14 September 2005
WHO issues new H5N1 pandemic flu recommendations for policy-makers
At the beginning of this month the World Health Organization (WHO) posted on their website (www.who.int) an 18-page document addressed to policy-makers titled: Responding to the avian influenza pandemic threat: Recommended strategic actions. Several of the highlights of this key document warrant emphasis.
The opening page reiterates the official WHO position that “In view of the immediacy of the threat, the WHO recommends that all countries undertake urgent action to prepare for a pandemic.” The real-world difficulty of pandemic flu preparedness is captured by the WHO description of the situation today as “characterized by both urgency and uncertainty” (italics added for emphasis).
Six points are discussed in assessing the current potential pandemic situation:
1.) The risk of a pandemic is great.
2.) The risk will persist
3.) Evolution of the threat cannot be predicted
4.) The early warning system is weak
5.) Preventive intervention is possible, but untested
6.) Reduction of morbidity and mortality during a pandemic will be impeded by inadequate medical supplies.
WHO then discusses three (3) phases of a pandemic ((1) pre-pandemic; (2) emergence of a pandemic virus; (3) and when a pandemic is declared)) and what the objectives are for each phase and what strategic actions are recommended to achieve each objective within the three phases of the pandemic The example of the two objectives for the current pre-pandemic phase, and their strategic actions, are summarized below:
The first of two objectives for the pre-pandemic phase is: “Reduce opportunities for human infection”. The four strategic actions recommended to achieve this objective are:
1. Support the FAO/OIE (international animal health) control strategy
2. Intensify collaboration between the animal and public health sectors
3. Strengthen risk communication to rural residents
4. Improve approaches to environmental detection of the virus
The second objective of this pre-pandemic phase is: “Strengthen the early warning system”. The seven strategic actions to achieve this objective are:
1. Improve the detection of human cases
2. Combine detection of new outbreaks in animals with active searches for human cases.
3. Support epidemiological investigation
4. Coordinate clinical research in Asia
5. Strengthen risk assessment
6. Strengthen existing national influenza centres throughout the risk-prone region
7. Give risk-prone countries an incentive to collaborate internationally.
In addition to these recommended actions, WHO emphasizes several sobering facts about international (lack of) preparedness:
1). Only one-fifth (1/5) of the nations in the world have any form of a pandemic flu response plan, and these vary widely in detail and stage of completeness.
2). Twenty-three (23) nations have ordered anti-influenza drugs for national stockpiles, but these orders cannot be filled for at least one year.
3). Less than 10 nations have one or more domestic vaccine manufacturers working on a pandemic flu vaccine.
4). Given this current vaccine situation, the majority of developing nations “would have no access to a vaccine during the first wave of a pandemic and possibly throughout its duration”.
5). “The best opportunity for international collaboration---in the interest of all countries—is now, before a pandemic begins”.
Whether policy-makers, in developed or developing nations, act now on these WHO recommendations will certainly influence the severity of the coming pandemic, whenever it arrives.
At its best, working together internationally now on such a difficult and momentous health issue as pandemic influenza would also strengthen global efforts against other infectious diseases such as HIV/AIDS, tuberculosis, malaria and other parasitic diseases, the next SARS-like disease, and bioterrorism.
Daniel R. Lucey, MD, MPH
Adjunct Professor of Microbiology and Immunology
Georgetown University School of Medicine
Director, Centre for Biologic Counterterrorism and Emerging Diseases
Department of Emergency Medicine
Washington Hospital Center, Washington DC
Posted on www.BePast.org 14 Sept 2005.