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WHO Proposes Plan to Stop Pandemic in Its Tracks

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Science  20 Jan 2006:
Vol. 311, Issue 5759, pp. 315-316
DOI: 10.1126/science.311.5759.315

Ever since the H5N1 avian influenza strain began racing through Asia 2 years ago, the World Health Organization (WHO) has been urging the world to prepare for a possible pandemic. Now it is going a step further, planning a rapid response that just might quash a pandemic before it starts. To work, any country and WHO would have to recognize that the virus had acquired the ability to be transmitted easily among humans while its spread was still limited. Then, with international support, that country would have to impose quarantines and launch massive campaigns to administer antiviral drugs to contain the virus.

Rapid response.

The outbreak in Turkey has underscored the need for bold interventions. Above, Minister of Health Recep Akdag visits a child being treated for a possible H5N1 infection.

CREDIT: REUTERS/ANATOLIAN NEWS AGENCY

“Clearly, there is no guarantee that we would stop a pandemic,” admits WHO virologist Keiji Fukuda. “But if successful, this could prevent enormous [amounts] of illness and death.” At the moment, however, few of the developing countries hardest hit by H5N1 have the necessary capabilities, and it is unclear whether developed countries will offer sufficient technical and financial support.

WHO proposed the plan at a Japan-WHO Joint Meeting on Early Response to Potential Influenza Pandemic in Tokyo on 12 and 13 January, announcing that it will form a new Global Task Force for Influenza. The 20 or so outside experts in virology and public health will be on standby to help the agency assess the signals that may presage a pandemic.

Two modeling studies published late last summer gave weight to the idea that early intervention was at least theoretically possible, says Fukuda. One, from a team led by Ira Longini of Emory University in Atlanta, Georgia, appeared in Science (12 August 2005, p. 1083). The second team, led by Neil Ferguson of Imperial College London, published its results in the 8 September issue of Nature. Both concluded that, under the right circumstances, early intervention could stop a pandemic in its tracks (Science, 5 August 2005, p. 870).

But the gap between the ideal and current reality was apparent at the Tokyo meeting. The first step in this rapid-response scenario would be spotting a virus soon after it has acquired human-to-human transmissibility. This would be extremely difficult in the remote mountainous areas of Laos where technical capabilities are weak, said Baunlay Phommasack, a Department of Health official from that country. His views were borne out by an analysis of some 70 human cases in Asia in the past 2 years. As Hitoshi Oshitani, a public health specialist at Tohoku University in Sendai and consultant to WHO, described, on average, it took 2 weeks after the onset of symptoms for cases to be identified and notification sent to WHO. Lab confirmation of suspect H5N1 samples can add several days to 2 more weeks. “This is too late to contain the virus,” he said. He also noted that imposing an effective quarantine would be logistically difficult and could well run into opposition on human-rights grounds. Wide-scale administration of the antiviral Tamiflu, generically known as oseltamivir, also hinges on having sufficient stockpiles readily available. And even if supplies are on hand, recent studies have raised questions about proper dosing for H5N1, several meeting participants pointed out.

All these unknowns mean that an early response “is not a panacea,” says Shigeru Omi, director of WHO's Regional Off ice for the Western Pacific. But Omi and other WHO officials emphasize that even if it fails to thwart a pandemic, early intervention might slow the spread of disease, providing precious days or weeks for other countries to put pandemic plans into action and for drug companies to start developing a vaccine.

At the meeting Oshitani pointed out that few countries, if any, currently include early response as part of national pandemic-preparedness plans. Fukuda adds that the next step for WHO will be to launch “intensive discussions to develop plans reflecting each country's needs.” Most developing countries, he said, will need to upgrade both local surveillance and lab capabilities to deal with agricultural and human health threats. But that won't come cheap, cautioned World Bank official Jacques Baudouy, who reported bank estimates that globally between $1.2 billion and $1.5 billion will be needed over the next 3 years. Issues of international support for building such capacities in developing countries were due to be taken up at an International Donor Conference in Beijing on 17 and 18 January.

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