GLOBAL HEALTH | Addressing the world’s health challenges
18 November 2008
World Is 40 Percent Prepared for Pandemic, U.N. Official Says
Global avian flu efforts apply to other animal diseases that affect people
Washington — The world is about 40 percent prepared to grapple with the social, economic and political impacts of an influenza pandemic, according to a U.N. official involved in the international effort.
The estimate is based on an analysis in the Fourth Global Progress Report on Responses to Avian Influenza and State of Pandemic Readiness, released October 21 by the United Nations and the World Bank.
The report said there were fewer outbreaks of highly pathogenic H5N1 avian flu and fewer infected countries than in the same period in 2006 and 2007, but that only 53 percent of the 148 countries that provided data for the report had tested their pandemic plans in the past 12 months and only 38 percent had incorporated lessons learned from the testing into plan revisions. (See “Egypt Meeting Increases Total Avian Flu Assistance.”)
“I would say we are somewhere around 40 percent of where I’d like us to be,” Dr. David Nabarro, U.N system coordinator for avian and pandemic influenza, said at a November 13 briefing at the Center for Strategic and International Studies in Washington. “Planning for pandemics is now near global, but we are worried that not enough plans have been put to the test through simulations.”
Concerns include insufficient involvement of all levels of government in pandemic planning in some nations and substandard animal and human health services in too many countries, Nabarro said.
“No nation, including the United States, is truly prepared for a severe pandemic,” said Ambassador John Lange, special representative on avian and pandemic influenza at the U.S. State Department. “In North America and around the globe, much more needs to be done.”
POTENTIAL THREAT
Since 2003, hundreds of millions of domestic birds in 63 countries either have died of H5N1 avian flu or been killed to prevent its spread. In 15 countries, 387 people have been infected and 245 have died. Worldwide efforts to control the devastation have helped more than 50 countries eliminate H5N1, but the virus has become endemic in Bangladesh, China, Egypt, Indonesia, Pakistan and Vietnam.
“We’ve done a lot throughout the world to get on top of the bird flu virus,” Nabarro said, “but we still get episodes of infectivity that worry us.”
So far in 2008, there have been outbreaks among birds in Bangladesh and Indonesia, continued outbreaks in Vietnam and on the Vietnamese-Chinese border, outbreaks in Egypt, particularly along the Nile Valley, and occasional outbreaks in the African nations of Nigeria and Togo.
Human outbreaks in 2008 have occurred in Bangladesh (one case, no deaths), China (three cases, three deaths), Egypt (seven cases, three deaths), Indonesia (20 cases, 17 deaths) and Vietnam (five cases, five deaths).
The virus has been infecting birds, a few other animal species and people for five years without mutating to become easily transmissible among people — the required first step in triggering a pandemic. But it is still important for governments, international organizations and citizens in affected nations to remain alert.
“Previous pandemics occurred as a result of mutations that may have taken place eight, 10 or 15 years after humanity first came in contact with the bird flu virus,” Nabarro said. “So the lesson is, this very dangerous killing virus is still potentially a threat to humankind, could well be the cause of the next influenza pandemic and therefore requires us to treat it with much respect.”
BENEFITS AND BURDENS
One area of global pandemic planning that remains a challenge to all nations involves creating a more equitable system for sharing virus samples from flu patients with the World Health Organization (WHO) Global Influenza Surveillance Network and distributing to all nations — rich and poor — vaccines created from those samples.
The question of benefits for developing nations arose in January 2007 when Indonesian Health Minister Siti Fadilah Supari announced that her nation — which to date has confirmed 137 human cases of avian flu, 112 of them fatal — would stop sharing avian flu samples with the World Health Organization because it was unfair for rich countries to use the samples to develop vaccines that poorer nations could not afford to buy.
In May 2007, the WHO World Health Assembly passed Resolution 60.28, which outlined the flow of activities designed to ensure that countries receive the benefits they feel they need from virus sharing. Meetings were held in Singapore and Geneva in 2007 and in Geneva in April 2008.
The next meeting will be held December 8-13 in Geneva to continue discussions on two main efforts.
“One is to resume as soon as possible the sharing of samples of influenza viruses with human pandemic potential,” Lange said. “The other is to make progress on defining a package of benefits to be provided to developing countries on a voluntary basis, on a multilateral basis, so developing countries will not be disadvantaged in a pandemic.”
“There are major difficulties around ensuring that there is adequate financial support for countries so there is a more equitable sharing of both benefits and burdens,” Nabarro said, “but we’ve been making progress on this.”
The text of the latest U.N. report and summaries in six languages are available on a U.N. avian flu Web site.
