28 January 2006
WHO Announces a 3rd Strategy to Address Pandemic Flu: Rapid Response and Containment Protocol and Training
On Friday, January 27 the World Health Organization (WHO) posted on their website (www.who.int) a 15-page document titled: “WHO pandemic influenza draft protocol for rapid response and containment” that constitutes a new, 3rd strategy for addressing the threat of the next flu pandemic.
Until now the first primary strategy included containing outbreaks of avian flu in poultry, strengthening the early warning systems, and decreasing the potential for human infections from poultry. The second primary strategy has been to increase national preparedness plans, access to antiviral drugs, development of vaccines against a future pandemic flu virus, and improve public health and communication preparedness efforts.
This 3rd strategy is complementary to the first two, namely: “…national and international planning and resources are coordinated and focused for the purpose of rapidly detecting, and potentially stopping---or containing---an emerging pandemic virus near the start of a pandemic. The purpose of this protocol is to facilitate rapid detection and assessment of potential “signals” that the virus is improving its transmissibility, and to guide implementation of effective response interventions before an emerging pandemic virus has spread beyond an initial outbreak zone”.
WHO admits that containment of a pandemic of influenza has never been attempted before because “the world has never before received an advance warning that a pandemic may be imminent”.
The WHO will serve as the coordinating body for all international efforts to contain the initial outbreak of a pandemic virus. This initial rough draft protocol contains information on training personnel, global and regional antiviral (oseltamivir) stockpiles, non-pharmaceutical stockpiles to include N-95 respirators and surgical masks, and timelines for the next three months.
WHO will devote 3-5 staff and ask partner organizations to lend (“second”) staff to work full-time to implement the protocol. A pool of highly trained persons to mobilize on short notice and be deployed to the area of the world where the pandemic starts is another short-tem high priority.
In terms of stockpiles, the WHO has been promised a total of 5 million “treatment courses” (assuming the current treatment course estimate of 10 tablets/course is sufficient to treat one patient). Three million treatment courses will be kept “for containment purposes”; the additional two million courses (20 million tablets) “is flexible and under discussion”. “For reasons of security and logistics flexibility, one half of the supply is stored in Switzerland and one half in the USA”.
Non-drug supplies in the inventory include: Personal protective equipment kits with N-95 respirators and surgical masks, gloves, goggles, boot covers, disinfectant wipes, biohazard bags, and pictograph directions. In addition, hand washing soaps or alcohol-based hand rubs, and instructions in multiple languages are included.
From March 6-10, 2006 a global meeting will be held in Geneva to reach agreement on the key concepts and procedures for this new strategy. By May 1, 2006 a training faculty will be recruited and teaching materials developed.
While some may view this unprecedented 3rd strategy of the WHO as quixotic, the international cooperation that the details of this protocol mandate signifies valuable progress in and of itself. Global lessons learned from this protocol could be generalized to other future outbreaks in addition to pandemic flu, e.g., the next SARS-like novel respiratory virus.
In addition, it would be an important expression of this global cooperation to deploy some of the 50 million tablets of oseltamivir to regions of the world with human H5N1 infections, for example to stockpiles in two or more locations in Asia, rather than having all of the stockpiles in Switzerland and the USA.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterterrorism and Emerging Diseases
EROne Institutes, Washington Hospital Center
Co-Director, Master of Science Program
Biohazardous Threat Agents and Emerging Infectious Diseases
Georgetown University School of Medicine, Washington, DC
Website: www.BePast.org. 28 Jan 2006.