Mexican Swine Flu Cases, Deaths Stabilize; WHO Says No Evidence That Outbreak is Over

While Mexico's top health official on Thursday said the number of new H1N1 (swine flu) cases and deaths caused by the virus have slowed, the WHO "cautioned there is no evidence the worst of the global outbreak is over," the AP/Washington Post reports.

"The fact that we have a stabilization in the daily numbers, even a drop, makes us optimistic," Mexican Health Secretary Jose Cordova said, adding, "So we think we're on the right track." WHO's acting assistant director-general Keji Fukada, responded to the news out of Mexico with reservation, saying "For things to go up and down in a country is expected. If it didn't do that would be very unusual," Fukuda said (Haven/Price, AP/Washington Post, 5/1). 

According to the WHO, 11 countries have officially reported 331 cases of swine flu, including 156 confirmed cases in Mexico with nine deaths and 109 confirmed cases in the U.S. with one death.  In addition, "[t]he following countries have reported laboratory confirmed cases with no deaths - Austria (1), Canada (34), Germany (3), Israel (2), Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the United Kingdom (8)" (WHO Swine Influence update 7, 5/1).

While it has been "deadly in the disease epicenter, Mexico, and caused the death of one Mexican infant in the United States, in other countries people infected with swine flu have fared well, with diarrhea the biggest complaint," according to Reuters. WHO director-general Margaret Chan noted yesterday that "many patients infected in the United States have recovered on their own and without medicine," writes Reuters. "At this point, chances are it will be mild, but we can't rule out it will turn virulent. And even if it turns milder, it can still kill, depending on the kind of person it infects," Fukada said (MacInnis, Reuters, 4/30).

Fukada said that Roche – the makers of the antiviral Tamiflu – have started to ramp up production of the drug to deal with the global H1N1 outbreak, Reuters reports (Kahn/Nebehay, Reuters, 4/30). The WHO on Thursday "turned its attention to the developing world as it began to distribute part of its stockpile of 3.5m doses of antiviral drugs to southern Africa and other vulnerable regions," the Guardian reports (Pilkington/McGreal/Rice, Guardian, 5/1). 

HHS Secretary Kathleen Sebelius on Thursday announced the HHS began moving 400,000 courses of antivirals from the Strategic National Stockpile to Mexico. "Flu viruses don't stop at the border, and it is imperative we do whatever we can to slow the spread of the virus and help stop this outbreak," Sebelius said in a written statement (HHS press release, 4/30).  

Concern Remains About Flu Preparedness In Vulnerable Regions, Access to Antivirals, Potential Vaccine

Concern persists over how southern Africa can handle an outbreak of H1N1 because "the lack of adequate medical facilities, surveillance programmes, drugs and personnel would hamper screening, diagnosis and treatment," writes the Guardian. Gregory Pappas, a Nairobi-based pandemics expert said at a African flu preparedness conference earlier this week, "This region cannot even handle cholera. An outbreak of a pandemic flu would be catastrophic." According to the Guardian, South Africa is the only African country that has submitted a flu epidemic contingency plan with the WHO and has "offered help to poorer neighbouring countries, such as Namibia and Zimbabwe" (Pilkington/McGreal/Rice, Guardian, 5/1). 

VOA on Thursday examined how Eastern African countries are ramping up efforts to screen for the swine flu. VOA writes, the "Governments of Kenya, Rwanda, Tanzania, and Uganda say they have dispatched medical teams to screen travelers at all entry points, including airports, seaports, and border crossings" (Ryu, VOA, 4/30). The Los Angeles Times on Thursday explored the ways people and governments around the world are responding to the global outbreak of swine flu (Glionna/Rotella, Los Angeles Times, 4/30). 

The New York Times on Thursday reported on how the Chinese government is taking a "more visible approach" to a global swine flu outbreak that has yet to hit Asia, after being less forthcoming during the SARS outbreak of 2003. On Tuesday, only hours after Wen Jiabao held a cabinet meeting to discuss preparedness measures, President Hu announced "China was stepping up its inspection and quarantine procedures for people and imports of pigs and pork products," the New York Times writes. According to the New York Times, the Vice Premier Li Keqiang on Wednesday called for manufacturers to increase the production of face masks, sterilization chemicals and flu medicines (Bradsher, New York Times, 4/30).

