionals, impacting directly on first responders, law enforcement agencies and even waste disposal agencies. The imperative for co-ordination, planning, communication and preparedness was graphically demonstrated by the honest and open reflections made during these panel discussions.

Pacific Eclipse also highlighted the requirement for a responsive, responsible and facilitatory political environment in order for these plans and agencies to be effective. The impact of a range of political events on the bioterrorism scenario was explored. However, all the preparedness on the part of health, defence and police forces, first responders and others will not remedy a lack of political will to deploy and support these responses and to communicate clearly with the public at large. Without public buy-in, even the best laid plans will not succeed and are likely to be undermined. The need to take the political classes with us on these journeys is a hurdle that needs to be cleared. 2020 has taught us that this hurdle can extremely be high. Jurisdictions where there is vacillating, ineffective or obstructive political support for evidence based responses have failed dismally and will fail to control future threats of highly infectious pathogens, whether they are released on purpose as part of a bioterrorism threat or are naturally occurring pathogens.

Declaration of Competing Interest

The author declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.