In A Recent Simulation, A Coronavirus Killed 65 Million People

In October 2019, a group of 15 business people, government officials, and health experts gathered around a table in New York to plan out the global response to a worldwide outbreak of a never-before-seen — and completely fictional — coronavirus.

It was a training exercise with disturbing similarities, in retrospect, to 2019-nCoV — the Chinese virus that has swiftly gone global this month.

Three and a half hours later, the group finished the simulation exercise — and despite their best efforts, they couldn’t prevent the hypothetical coronavirus from killing 65 million people.
The fictional coronavirus at the center of the Event 201 simulation — a collaboration between the Johns Hopkins Center for Health Security, the World Economic Forum, and the Bill and Melinda Gates Foundation — was called CAPS, and it started with pigs in Brazil before spreading to farmers, not unlike how 2019-nCoV reportedly began with animals before spreading to people.

In the simulation, CAPS infected people all across the globe within six months, and by the 18-month mark, it had killed 65 million people and triggered a global financial crisis.

The “players” in the Event 201 simulation included health experts from the United Nations and the Centers for Disease Control and Prevention, as well as several academics and representatives from private companies. In other words, they were the same types of people likely to plan the world’s response to a real-life coronavirus pandemic.

That makes the exercise’s devastating outcome particularly troubling. But according to Event 201’s organizers, the purpose of the simulation wasn’t to stir up fear. Instead, they hoped it would serve as a learning experience, highlighting both the potential impact of a pandemic as well as current gaps in our preparedness for one.

To that end, after the simulation ended, they created a list of seven actions that leaders in both the public and private sectors could take now to prepare for a scenario like Event 201.

The troubling implication remains, though, that if 2019-nCoV reaches the pandemic level, it might already be too late to prevent the millions of deaths predicted by Event 201.


Live Simulation Exercise to Prepare Public and Private Leaders for Pandemic Response

The Johns Hopkins Center for Health Security in partnership with the World Economic Forum and the Bill & Melinda Gates Foundation will host Event 201: a high-level simulation exercise for pandemic preparedness and response, in New York, USA, on Friday 18 October, 08.45 - 12.30 EDT.

The exercise will bring together business, government, security and public health leaders to address a hypothetical global pandemic scenario. It will also feature a live virtual experience from 08.50 – 12.30 EDT to engage stakeholders worldwide and members of the public in a meaningful conversation of difficult high-level policy choices that could arise in the midst of a severe pandemic.

The world has seen a growing number of epidemics in recent years, with about 200 events annually including Ebola, Zika, MERS and SARS. At the same time, collective vulnerability to the social and economic impacts of infectious disease crises appears to be increasing. Experts suggest there is a growing likelihood of one of these events becoming a global threat – or an “event 201” pandemic – that would pose disruptions to health and society and cause average annual economic losses of 0.7% global GDP, similar in scale to climate change.

"We are in a new era of epidemic risk, where essential public-private cooperation remains challenged, despite being necessary to mitigate risk and impact” said Arnaud Bernaert, Head of Shaping the Future of Health and Health Care, World Economic Forum. “Now is the time to scale up cooperation between national governments, key international institutions and critical industries, to enhance global capacity for preparedness and response.”

The International Health Regulations (IHR) that unite 196 countries across the globe in a legal commitment to prevent and respond to acute public health risks, prioritize both minimizing public health risks and avoiding unnecessary interference with international traffic and trade. Minimizing the economic impact of epidemics also represents an opportunity to build core capacities to prevent, detect, and respond to outbreaks generally.

"We live in an increasingly interconnected world, and we must help all UN member states align with the International Health Regulations and be prepared to prevent, detect, and respond to acute outbreaks,” said Chris Elias, President of Global Development at the Gates Foundation. “If we fail to do so, the world will be unprepared for the next pandemic."

"In this new era of extreme pandemic threat, public-private cooperation is essential for an effective response,” said Tom Inglesby, Director of the Johns Hopkins Center for Health Security. “While governments and public health systems are already strained due to the increase in dangerous outbreaks, experts agree that a severe, fast-spreading human-to-human pandemic incident could happen at any time. We believe this well-crafted and thorough realistic tabletop exercise will provide leaders with a deeper understanding of the impact of epidemics on their communities and inspire them to take important steps to advance prevention and response.”


The participants in the live simulation represent a range of backgrounds and industries and include:

    Latoya Abbott, Risk Management/Global Senior Director Occupational Health Services, Marriott International
    Stan Bergman, Chairman and CEO, Henry Schein
    Sofia Borges, Senior Vice President, UN Foundation
    Chris Elias, President, Global Development division, Bill & Melinda Gates Foundation
    Tim Evans, Former Senior Director of Health, World Bank Group
    George Gao, Director-General, Chinese Center for Disease Control
    Avril Haines, Former Deputy Director, Central Intelligence Agency; Former Deputy National Security Advisor
    Jane Halton, Board member, ANZ Bank; Former Secretary of Finance and Former Secretary of Health, Australia
    Matthew Harrington, Global President and Chief Operations Officer, Edelman
    Chikwe Ihekweazu, Director General, Nigeria Centre for Disease Control
    Martin Knuchel, Head of Crisis, Emergency and Business Continuity Management, Lufthansa Group Airlines
    Eduardo Martinez, President, The UPS Foundation
    Stephen Redd, Deputy Director for Public Health Service and Implementation Science, US CDC
    Paul Stoffels, M.D., Vice Chair of the Executive Committee and Chief Scientific Officer, Johnson & Johnson
    Hasti Taghi, Vice President and Executive Advisor, NBCUniversal Media
    Lavan Thiru, Chief Representative, Monetary Authority of Singapore

Similar high-level pandemic exercises designed to address difficult policy issues have included: Dark Winter, examining the challenges of a biological attack on the US; Atlantic Storm, asking NATO leaders to respond collaboratively to a bioterrorist attack: and most recently, Clade X, calling on US government leaders to make difficult national security and public health decisions in the face of a rapidly evolving global crisis.

