Monday, April 27, 2009

Day late and a dollar short on swine flu response

Reasonably intelligent people could tell on Saturday morning that the appropriate pandemic level was Phase 4 (or even 5), that people should be advised not to travel to Mexico, California, and Texas, and I would argue that travel be stopped.  And I can understand not saying anything until consultation occurred and measures were in place.  But it appears to me that WHO, CDC, and the White House, were a day or two late in treating this situation as a genuine pandemic risk.  I hope that we will not live (or die) to regret that delay.  Obviously, the cat may have already been out of the bag as WHO argues, but I still think that closing borders would have been wise.  Now, today WHO raised the level to phase 4, but says that closing the borders will no longer do any good given the spread to the U.S. and Canada.  Apparently there are other countries reporting influenza like illnesses not yet confirmed as swine flu.  But absent a spread outside North America, I still think that it make sense to close borders, even if only to delay the spread across these large countries.

Here's WHO's statement after the second meeting of the Emergency Committee today:


Statement by WHO Director-General, Dr Margaret Chan
27 April 2009

Swine influenza


The Emergency Committee, established in compliance with the International Health Regulations (2005), held its second meeting on 27 April 2009.

The Committee considered available data on confirmed outbreaks of A/H1N1 swine influenza in the United States of America, Mexico, and Canada. The Committee also considered reports of possible spread to additional countries.

On the advice of the Committee, the WHO Director-General decided on the following.

The Director-General has raised the level of influenza pandemic alert from the current phase 3 to phase 4.

The change to a higher phase of pandemic alert indicates that the likelihood of a pandemic has increased, but not that a pandemic is inevitable.

As further information becomes available, WHO may decide to either revert to phase 3 or raise the level of alert to another phase.

This decision was based primarily on epidemiological data demonstrating human-to-human transmission and the ability of the virus to cause community-level outbreaks.

Given the widespread presence of the virus, the Director-General considered that containment of the outbreak is not feasible. The current focus should be on mitigation measures.

The Director-General recommended not to close borders and not to restrict international travel. It was considered prudent for people who are ill to delay international travel and for people developing symptoms following international travel to seek medical attention.

The Director-General considered that production of seasonal influenza vaccine should continue at this time, subject to re-evaluation as the situation evolves. WHO will facilitate the process needed to develop a vaccine effective against A/H1N1 virus.

The Director-General stressed that all measures should conform with the purpose and scope of the International Health Regulations.

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