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WHO Likely to Declare Swine Flu Pandemic

June 10, 2009 at 12:00 AM EDT
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The World Health Organization is expected to declare H1N1 flu a pandemic as the number of cases continues to grow worldwide. Ray Suarez speaks to WHO Director Margaret Chan in Geneva.
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JIM LEHRER: Next, the flu and the latest on the global health response. Ray Suarez and our Global Health Unit were at the World Health Organization headquarters in Geneva today. Its health chief has convened an emergency meeting tomorrow to decide whether to declare the situation a pandemic. Ray has that story.

DR. MARGARET CHAN, director-general, World Health Organization: So what are you working on?

RAY SUAREZ: At World Health Organization headquarters in Switzerland, Director-General Dr. Margaret Chan was talking to staff today in what’s called the SHOC room, the Strategic Health Operation Center, where data on new H1N1 flu cases is coming in from around the world.

WORLD HEALTH ORGANIZATION EMPLOYEE: Four hundred and eighty-five cases, but no deaths.

RAY SUAREZ: The U.N. agency is preparing to raise the new flu to the highest alert status, level six. We spoke to Dr. Chan in Geneva.

Defining 'pandemic'

RAY SUAREZ: Director-General, welcome to the program.

DR. MARGARET CHAN: Thank you for the invitation. Happy to be here.

RAY SUAREZ: Let's begin with the basics. What is a pandemic?

DR. MARGARET CHAN: We do have a pretty good and reasonable definition, at least a working definition on influenza pandemic.

When we see a new virus, you know, perhaps coming from the animal kingdom or the bird kingdom, jumping to cause disease in human, and if this is a new virus that has not been seen in the past and it is causing disease in people, and most of the world's people don't have immunity to this new virus, and if the virus is spreading on a global scale, and that, you know, by definition, we can say that we have the epidemiological evidence to say that, hey, maybe we are seeing an influenza pandemic.

RAY SUAREZ: But hasn't part of the yardstick in the past been lethality, whether it's killing people or not, whether it's a threat, a widespread threat to human health, in addition to just being spread globally?

DR. MARGARET CHAN: I think this is an important question. Yes, indeed, oftentimes, people associate severity of disease and also associate serious illness or even deaths with pandemic.

Sustained transmission

RAY SUAREZ: But why go to a higher alert level for a disease that appears to be much less dangerous to people?

DR. MARGARET CHAN: In April, we are seeing a new virus, H1N1, causing sustained transmission, meaning it is not just sporadic cases and then it stops. The transmission continues. So we had to go up from level three to level four.

And this is important, that the meaning of the alert level we must understand, what is the function of it? Is it really like an early warning signal.

So if the World Health Organization comes out and makes the announcement, "Hey, public health officials of the world, please pay attention. This is what we are seeing as evidence. We would like to give you an alert, so please put in place in your country appropriate public health measures to deal with a possible threat to your people."

'New disease is unpredictable'

RAY SUAREZ: Are there member countries of the WHO that don't want the highest alert level because they're afraid of Mexico's example? Yes, it was a good health outcome, but also a very costly economic one.

DR. MARGARET CHAN: I think you bring up a very important question. This is the kind of dilemma, you know, many of my member states or many of my countries are in. They understand the importance of an early-warning system so that they can prepare, you know, as I said, put in place appropriate measures to reduce sickness and to reduce deaths in their country.

But having said that, when you give people an alert about a new disease, it does cause a level of anxiety, worry in the people's mind. And it is understandable, because, by definition, a new disease is unpredictable. A new disease is anxiety-creating.

So you need to appreciate, it is OK for people to get worried. It is legitimate. But people can make the transition and the adjustment very quickly.

And oftentimes, I mean, based on my past experience in managing crisis, actually, the general public, the community, their resilience is actually better than we worried. So do trust your community. And I'm sure the, you know, discomfort would be -- last only a short while.

But, you know, let me caution one thing: You're absolutely correct. H1N1 at this stage is causing mild illness, mild symptoms. The majority of the people infected, the disease was quite self-limiting. Many people did not even require medicine and they made full recovery.

But having said that, I must caution, you know, my member states, my countries that this is at the very early stage of the pandemic. We need to continuously to monitor the virus and see whether it will change.

Now, as we are talking, we are now six weeks into this, you know, imminent pandemic. We are already hearing reports of severity, meaning some people are dying, some people are on ventilators.

And we see two features which are of concern to us. Number one, there is a disproportion of young people between the age group of 30 to 50 getting, you know, serious illness and some of them dying.

And also we are seeing people with pre-existing medical conditions, and including pregnancy, they are also suffering more severe cases, more severe illness, and some of them die. So we need to continue to monitor and help us to find out exactly what age group, what kind of conditions would create what we call higher vulnerability.

Assessing threat levels

RAY SUAREZ: You've described for me a system where you've got a very dangerous illness that's at alert level three and one that's maybe not so dangerous that you may be on the verge of declaring level six. Do you need a new yardstick? Do you need a new way of measuring these things that's perhaps easier for the public to understand?

DR. MARGARET CHAN: I think you ask an extremely difficult question and a question that I'm also asking myself. And I think when we are dealing with new diseases and dealing with a crisis situation like that, there's a discipline we call crisis communication.

And this is not easy. This is an extremely complicated issue and subject matter.

H1N1, as I said, has the power to spread very quickly. Within six weeks, it has gone from Mexico and U.S. to more than 70 countries.

H5N1, we've been dealing with this threat for more than 10 years. If you recall, the first outbreak of H5N1 was actually in 1997 in Hong Kong when I was working in Hong Kong managing that outbreak. So I've been following this virus for the past 10 to 12 years.

Now, this is a very lethal virus, but if it won't have the ability to spread easily, maybe that is a blessing in disguise. We are getting a grace period from the viruses, but now the risk for us is we are having two viruses existing.

So my concern -- I've been warning my member states -- they need to maintain their vigilance. They need to enhance disease surveillance, making sure that we do not provide opportunity for these two viruses to mix.

We cannot predict influenza virus. The only thing we can predict influenza virus is uncertainty. It is full of surprises. So we need to keep our eyes on both, you know, viruses and make sure we don't drop both balls and do not allow them to present in a way that cause more disease and death.

RAY SUAREZ: Dr. Chan, thank you for joining us.

DR. MARGARET CHAN: Thank you for the opportunity.