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WHO hesitates over declaring flu pandemic
2009-05-21 12:37:41.712 GMT
by Alexandra Troubnikoff
ATTENTION - ADDS criteria for pandemic six ///
GENEVA, May 21, 2009 (AFP) - A month after the world was alerted
to a potential flu pandemic, the WHO was caught Thursday between
the spread of the new swine flu virus to 41 countries and doubts
fostered by its mild symptoms.
More than 11,000 cases and 85 deaths have been recorded since
the outbreak of A(H1N1) influenza emerged in Mexico and the United
States, and the world remains at flu alert level five, signalling an
"imminent pandemic".
But World Health Organisation Director General Margaret Chan has
stopped short of declaring a fully-fledged pandemic by moving to
phase six, even though travellers have carried it to other
continents.
The top level would indicate sustained community transmission in
a second region outside the Americas.
On Thursday, Japanese Prime Minister Taro Aso appealed for calm
as a total of 281 swine flu cases were reported in the country,
including the first in greater Tokyo, the world's largest urban
area.
Antoine Flahaut, an epidemiologist and head of the School of
Public Health (EHESP) in France, told AFP that the technical
elements were in place to move into the pandemic phase.
"But the WHO senses that recommendations which go with that are
not adapted to the situation," he explained, pointing to air travel
restrictions or advice to wear surgical masks.
"Invoking phase six would be disproportionate with the current
situation."
The doubts have grown because of the relatively mild symptoms of
swine flu, which experts acknowledge is no worse than seasonal
influenza for now.
Many of the deaths have occurred among those who were suffering
from other ailments, a common pattern for ordinary strains of flu.
During a meeting at the WHO's annual assembly Thursday, Chan
listed the issue of swine flu's severity among other criteria that
were prompting caution.
"One of the things we're not seeing is the same spread in the
southern hemisphere that we've seen in the first three countries," a
WHO official added.
When the assembly opened on Monday, British Health Secretary
Alan Johnson voiced doubts about phase six that had been growing
behind the scenes after countries rushed to contain new cases of
swine flu.
Those calls for caution and a more fleixble system prompted nods
of approval from other countries afterwards, including China, Japan
and New Zealand.
"She has taken that on board," WHO spokesman Thomas Abraham
said, underlining that most of the cases in Japan were largely
confined to students or their close entourage.
Chan acknowledged this week that the WHO's pandemic response
plan, introduced nearly four years ago, was largely designed around
the more deadly and virulent, but less transmissible, H5N1 bird flu
virus.
"This scale was based on geographical distribution, but the
public belief is that pandemic means seriousness," said Sylvie
Briand, acting director of the WHO's Global Influenza Program.
But the WHO is also looking ahead at the potential progress of
the new virus, and fears of its impact in poor countries, where
millions of people are already weakened by chronic illness.
"Whatever the member states might say, we are in phase five,"
Abraham remarked.
In studies released by the New England Journal of Medicine,
scientists pointed out the similarities between the new A(H1N1)
virus and ones behind pandemics that marked the 20th century.
Those pandemics in 1918-1919 -- which killed an estimated 50
million people -- in 1957-1963 and 1968-1970 started off as mild but
went through waves that became more lethal at their peak, often the
second season, and had different impacts in different regions.
They also affected young people -- a feature underlined by the
WHO in the current outbreak -- and were highly transmissible, the
researchers from the US National Institutes of Health and George
Washington University said.
Abraham said it was still not clear if young people were more
affected by swine flu because of the nature of the virus, or because
it was more likely to be passed around among students in the close
confines of schools.
"This virus does affect younger people, we don't know the reason
for this - whether it's viral or epidemiological," he explained.
pac/co
