Overview
Chapter 4 summary
Learning lessons, thinking ahead
Chapter 4 is devoted to potential public health emergencies of international concern, the most feared of which remains pandemic influenza. The response to this threat has already been proactive − facilitated by early implementation of IHR (2005). This has been a rare opportunity to prepare for a pandemic, and possibly to prevent the threat becoming a reality by taking full advantage of advance warning and by testing a model for pandemic planning and preparedness. This advantage must be fully exploited to enhance global preparedness within the framework of IHR (2005).
Coming on the heels of the SARS outbreak, the prospect of an influenza pandemic sparked immediate alarm around the world. Far more contagious, spread by coughing and sneezing and transmissible within an incubation period too short to allow for contact tracing and isolation, pandemic influenza would have devastating consequences. If a fully transmissible pandemic virus emerged, the spread of the disease could not be prevented.
Based on experiences with past pandemics, illness affecting around 25% of the world’s population – more than 1.5 billion people – could be anticipated. Even if the influenza pandemic virus caused relatively mild disease, the economic and social disruption arising from sudden surges of illness in so many people would be enormous.
As the next influenza pandemic is likely to be of avian variety, many interventions have been taken to control the initial outbreaks in poultry, including the destruction of tens of millions of birds. Chapter 4 describes the key actions taken and the remarkable degree of international collaboration that has been achieved to reduce the pandemic risk. Among its many front-line activities, WHO has tracked and verified dozens of daily rumours of human cases. Field investigation kits have been dispatched to countries and training on field investigations and response intensified. The GOARN mechanism was mobilized to support the deployment of WHO response teams to 10 countries with H5N1 infection in humans and/or poultry, while over 30 assessment teams investigated the potential H5N1 situation in other countries.
With the aim of promoting global preparedness, WHO developed a strategic action plan for pandemic influenza that set out five key action areas.
- Reducing human exposure to the H5N1 virus.
- Strengthening the early warning system.
- Intensifying rapid containment operations
- Building capacity to cope with a pandemic.
- Coordinating global scientific research and development.
By May 2007, when 12 countries had reported 308 human cases including 186 deaths, nearly all countries had established avian and human pandemic preparedness plans. Working together, WHO and some Member States created international stockpiles of oseltamivir, an antiviral drug that potentially could stop transmission in an early focus of human-to-human transmission. The pharmaceutical industry continues to search for a pandemic influenza vaccine. In 2007, outbreaks in poultry continued, as did sporadic cases in humans, but a pandemic virus failed to emerge. Nevertheless, scientists agree that the threat of a pandemic from H5N1 continues and that the question of a pandemic of influenza from this virus or another avian influenza virus is still a matter of when, not if.
Chapter 4 also highlights the problem of XDR-TB in southern Africa, exacerbated by inadequate health systems and the resulting failures in programme management, especially poor supervision of health staff and patients’ treatment regimens, disruptions in drug supplies, and poor clinical management, all of which can prevent patients completing courses of treatment. The current situation is a wake-up call to all countries, and especially those in Africa, to ensure that basic tuberculosis control reaches international standards and to initiate and strengthen management of drug-resistant forms of the disease.
The 2003-2005 global spread of poliovirus caused by inadequate control in Nigeria (described in Chapter 2) was another wake-up call. It underscored the risk that polio might re-emerge post-eradication and the importance of the designation of polio as a notifiable disease in IHR (2005). The alert and reporting mechanisms mandated by IHR (2005) are an essential complement to activities undertaken by the extensive surveillance network already in place around the world that provides for the immediate notification of confirmed polio cases and for standardized clinical and virologic investigation of potential cases. This capacity to remain alert and to respond is fundamental to the ability to eradicate polio because, once the virus is eradicated in nature, the world will need be vigilant in case of accidental or deliberate release of the virus.
Finally, Chapter 4 considers natural disasters which, in 2006 alone, affected 134.6 million people and killed 21 342 others. Just as these situations endanger individuals, they can also threaten already stressed health systems that people rely on to maintain their personal health security. The indirect effects of natural disasters include the threat of infectious disease epidemics, acute malnutrition, population displacement, acute mental illness and the exacerbation of chronic disease, all of which require strong health systems to deal with them.