Gates Package — page 1058

ch held a full173 A drill, for example, is a test of just one part of a system--say, whether the fire alarm in your building works, and whether everyone knows how to get out quickly. Then, moving up the scale of complexity, there's the tabletop exercise, a discussion designed to identify and solve problems. More complicated still is the functional exercise, a simulated disaster that tests how well the whole system operates, but without moving people or equipment. Finally, there are full-scale exercises, such as Cascadia Rising. These are designed to get as close to the real thing as possible--complete with actors pretending to be sick or injured and vehicles moving people and equipment around. For as long as I've been learning about pandemic preparedness and prevention, I've been amazed that there isn't an ongoing series of full-scale exercises designed to test the world's ability to detect and respond to an outbreak. As the WHO's flu preparedness program put it in a 2018 guide to running outbreak exercises, "Considerable efforts and resources have been invested by countries around the world in developing national pandemic influenza preparedness plans and the capacities needed to respond to an influenza pandemic. However, to be effective, plans need to be tested, validated and updated periodically through simulation exercises."4 There have been many tabletop and functional exercises for disease outbreaks, but perhaps only a handful of country-scale ones designed to simulate an outbreak of flu or coronavirus.* Credit for running the first one seems to belong to Indonesia, which held a full- * Exercises related to animal-borne diseases aren't unheard of. For example, four years after a disastrous outbreak of foot-and-mouth disease in 2001, the United Kingdom and five