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HEALTH: Flu Pandemic Declared; Poor Countries at Highest Risk

Gustavo Capdevila

GENEVA, Jun 11 2009 (IPS) - The cautious tone taken by World Health Organisation (WHO) Director General Margaret Chan when she declared an H1N1 influenza virus pandemic Thursday was only modified when she expressed concern over the potential effects of the virus in developing countries, and among young pregnant women in particular.

“(P)erhaps of greatest concern, we do not know how this virus will behave under conditions typically found in the developing world,” Chan told the press. “To date, the vast majority of cases have been detected and investigated in comparatively well-off countries.”

Under the WHO’s six-level global flu alert system, the highest level, a full-scale pandemic, implies sustained community level outbreaks in different countries in several regions.

The word “pandemic” is derived from Greek, with pan meaning “all” and demos meaning “people”.

The virus is becoming stable in some countries, said WHO Assistant Director General Keiji Fukuda.

WHO experts underlined that the virus, a novel strain of influenza A popularly known as swine flu, is here to stay.

But neither Chan nor Fukuda identified the countries where community level outbreaks of the H1N1 virus have been seen.

Nevertheless, it is clear that the three countries of North America – Canada, Mexico and the United States – are on the list.

In Australia, another country with a large number of cases, community level outbreaks are localised.

Other countries with community level outbreaks are in Europe and South America.

The response of countries to the declaration of a global pandemic will depend on the situation in each one.

“Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection,” said Chan.

Guidance for specific protective and precautionary measures has been sent to the health ministries of all 193 WHO member countries, she said.

“Countries with no or only a few cases should remain vigilant. Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities,” Chan added.

As it has done since the epidemic was first detected in North America in late April, the WHO reiterated that it does not recommend travel or trade restrictions or border closures.

Chan did not refer to the effects of the pandemic alert on the world’s economic and financial markets.

A diplomat from the Caribbean who did not want to be identified told IPS that his government was keeping a worried eye on WHO policies because a restriction on travel could have a severe impact on the tourism industry, on which his country depends.

The WHO chief also avoided making any statement on an eventual freeing up of patents on anti-flu medication.

She added, however, that the WHO has been in “close dialogue with influenza vaccine manufacturers,” and that production of vaccines for seasonal influenza in the northern hemisphere winter will be completed soon, so “full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.”

But the vaccine against the H1N1 virus will not be available on the market until September, she clarified.

Chan said the WHO has sent anti-flu medication to 131 countries in the developing world.

One of the reasons for the specific concern about poor countries is that 99 percent of maternal deaths, a marker of poor quality care during pregnancy and childbirth, occur in the developing world, said the WHO director general.

Another reason is that roughly 85 percent of the chronic disease burden is concentrated in low and middle-income countries, she added.

And “Although the pandemic appears to have moderate severity in comparatively well-off countries, it is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care, and a high prevalence of underlying medical problems,” said Chan.

One of the WHO’s arguments for raising the alert level is the unpredictability of the virus, which “writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time,” she underscored.

Chan also stressed that the WHO has “good reason to believe that this pandemic, at least in its early days, will be of moderate severity. On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment.”

She also pointed out that the number of deaths worldwide has been small.