In addition, Bill Gates co-chaired a simulation at the Forum’s Annual Meeting 2017, resulting in the creation of the Epidemics Readiness Accelerator, a public-private platform to address effective readiness in issues including travel and tourism, supply chain and logistics, legal and regulatory, communications and data innovations.



About the Event 201 exercise

Event 201 was a 3.5-hour pandemic tabletop exercise that simulated a series of dramatic, scenario-based facilitated discussions, confronting difficult, true-to-life dilemmas associated with response to a hypothetical, but scientifically plausible, pandemic. 15 global business, government, and public health leaders were players in the simulation exercise that highlighted unresolved real-world policy and economic issues that could be solved with sufficient political will, financial investment, and attention now and in the future.

The exercise consisted of pre-recorded news broadcasts, live “staff” briefings, and moderated discussions on specific topics. These issues were carefully designed in a compelling narrative that educated the participants and the audience.
The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation jointly propose these recommendations.

Purpose

In recent years, the world has seen a growing number of epidemic events, amounting to approximately 200 events annually. These events are increasing, and they are disruptive to health, economies, and society. Managing these events already strains global capacity, even absent a pandemic threat. Experts agree that it is only a matter of time before one of these epidemics becomes global—a pandemic with potentially catastrophic consequences. A severe pandemic, which becomes “Event 201,” would require reliable cooperation among several industries, national governments, and key international institutions.

Recent economic studies show that pandemics will be the cause of an average annual economic loss of 0.7% of global GDP—or $570 billion. The players’ responses to the scenario illuminated the need for cooperation among industry, national governments, key international institutions, and civil society, to avoid the catastrophic consequences that could arise from a large-scale pandemic.

Similar to the Center’s 3 previous exercises—Clade X, Dark Winter, and Atlantic Storm—Event 201 aimed to educate senior leaders at the highest level of US and international governments and leaders in global industries.

It is also a tool to inform members of the policy and preparedness communities and the general public. This is distinct from many other forms of simulation exercises that test protocols or technical policies of a specific organization.

Exercises similar to Event 201 are a particularly effective way to help policymakers gain a fuller understanding of the urgent challenges they could face in a dynamic, real-world crisis.

Recommendations

The next severe pandemic will not only cause great illness and loss of life but could also trigger major cascading economic and societal consequences that could contribute greatly to global impact and suffering.

The Event 201 pandemic exercise, conducted on October 18, 2019, vividly demonstrated a number of these important gaps in pandemic preparedness as well as some of the elements of the solutions between the public and private sectors that will be needed to fill them. The Johns Hopkins Center for Health Security, World Economic Forum, and Bill & Melinda Gates Foundation jointly propose these recommendations.

When/where

Friday, October 18, 2019
8:45 a.m. – 12:30 p.m.
The Pierre hotel
New York, NY

Audience

An invitation-only audience of nearly 130 people attended the exercises, and a livestream of the event was available to everyone.

Exercise team

Eric Toner, MD, is the exercise team lead from the Johns Hopkins Center for Health Security. Crystal Watson, DrPH, MPH and Tara Kirk Sell, PhD, MA are co-leads from the Johns Hopkins Center for Health Security. Ryan Morhard, JD, is the exercise lead from the World Economic Forum, and Jeffrey French is the exercise lead for the Bill and Melinda Gates Foundation.

Exercise team members are Tom Inglesby, MD; Anita Cicero, JD; Randy Larsen, USAF (retired); Caitlin Rivers, PhD, MPH; Diane Meyer, RN, MPH; Matthew Shearer, MPH; Matthew Watson; Richard Bruns, PhD; Jackie Fox; Andrea Lapp; Margaret Miller; Carol Miller; and Julia Cizek.

Event 201 was supported by funding from the Open Philanthropy Project.



Statement about nCoV and our pandemic exercise

In October 2019, the Johns Hopkins Center for Health Security hosted a pandemic tabletop exercise called Event 201 with partners, the World Economic Forum and the Bill & Melinda Gates Foundation. Recently, the Center for Health Security has received questions about whether that pandemic exercise predicted the current novel coronavirus outbreak in China. To be clear, the Center for Health Security and partners did not make a prediction during our tabletop exercise. For the scenario, we modeled a fictional coronavirus pandemic, but we explicitly stated that it was not a prediction. Instead, the exercise served to highlight preparedness and response challenges that would likely arise in a very severe pandemic. We are not now predicting that the nCoV-2019 outbreak will kill 65 million people. Although our tabletop exercise included a mock novel coronavirus, the inputs we used for modeling the potential impact of that fictional virus are not similar to nCoV-2019.