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Source: http://www.vancouversun.com/health/Pandemic+alert+must+show+actual+danger+experts/1945177/story.html
Pandemic alert must show 'actual danger': experts
By Mohammed Adam, Canwest News ServiceAugust 30, 2009 2:01 PM
OTTAWA ? Canadian infectious disease experts say the H1N1 outbreak shows the World Health Organization's pandemic-alert system is a failure, as it doesn't show "actual danger."
WHO's alert system determines when a flu outbreak or epidemic has turned into a worldwide pandemic, and allows governments and public health agencies to respond appropriately to protect people.
But Dr. Brian Ward and Dr. Michael Libman, both of McGill University in Montreal, said H1N1, formerly known as swine flu, has exposed a major weakness in the rating system that must be fixed: the failure to articulate a real sense of the gravity of the flu outbreak, and how much of a public danger it really is.
"All the WHO criteria were based on spread and geography without any indication of severity . . . and what happened was that they were caught with an inadequate system of classification," said Ward, associate director of the Research Institute of the McGill University Health Centre.
Libman agreed, saying there was growing recognition among experts that some changes have to be made.
"To be useful, the rating has to have relevance to the actual danger that is present," said Libman, director of the division of infectious diseases at McGill.
"It is recognized now and there is some movement to look at how to revise this type of scheme so it has more relevance to the public."
WHO's alert system rates the threat of pandemics on a scale of one to six.
Level 1 indicates normalcy, while Level 2 shows a virus circulating among animals that are known to have infected people and therefore poses a potential pandemic threat.
Level 6 signals a global pandemic, with sustained human-to-human transmission over many countries and continents.
Declaring a pandemic is a serious step, because it says that the world is on the brink of a catastrophic health emergency that could cost millions of lives.
When people think of a pandemic, it conjures up images of global calamities like the Black Death or Spanish Flu ? and in response, the headlines scream catastrophe.
So when WHO officials declared the H1N1 pandemic in June following the swine flu outbreak in Mexico in April, that's exactly what happened ? the world reacted with a sense of foreboding.
In reality, pandemic declarations are based on a geographical spread of the virus across several continents ? not its deadliness.
But that fact was lost on the public.
Unable to make sense of a pandemic that for the most part turned out to be no worse than the common flu, many people began to question whether H1N1 really poses any serious danger at all.
Some claimed it was all government and media hype.
Ward and Libman acknowledge that part of the confusion lies with the WHO rating system.
They said it operates on the assumption, based on historical evidence, that by the time a flu spreads across continents to become a pandemic, it is indeed lethal.
"WHO found itself in the uncomfortable position of a rating system where nobody ever anticipated that there would a global pandemic that wasn't really nasty, nastier than the common flu," Ward said.
But now that H1N1 has so far proved that theory wrong, adjustments must be made to maintain confidence in WHO's alert system, which is a critical part of the world's response to pandemics, they said.
Ward said a new, "modulated" classification that also assesses the severity of pandemics, and includes it in the overall rating, might be more useful in avoiding unnecessary panic.
"I think in the coming year or years, we will probably see a new WHO classification that includes a severity indicator," Ward said.
Pandemic alert must show 'actual danger': experts
By Mohammed Adam, Canwest News ServiceAugust 30, 2009 2:01 PM
OTTAWA ? Canadian infectious disease experts say the H1N1 outbreak shows the World Health Organization's pandemic-alert system is a failure, as it doesn't show "actual danger."
WHO's alert system determines when a flu outbreak or epidemic has turned into a worldwide pandemic, and allows governments and public health agencies to respond appropriately to protect people.
But Dr. Brian Ward and Dr. Michael Libman, both of McGill University in Montreal, said H1N1, formerly known as swine flu, has exposed a major weakness in the rating system that must be fixed: the failure to articulate a real sense of the gravity of the flu outbreak, and how much of a public danger it really is.
"All the WHO criteria were based on spread and geography without any indication of severity . . . and what happened was that they were caught with an inadequate system of classification," said Ward, associate director of the Research Institute of the McGill University Health Centre.
Libman agreed, saying there was growing recognition among experts that some changes have to be made.
"To be useful, the rating has to have relevance to the actual danger that is present," said Libman, director of the division of infectious diseases at McGill.
"It is recognized now and there is some movement to look at how to revise this type of scheme so it has more relevance to the public."
WHO's alert system rates the threat of pandemics on a scale of one to six.
Level 1 indicates normalcy, while Level 2 shows a virus circulating among animals that are known to have infected people and therefore poses a potential pandemic threat.
Level 6 signals a global pandemic, with sustained human-to-human transmission over many countries and continents.
Declaring a pandemic is a serious step, because it says that the world is on the brink of a catastrophic health emergency that could cost millions of lives.
When people think of a pandemic, it conjures up images of global calamities like the Black Death or Spanish Flu ? and in response, the headlines scream catastrophe.
So when WHO officials declared the H1N1 pandemic in June following the swine flu outbreak in Mexico in April, that's exactly what happened ? the world reacted with a sense of foreboding.
In reality, pandemic declarations are based on a geographical spread of the virus across several continents ? not its deadliness.
But that fact was lost on the public.
Unable to make sense of a pandemic that for the most part turned out to be no worse than the common flu, many people began to question whether H1N1 really poses any serious danger at all.
Some claimed it was all government and media hype.
Ward and Libman acknowledge that part of the confusion lies with the WHO rating system.
They said it operates on the assumption, based on historical evidence, that by the time a flu spreads across continents to become a pandemic, it is indeed lethal.
"WHO found itself in the uncomfortable position of a rating system where nobody ever anticipated that there would a global pandemic that wasn't really nasty, nastier than the common flu," Ward said.
But now that H1N1 has so far proved that theory wrong, adjustments must be made to maintain confidence in WHO's alert system, which is a critical part of the world's response to pandemics, they said.
Ward said a new, "modulated" classification that also assesses the severity of pandemics, and includes it in the overall rating, might be more useful in avoiding unnecessary panic.
"I think in the coming year or years, we will probably see a new WHO classification that includes a severity indicator," Ward said.
