Written by: Helen Branswell, Medical Reporter, THE CANADIAN PRESS
Jun. 9, 2009
TORONTO - The World Health Organization is very close to declaring the first influenza pandemic since 1968, the agency's senior influenza expert suggested Tuesday.
Dr. Keiji Fukuda all but acknowledged that a swine flu pandemic is underway, saying the WHO is aware there is "a great deal" of community spread of the virus in at least one part of Australia - a fact which under the WHO's definition should trigger a pandemic call.
He also said the WHO is concerned about reports of severe illness among First Nations people in Manitoba, noting that in previous pandemics such populations have been hit particularly hard.
The Geneva-based organization is facing criticism for its apparent slowness to declare a pandemic in the face of mounting evidence that the new H1N1 virus is spreading widely around the world. As of Tuesday, there were 26,563 confirmed cases in 73 countries and 140 deaths.
"I believe that WHO is very close to going over the scientific credibility cliff, from which it will be hard to get back up out of that gorge if they hit the bottom," declared Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.
"They have been forecasting for 10 days that this is coming. And the data only become more compelling every day."
Several infectious disease experts in Australia have also said transmission in that country has crossed the pandemic threshold, the BBC reported. The WHO's pandemic alert scale says a pandemic will be underway when there is evidence of sustained community spread in countries in two different WHO regions.
Even WHO Director General Dr. Margaret Chan seemed to suggest Tuesday that those conditions may have been met. Chan told reporters in Geneva that "on the surface of it" the evidence needed to declare a pandemic may exist. But she added she will have a conference call Wednesday with governments to clarify what the true conditions are on the ground.
"Once I get indisputable evidence, I will make the announcement," she said. An agency spokesperson, Dick Thompson, said later that Chan was not suggesting an announcement would be made Wednesday.
Chan has repeatedly said the virus's behaviour will dictate whether and when a pandemic is called.
But Osterholm said the WHO has the evidence it needs, with ongoing and out-of-season spread in the Northern Hemisphere and now community spread in the Southern Hemisphere.
He suggested some countries have been dragging their heels on conducting surveillance for cases, trying to avoid triggering the pandemic call. He declined to name names.
But others have questioned case counts from the United Kingdom and Spain, where authorities initially discouraged most doctors from testing people for swine flu unless they had been in contact with a known case or had recently travelled to a place where swine flu was spreading. Community spread can only be observed if people who haven't travelled and don't have links to cases are tested.
"Absence of evidence is not evidence of absence," Osterholm said. "There are some countries right now who are making it difficult to find cases. And WHO knows this."
"But the point is there is enough evidence in enough places," he continued. "When you have the kind of transmission going on in the Northern and Southern Hemispheres that we're seeing right now, that is dramatic."
Fukuda's remarks seemed to imply part of the rationale for the delay was a desire to prepare the world psychologically for the call, so that countries don't impose unhelpful measures and people don't panic. He listed travel bans, border closures and trade embargoes as the types of measures the WHO believes would be counterproductive at this point.
The WHO wants to avoid a "blossoming of anxiety," said Fukuda, who is the acting assistant director general for health security and environment.
He said the agency is working hard to explain what declaring a pandemic actually means.
"It's a little bit paradoxical. You would think that by going up a scale, that it would mean that the level of concern should go up. But really what the going up the scale would mean is that we are seeing greater spread of the virus," said Fukuda.
"It does not mean that the severity of the situation has increased or that people are getting seriously sick at higher numbers or higher rates than they are right now."
Fukuda suggested the pandemic declaration, when it comes, will be accompanied by a statement describing the pandemic as being of moderate severity, noting there is concerning evidence that in vulnerable populations the virus may exact a higher toll than elsewhere. He pointed specifically to the reports emanating from Manitoba.
"If we see spread of this virus into populations which are especially vulnerable, it means that we may see more severe disease than we would see in populations which are relatively well off. I think the current reports coming from Canada ... are a good example of this."
Fukuda also said the WHO and scientific societies are trying to find a better name for the virus, which is now variously called swine flu, the Mexican flu or influenza A/H1N1 virus. The first two options are objected to strenuously by pork producers and the Mexican government while the latter creates confusion because there is a human flu virus by the same name that has circulated for most of the last century.
hat-tip: http://afludiary.blogspot.com/
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