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Hurdles in Declaring Swine Flu a Pandemic

Interviewee: Laurie Garrett, CFR Senior Fellow for Global Health
Interviewer: Toni Johnson, CFR Staff Writer
June 12, 2009

After weeks of debate, the World Health Organization (WHO) raised its pandemic threat level alert from five to six, declaring swine flu (H1NI influenza) a full-blown pandemic. "What now kicks in is a greater sense of urgency for the pharmaceutical industry," says CFR Senior Fellow for Global Health Laurie Garrett. "Now that pandemic has been declared, more and more countries will guarantee that they will purchase vaccine if it is available, and WHO and World Bank will guarantee to purchase for the poorest countries in the world."

Garrett says a number of factors delayed the organization from raising the threat level earlier. When this system for declaring pandemics was developed, she says, it was developed using the model of the bird flu (H5N1 influenza), a virus that is extremely virulent but not readily transmitted between people. Because of this, Garrett says, the WHO didn't worry about the severity issue, they worried about examples of human-to-human transmission. Garrett, who recently wrote in the New York Times on the issue, says the problem is that swine flu perfectly fits the system but is a "wimpy virus"--the opposite of what they expected--that is highly transmissible but not very virulent. "The truth of the matter is all the qualifications for jumping to pandemic six, under their criteria, were met a month ago if not six weeks ago," she says.

Another issue, Garrett says, is the organization can't fundamentally change any aspect of its regulatory apparatus without getting approval from the WHO's governing body, the World Health Assembly, which gives equal representation to each of its 193-member countries. Changes can sometimes be "a very difficult process because different countries have different cultural, economic, and political issues that come to play," she says. When the assembly met for their annual meeting in May, WHO officials knew that there was this looming pandemic threat and tried to get countries to acknowledge the need for preparedness. But "there were some countries that were not happy about this," Garrett says."They felt that far more serious health problems were being shoved aside such as infant mortality questions and HIV/AIDS." It took three days of emergency meetings in June to win enough international support to finally get the threat level raised, she says.

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