May 18, 2009 — Dr. Rebecca Katz, assistant research professor in the Department of Health Policy at The George Washington University School of Public Health and Health Services, and Dr. Julie Fischer, senior associate with the Global Health Security program at the Henry L. Stimson Center, joined us for a discussion on how the 2009 H1N1 influenza (“swine flu”) epidemic tested disease detection and response strategies adopted in the wake of the SARS epidemic.
As of the time of the briefing, the World Health Organization (WHO) rated the H1NI outbreak at Pandemic Stage 5 – which translates as a pandemic being imminent. However, it is important to bear in mind that the ratings are based on the level of transmit-ability, not severity, of the disease.
In the US, all but two states had a confirmed case of H1N1, with two reported deaths. Worldwide, forty countries had been affected, with around seventy deaths. There is a strong possibility that H1N1 will be more prevalent in the fall, when people are most vulnerable to flu type ailments.
Global infectious diseases, such as H1N1, are becoming more common. The general underlying causes of this are twofold and closely linked to globalization. Firstly, the process of rapid urbanization in developing countries with poor health care creates conditions where disease can spread easily. Secondly, the vastly increased number of direct flights originating in these countries means these diseases can be spread internationally very quickly. A typical example was SARS in 2002/03, where a small outbreak went global in a short space of time.
In the aftermath of SARS, the international community, via WHO, sought to put into place a new infectious diseases strategy that emphasized ‘evolving diseases’ over the previous focus on existing diseases. The main components of this new strategy were laid out in the 2005 International Health Regulations, and required that countries that were the source of infectious diseases had a National IHR focal point (NFP); responded to WHO requests for information regarding public health risks; notified WHO within 24 hours of a potential health crisis; met the minimum core capacity for detection, reporting and assessment; and provided disease inspection and controls at ports of entry.
The H1N1 out break was the first major test of this new strategy.
Overall, the response to the H1N1 outbreak has been strong, and appears to vindicate the system put in place in the aftermath of the SARS outbreak. Specifically, the notification system was adhered to by Mexico and later the US. Also, the initial communication flows between countries was adequate. WHO itself acted quickly and in line with the agreed guidelines in swiftly announcing a public health emergency. Finally, the ongoing communication between National IHR Focal Points and WHO was a success.
Although the global response was mostly effective and well coordinated, there were some problems. Most notably, the unilateral decision by some countries to ban US pork, followed by calls from within the EU to avoid travel to North America were unhelpful, unnecessary and hindered the cooperation between countries that was otherwise evident.
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