WHO warns of lax flu epidemic preparations

Despite warnings the recent Avian bird flu outbreak in Asia signifies another influenza pandemic could be imminent, governments worldwide are behind in preparations and need to intensify their efforts, the chief of the World Health Organization warned.

Despite warnings the recent Avian bird flu outbreak in Asia signifies another influenza pandemic could be imminent, governments worldwide are behind in preparations and need to intensify their efforts, the chief of the World Health Organization warned. “We know another pandemic is inevitable. It is coming, and when this happens, we also know that we are unlikely to have enough drugs, vaccines, healthcare workers and hospital capacity to cope,” Dr. Lee-Wook Lee, WHO’s director-general told more than 100 health experts Thursday at the end of a three-day influenza pandemic preparedness meeting. “We are certain we are going to face shortages of vaccines and drugs at the start of a pandemic and perhaps for several months to come,” Lee said, underscoring that most countries will have no supplies to distribute. Epidemiological models, according to WHO scientists, project an influenza pandemic in industrialized countries alone would result in 57 million to 132 million outpatient hospital visits, plus 1 million to 2.3 million admissions and between 280,000 to 650,000 deaths in less than two years. The impact in poor nations would be far greater, however, because healthcare resources already are strained and scarce, they add. Dr. Klaus Stohr, head of WHO’s global influenza program, told reporters a pandemic is possible because of the avian outbreak. “There is no time for complacency. As long as the highly pathogenic avian influenza virus is circulating in animals, that’s a risk for humans to fall ill, to die. There is a high case fatality rate,” he said. “We realize we are not ready for a pandemic, plans are not up to date, and we therefore need a political commitment for preparing for the pandemic, and a core element of this is to be aware of the shortages,” Dr. Rene Snacken, head of epidemiology and toxicology at Belgium’s Scientific Institute of Public Health, told United Press International. The world is facing a potential pandemic, said Karl Nicholson of England’s Leicester Royal Infirmary. “It is desperately important that governments are briefed on what is going on in order to make preparations and better inform people.” Nicholson called the meeting “extremely important” and said it could help kick-start preparatory measures. Stohr said to boost global efforts, health officials must focus on actions that could be taken by individual countries and cooperatively by the international community to slow an influenza virus, enhance disease surveillance, and address vaccine availability, problems related to production and related public health measures. Aileen Plant, of Australia’s Curtin University of Technology, said the surveillance challenge is to “identify the first case, the first time humans are infected, the first time the disease goes from human to human, and then to identify when it starts to spread quickly.” For surveillance efforts to work, Plant told reporters, they must be transparent and encourage countries to work together. “Surveillance has to build on current systems, integrating surveillance with other communicable diseases,” she said. To be ready for the early phases of the pandemic “we need to ensure that all countries have got access to rapid diagnostic tests for diagnosing influenza,” Plant added. Mandatory reporting internationally is a must, she said. “If you have good surveillance systems, you will detect the first case,” Stohr noted. Some of the biggest gaps in readiness, however, involve limitations in the manufacturing capacity and availability of antivirals, which are essential in the early stages. Vaccine shortages are particularly acute in poor nations, health experts said, and noted about 90 percent of vaccines are produced in the richest countries that account for only about 10 percent of global population. Stohr said vaccine and anti-viral production capacity is driven by market forces. He estimated vaccine production capacity ranges from about 260 million to 280 million doses, but added if a pandemic vaccine is produced, that figure could increased to 750 million to 1 billion doses within about six months. He said one way to increase capacity is to enact vaccine usage policies. In view of the shortfalls, however, experts suggested the need to create international stockpiles of antivirals, as there would be four to six months between isolation of a virus and the availability of the first doses of vaccine. Moreover, regional and global production or purchase strategies should be explored, especially for countries without production capacities, said Dr. Supamit Chunsuttiwat of Thailand’s ministry of public health. Experts said travel bans would not be an effective way to fight a pandemic because, at best, they would have a minimal effect on the spread of infections. Still, such restrictions could have some advantages at the beginning of an outbreak in a very localized area, said Angus Nicoll, of the U.K. public health protection agency. That is when drastic action would be warranted, he added. (Source: United Press International, March 2004)