New Zealand isn't prepared enough for a major pandemic, which could strike as swiftly as an earthquake and bring the country to its knees, researchers argue.
The Ministry of Health recently updated its strategy and is now reviewing its readiness plans in the run-up to the centenary of the 1918 flu pandemic, which killed more than 8600 New Zealanders and 500 million people around the world.
But the co-author of an article recently published in the Australian and New Zealand Journal of Public Health sees much more room for improvement, particularly with massive and modern threats posed by antimicrobial resistance, climate change and rising populations.
"For a small country, we are in danger of making things very difficult for ourselves," prominent Otago University public health expert Professor Michael Baker said.
Baker believes our capacity to deal with the threat has become fractured and eroded over the past 20 years.
The article, co-authored by Otago colleagues Julia Scott and Associate Professor Nick Wilson, set out ways health authorities could better prevent, detect or respond to a pandemic, which were suggested during a workshop with front-line officials earlier this year.
They included completing a plan to deal with antimicrobial resistance, with more collaboration between human and animal health sectors; creating labs for highly pathogenic organisms; and developing real-time surveillance beyond notifiable diseases and influenza.
The authors said a new framework was needed to cover a broad range of emerging infectious diseases, especially those with greatest potential to spread in our region, and carry out regular exercises targeted at them.
Independent assessments were also needed to check on resourcing in New Zealand, as well as low- and middle-income countries in the Pacific.
Baker said legislation around the area was now "horribly out of date", some response efforts were split between various agencies, and he questioned whether authorities had the expertise in place to deal with a sudden pandemic.
"With earthquakes, you know they are going to happen, but you just don't know when, or how big they'll be - pandemics are very similar."
The belief that New Zealand was somehow less exposed to major pandemics was proven wrong in 2009 when Rangitoto College students returned from Mexico with swine flu, making the country one of the first to be affected by what would become a global pandemic that killed more than 14,000 people.
Other pandemics, like that of mosquito-spread zika virus, had come unexpected to health authorities.
Conversely, antimicrobial resistance developed slowly but its impacts could be discovered disastrously too late.
"The most dramatic example I can think of is two years ago, when we woke and realised that a third of campylobacter cases across the country had been caused by a strain resistant to antibiotics," he said.
"As best as we can tell, the threat of pandemic appears to be increasing, and that's partly related to an increase in population growth and a long list of factors that are creating conditions that encourage emergence of new threats."
There were thought to be around 1400 different pathogens that affect humans, and, over the past few thousand years, most of them had crossed from animal "reservoirs" that carried them.
"There are still thousands of other microbes that can do that, so they are going to continue to surprise us."
Among nine "high priority" pathogens currently short-listed by the World Health Organisation are filoviral diseases like Ebola, which killed more than 11,000 people in a recent global epidemic, and highly pathogenic coronaviral diseases such as notorious Severe Acute Respiratory Syndrome, or SARS.
"But the good thing is we know from past events what works - and almost all pandemics are manageable if you have the capacity in place.
"Also, the benefit of investing in capacity to detect and respond is that some of that capacity can be used to look at prevention.
"Because, even though you can't prevent every pandemic, we do know the conditions that increase the risk of pandemics."
Responding to the researchers' concerns, the Ministry of Health stated it was leading a programme across other agencies to ensure plans were up to date.
That included national pandemic exercises to help familiarise officials with New Zealand's recently updated action plan.
"The severity and impact of a particular pandemic strain will only be known at the time, and the Influenza Pandemic Action Plan allows a flexible response to milder pandemics such as H1N1 in 2009 as well as our 'standard planning model' based on the 1918 pandemic," a ministry spokesman told the Herald.
Elsewhere, the ministry was reviewing areas such as surveillance capability for seasonal flu and how it could be scaled for a pandemic, with potential for social media to be used in tracking spread.
Over the next year, DHBs would be running a large-scale mass vaccination campaign with pandemic specific vaccine.
New Zealand also recently published a new plan to tackle antimicrobial resistance, with 18 priorities for the next five years, including prevention, stewardship and governance.