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.
Email:Daniel.R.Lucey@Medstar.net