15 May 2009
As H1N1 Flu Cases Increase Worldwide, Health Ministers to Meet
Experts consider “painstaking and difficult process” of making H1N1 vaccine
Washington — International scientists and public health officials will come together over the next week to discuss pandemic influenza and vaccines. Among the discussion topics: whether to produce a vaccine for the new H1N1 virus and if so, how to make sure poorer countries have equitable access to it.
As the World Health Organization (WHO) announced that 34 countries officially have reported 7,520 cases of H1N1, the Intergovernmental Meeting on Pandemic Influenza Preparedness convened May 15 for a two-day meeting in Geneva.
“This is a time of great uncertainty and great pressure on governments, ministries of health and WHO,” WHO Director-General Margaret Chan told meeting attendees. “I take it as my personal responsibility to keep the world informed, to adjust our recommendations as the situation evolves and to prepare for a multiplicity of future scenarios.”
She added, “Many critical measures are under way, for enhanced preparedness and for mitigation of the health effects. As I have consistently stated, gaps in response, coping and mitigation capacities in different countries must be a top priority for WHO and the international community.”
A second meeting, to be held in Geneva May 18–22, is the 62nd session of the World Health Assembly, the world’s highest health-policy-setting body and the forum through which health ministers from the 193 WHO member states govern the organization.
The assembly will discuss pandemic flu preparedness; sharing of flu viruses and access to vaccines and other benefits; primary health care and strengthening health systems; social determinants of health; implementing the International Health Regulations; and monitoring the achievement of the health-related United Nations Millennium Development Goals.
The International Health Regulations, revised in 2005 and implemented by all WHO member nations in 2007, are global rules to enhance national, regional and global public health security. Their aim is to help the international community prevent or respond to acute public health risks that have the potential to cross borders and threaten people worldwide. The eight United Nations development goals include reducing extreme poverty, reducing child mortality rates, fighting disease epidemics and developing a global partnership for development.
H1N1 VACCINE
One of the most important questions for health officials following H1N1 outbreaks involves the production of a vaccine for this new H1N1 virus strain. Vaccine manufacturers are already producing a vaccine for seasonal flu that is made up of killed or weakened forms of three different strains of circulating viruses: one influenza A H3N2 virus, one influenza A H1N1 virus that has a different genetic composition than the new H1N1 virus, and one influenza B virus.
Vaccines are also under development for the highly pathogenic H5N1 avian flu that since 2003 has killed hundreds of millions of birds, sickened 423 people in 15 countries and killed 258.
“As soon as the [H1N1] virus was identified, work began on turning [it] into a candidate virus that could be provided to companies so they could test it out in their processes to see how well they might turn it into a vaccine,” Dr. Keiji Fukuda, WHO assistant director-general for health security and environment, said in a May 14 briefing.
Scientists must determine the right H1N1 viral strains to go into a vaccine, he said, and companies would need several weeks to test the candidate vaccine. Experts must then decide whether to produce the vaccine. If they do, they must also decide whether to increase production capacity for the H1N1 vaccine by stopping production of the seasonal flu vaccine or stopping development of the H5N1 vaccine.
“What is really going to be wrestled with is that seasonal influenza itself has a significant impact on people. This is not a benign infection; this is an infection which is estimated to kill some hundreds of thousands of people a year around the world. So there’s a real trade-off if you stop making that vaccine,” Fukuda said.
“These are the kinds of questions which will be discussed as we go through these meetings,” he said. “It is not possible to say that there will be a decision made by [a certain] date. It really is going through this painstaking and difficult process.”
AROUND THE WORLD
As of May 15, according to WHO, Mexico reported 2,446 laboratory-confirmed human cases of H1N1 infection with 60 deaths, the United States reported 4,298 confirmed cases with three deaths, Canada reported 449 confirmed cases with one death and Costa Rica reported eight confirmed human cases with one death. Many countries, on many continents, have confirmed cases as of May 15 but have recorded no deaths.
“This is an event which is serious,” Fukuda said. “This is something which requires close monitoring, but most of the cases at this time continue to be mild cases where [most] people recover without needing hospitalization.”
This estimation of severity could change, Chan said, because of the intrinsic ability of influenza viruses to mutate and other factors.
“First, scientists are concerned about possible changes that could take place as the virus spreads to the Southern Hemisphere and encounters currently circulating human viruses as the normal influenza season in this hemisphere begins,” Chan said.
“Second … the H5N1 avian influenza virus is endemic in poultry in some parts of the world,” she said. “It is out there, entrenched. No one can predict how the H5N1 virus will behave under the pressure of a pandemic.”
Influenza A viruses like H5N1 and the new H1N1 virus mutate easily. If the new H1N1 virus begins to spread in countries where highly pathogenic H5N1 is already established, scientists fear that their genetic components could mix, creating a new virus that spreads easily from person to person, as does the new H1N1 virus, and that kills nearly 60 percent of the people it infects, as does the H5N1 virus.
More information about the H1N1 situation is available at CDC, WHO and America.gov Web sites.
