Its A Pandemic, Experts Say; Who Tweaks Label to Avoid Panic
Margaret Chan, the WHOs director-general, will make the announcement sometime in the next 10 days, said the people, who spoke on condition of anonymity because the deliberations are private. The agency, having spent the past five years alerting the world to the dangers of a pandemic, is now looking for a way to declare one without causing panic.
Chan has to navigate a delicate path between raising alarm about a virus that in most cases causes little more than a fever and a cough, and underestimating a bug that could kill millions. Moving to the top of WHOs six-step pandemic scale may spur some countries to restrict travel, ban public events and adopt other measures that arent needed for mild flu, worsening the deepest economic slump since the Great Depression.
“The formalization of an influenza pandemic does have cascading consequences,” said Michael Leavitt, former U.S. health and human services secretary. “The decision ought not to be taken lightly,” Leavitt said in an interview. “The system of evaluating and triggering different levels of alert is still being refined at the WHO.”
Chan and colleagues spent 7 hours on June 1 consulting experts and public health officials from 23 countries on how to explain that swine flu is global, but not severe.
Severity Scale
Following the discussion, the WHO is considering a three- point scale to denote different levels of severity once phase 6 has been declared, Keiji Fukuda, the agencys assistant director-general of health security and environment, said on a conference call with reporters yesterday.
The agency should offer tailored guidance to countries on how to respond to a pandemic, said Fukuda and Harvey Fineberg, president of the Institute of Medicine in Washington.
“Its one thing to say an outbreak has pandemic proportions, that its in so many places at once,” said Fineberg, who co-wrote an analysis of the federal immunization program against swine flu in 1976.
“Its a separate consideration to show how extensive it is, how many people are infected, and how severe the infections are,” he said in an interview yesterday. “A more complete characterization system would have to deal with all that.”
Adding a severity scale will give Chan leeway to raise the alert again if the new swine flu virus, called H1N1, becomes more deadly or if another threat emerges, said Peter Sandman, a New Jersey risk-communication consultant whose client list includes the U.S. Department of Homeland Security, the Centers for Disease Control and Prevention and WHO.
Wake-Up Call
As far as scientists are concerned, a flu pandemic isnt defined by its severity. The key criterion is geographic. The WHOs guidelines say a pandemic is imminent when a new virus causes outbreaks “in at least two countries in one WHO region” and its in progress when its widespread in “at least one other country in another WHO region.”
The new H1N1 flu strain, discovered in April, has turned up in 64 countries as far removed as Japan, Iceland and New Zealand. The virus is now starting to spread in Australia, Japan, U.K., Spain and Chile among people with no travel history and outside of schools and other institutional settings, Fukuda said.
More Proof Needed
“We are still waiting for evidence of really widespread community activity in these countries,” Fukuda told reporters yesterday. “They are in transition and are not quite there yet, which is why we are not in phase 6 yet.”
The virus, a new strain thats evolved in pigs, humans and birds, has sickened 18,965 people and killed 117 worldwide, Fukuda said. The WHO estimates seasonal flu causes up to 500,000 deaths a year. The H5N1 bird flu virus, which isnt easily transmitted among people, has killed 61 percent of the 432 people known to have been infected since 2003.
“In a macabre way of course, if it was really severe then a lot of decisions would be a lot easier,” Fukuda said in a May 11 interview.
Vaccine Dilemma