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UK urges more flexibility in criteria for flu pandemic alerts

BMJ 2009; 338 doi: (Published 21 May 2009) Cite this as: BMJ 2009;338:b2067
  1. Adrian O’Dowd
  1. 1London

    Greater flexibility and additional information are needed when deciding whether to declare a flu pandemic, a delegation of countries have told the World Health Organization.

    The United Kingdom proposed at this week’s World Health Assembly in Geneva that a phase 6 alert—the top level—should reflect the severity of a new virus and not just its geographical spread.

    Speaking at the assembly the health secretary, Alan Johnson, said that WHO should not just be driven by a purely “mechanistic approach” but should also be able to use emerging knowledge about the severity of the disease and other considerations before taking the decision to move a flu pandemic alert to phase 6.

    Mr Johnson told WHO’s general secretary, Margaret Chan: “It is my belief we need to give you and your team more flexibility as to whether we move to phase 6.”

    Dr Chan replied: “I take on board your request to me, but I would like to get guidance and advice from other member states on how we move forward.”

    The UK’s suggestion was supported by Japan, China, Oman, Nigeria, New Zealand, and Egypt.

    In her main address to the assembly Dr Chan warned countries not to slip into a false sense of security from an apparent waning of swine flu.

    “Influenza viruses are the ultimate moving target,” said Dr Chan. “Their behaviour is notoriously unpredictable. The behaviour of pandemics is as unpredictable as the viruses that cause them.

    “This virus may have given us a grace period, but we do not know how long this grace period will last. No one can say whether this is just the calm before the storm.”

    Richard Besser, acting director of the US Centers for Disease Control and Prevention, told the assembly that the CDC was also trying to boost diagnostic capability across all states in the United States and throughout the world. He noted that the CDC has provided diagnostic test kits in all 50 states as well as to 237 laboratories in 107 countries. Each kit has a capacity for 1000 tests.

    However, Dr Besser, along with China’s health minister and Dr Chan, voiced concerns about a possible reassortment of the H1N1 virus with a more potent virus like H5N1.

    “We need to be vigilant and test it as it spreads,” Dr Besser said.

    Dr Chan warned: “We have every reason to be concerned about interactions of the new H1N1 virus with other viruses that are currently circulating in humans.”

    She added: “We must never forget that the H5N1 avian influenza virus is now firmly entrenched in poultry in several countries. No one can say how this avian virus will behave when pressured by large numbers of people infected with the new H1N1 virus.”

    So far the death rate in people infected with the H1N1 virus has been around 2%, whereas the H5N1 virus has shown a death rate of more than 50%.

    However, developing nations such as Brazil, Thailand, and Nigeria voiced concerns at the assembly that antiviral drugs and vaccines may not be distributed equitably, given that production capacity is predominantly concentrated in rich nations.

    An outbreak of swine flu in Japan over the past weekend has boosted the overall number of cases worldwide to 8830.

    As the BMJ went to press the UK had 102 confirmed cases of A/H1NI (up from 71 on Friday 15 May), and the number worldwide was 9830, in 40 countries, including 79 deaths.

    The latest WHO figures show that one of the sharpest rises was in Japan, where the number grew from just four confirmed cases on Friday 15 May to 159 cases by Tuesday. The countries with the highest numbers of confirmed cases are now the United States (5123), Mexico (3648), Canada (496), and Japan (159).

    The UK has made agreements with vaccine manufacturers to secure supplies of 90 million doses of A/H1N1 vaccine.

    The Department of Health announced a deal with GlaxoSmithKline and Baxter that will allow production of a pre-pandemic vaccine to begin as soon as possible.

    The department said that the deal could provide enough vaccine to protect the most vulnerable people in the population before a pandemic was likely to arrive, without affecting the supply of seasonal flu vaccine.


    Cite this as: BMJ 2009;338:b2067

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