October 15, 2017


Allison Aiello, PhD
Professor of epidemiology


First, it is imperative to acknowledge that a pandemic will occur. The 1918 flu epidemic infected one-fifth of the world’s population and killed a record 50 million people around the world – and something with that potential will happen again.

The World Health Organization consistently states that an influenza pandemic is imminent. With the possibility of new pandemic influenza virus outbreaks on the horizon, pandemic preparedness has been considered an important research and policy priority in the U.S. Although many of the practical considerations of implementing pandemic planning and response have been addressed, there are few data regarding how these interventions would be carried out effectively in real-world pandemic situations.

Q: How do we strengthen our defenses against such emerging respiratory a infectious diseases?

A: While certain types of respiratory infections can be incredibly infectious and easily transmitted from one individual to another, some simple measures can help us prepare for and mitigate the spread of highly infectious respiratory pathogens.

Pharmaceutical interventions, particularly vaccinations, have been the principal public health method of preventing and controlling seasonal influenza, one of the most concerning respiratory infections. Nonetheless, the experience of pandemic influenza, both historic and the more recent H1N1 pandemic, has changed this perspective.

It took great effort to produce an H1N1 vaccine quickly. Many individuals who needed protection did not receive it right away, and only a limited number of vaccine doses were available. To date, no universal vaccine protects against all current and future influenza strains. Fortunately, researchers are working on this problem of universal protection.

Nonetheless, it is possible that an entirely new non-influenza virus may arise in the future for which there are no available vaccines. This leaves nonpharmaceutical interventions (NPIs) as some of our key tools for mitigating the impact of a pandemic.

Q: What are some of a these interventions?

A: Among suggested NPIs are social distancing, school closings and use of protective face masks, all of which we have studied in our research. These measures reduce transmission of respiratory infections, but there are many questions about how to shape policies and protocols for practicing these interventions. The CDC has promoted layered NPIs to ensure that any gaps in one single recommended intervention would be covered by other practices.

Q: How does your research address these concerns?

A: There is little research on the social, psychological and real-world implications of implementing NPI recommendations. For instance, clear guidelines have been developed to help schools implement closings (tinyurl.com/community-guide-task-force), but we have little experimental data on how these recommendations will work in practice.

This is also true for the workplace environment, where guidelines are less consistent across different work settings than in schools. In addition, we have few data on the societal and psychological implications of implementing all recommended NPIs together, in the case of a pandemic.

We have tested several different NPIs for respiratory infections, including face masks, hand hygiene and social distancing. We learned a lot from these studies, including identifying barriers to implementation and studying the overall effectiveness of these measures for decreasing transmission of respiratory infections.

This year, we plan to conduct a study using proximity sensors to detect interactions between individuals in the workplace and identify types of behaviors and actions that lead to hand hygiene. For example, if individuals are talking to each other, and one individual coughs, are both people likely to practice hand hygiene after that conversation?

These are basic questions related to behaviors and norms, which have not been well studied in the workplace. With issues related to stringent sick-leave policies, our research may provide insights into practices that could be enhanced in the work place to reduce transmission of infectious diseases.

Q: What kinds of research teams will we need to address these pandemic threats in the future?

A: One thing I learned through this research is that interdisciplinary teams are key. It is crucial that epidemiologists work with researchers from numerous disciplines, such as anthropology, history, sociology and health behavior – as well as laboratory researchers, clinicians, computer scientists, engineers and communication experts, including those who know how to use social media effectively. Together, these experts can provide important insights for carrying out and interpreting the results of NPI studies – and implementing a plan.

Q: What simple measures could an individual take to offset the threat of a pandemic?

A: Be sure to use proper hand-hygiene technique, stay home while ill, cough or sneeze into your elbow, keep a basic surgical mask at home in the case of a pandemic – and follow the CDC’s advice when a vaccine becomes available.


Return to Table of Contents

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit sph.unc.edu/cph