Changing the pandemic rules

May 25, 2009

The World Health Organisation literally changed the rules of the game while playing it last week, when it said it was rethinking the criteria it would use to declare a global flu pandemic is underway.

Britain and other countries affected by the newly-discovered H1N1 virus were pushing WHO Director-General Margaret Chan to pause before raising the six-point pandemic scale to its highest notch, as her United Nations agency’s rulebook says she should do once it is spreading in more than one region of the world.

Those rules were developed in anticipation of a pandemic from the toxic H5N1 bird flu strain, which kills about half those it infects but so far has not passed easily from person to person.  The WHO activated that alert system when it saw the new strain — which has genetic pieces of swine, bird and human viruses — was killing people in Mexico, including the young and seemingly healthy.  But it caused milder symptoms as it spread worldwide, and health experts now say that many of those infected may not even realise it.

So does its global spread still represent a pandemic?

After weeks of trying to explain that its alert scale is based on the way a potentially dangerous virus is spreading, not the severity of its effects at the present time, the WHO capitulated to pressure and changed its guidance.  Top official Keiji Fukuda told reporters on Friday that “what we are looking for and what we will be looking for is something, events, which signify a really substantial increase in risk of harm to people.”  This means that although there are pockets of sustained transmission in Japan, Britain, and Spain, the WHO will not have to issue the top alert unless the virus mutates or reverts to a more dangerous form.

While many nations are congratulating Dr. Chan for adding “flexibility” to the pandemic rules, others are raising questions about whether the WHO erred in yielding to the pressure from the mainly-rich countries with confirmed flu infections so far, who would be compelled to cough up money, drugs, vaccines, diagnostic tests, and other technology to poor nations if the world was on edge about Phase 6 flu.  A less severe threat level means less urgency in addressing those health-system shortcomings that affect not only poor countries’ response to H1N1, but also other deadly diseases such as tuberculosis, malaria, dengue and cholera.

While the WHO has said gaps in the world’s “pandemic preparedness” must be addressed as a matter of priority, it is apparent that this particular flu is not seen as enough of a trigger do so.  And that could have as much to do with politics as with science.

(Photo: Japanese students wear masks in Tokyo/Toru Hanai)


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