The Wall Street Journal on Friday examined preparedness levels for nations around the world. "The whole public-health system is much better prepared now than it was five to 10 years ago," said Jeffrey Koplan, the former director of the CDC, but "preparedness is a relative thing. Any system has constraints in capacity." Despite the global efforts to reduce the spread of the swine flu, should the virus "evolve into an especially deadly strain, the consequences will likely overwhelm even the most advanced health systems in the U.S. and other Western countries," the Wall Street Journal writes (Winslow/Johnson, Wall Street Journal, 5/1).

SciDev.Net reports that when a vaccine to protect against swine flu hits the markets, many of the world's most vulnerable may not have access to the vaccine. Though drug makers around the world have started the initial steps to produce a swine flu vaccine, it could take up to six months before a vaccine is commercially available.  "If [developing countries] don't have capacity [to produce vaccines] then they'll have to rely on the goodwill of developed countries, as well as companies," said Sangeeta Shashikant, a researcher at the Third World Network.  WHO spokesperson Ravini Thenabadu said WHO is communicating with vaccine makers to determine how much of their vaccine output could go to developing countries, according to SciDev.Net (Nightingale/Padma, SciDev.Net, 4/30).

Mexican Health Official Says WHO Responded Too Slowly To Pending Health Crisis

After criticizing the WHO for waiting too long to respond to initial warnings of an escalating health crisis in Mexico, Mexico's director of the National Epidemiology Center on Thursday called for an investigation, the AP reports. According to Miguel Lezana, he followed international protocols by notifying the local PAHO by e-mail on April 16, after his department became alarmed by an uncharacteristically high number of cases of flu and atypical pneumonia in Mexico. As the AP reports, "No action was taken until eight days later when the World Health Organization said it was 'very, very concerned' the outbreak could grow into a pandemic" (Selsky, AP, 5/1).

The Washington Post writes, "The delay in making the global health community aware happened despite the adoption in 2005 of international health regulations requiring nations to report to the WHO within 24 hours any disease outbreak that is serious, unusual, at risk of spreading internationally or potentially disruptive of trade" (Brown, Washington Post, 4/30).

"The procedure is very clearly established," Lezana said. "You have to notify the local office, then it sends the notification to the regional office. They analyze the data and decide whether to send it to the WHO in Geneva." After four days of waiting for a response, Lezana said the center followed up with the local office, only to be told PAHO was handling the alert (AP, 5/1). According to the Washington Post, Veratect, a biosurveillance firm out of Kirkland, Wash., also sent several warnings to WHO's Geneva headquarters, which the WHO later confirmed were received. "After the balky start, however, the WHO's pandemic response system is running well," writes the Washington Post (Washington Post, 4/30).

Opinion Round-up

• Tim Wilson of the Institute of Public Affairs in Melbourne, Australia, in the Wall Street Journal, lauds Mexico for its speedy effort in sharing samples of the swine flu with international health authorities and private companies so a vaccine could be readied. The quick reaction of Mexican officials, according to Wilson stands in contrast to how other countries have handled similar outbreaks, "jeopardizing efforts to create a vaccine" (Wilson, Wall Street Journal, 5/1).
• In the New York Times, Former Mexican Health Minister, now dean of the Harvard School of Public Health, Julio Frenk praises Mexico's vigilance in recognizing the threat of swine flu after people began dying from the new virus and a disease surveillance system picked up the trend.  Frenk writes, "Their fast action gave other countries the warning they needed to screen for the new virus, which is why cases of swine flu have already been discovered in a dozen other countries - cases that might otherwise have long gone unnoticed" (Frenk, New York Times, 5/1).
• Lawrence Gostin, a professor of global health at Georgetown University, in a Washington Post opinion piece says agencies, like WHO and CDC, "lack key powers and resources," to curtail epidemics.  In addition, he writes, "Many poor countries lack adequate surveillance, early warning systems and modern laboratories; they also have negligible public health infrastructures. Although the revised International Health Regulations urge capacity building, Western governments have donated precious little funding, and the WHO has no mechanism or resources for expanding public health capacities within individual countries (Gostin, Washington Post, 5/1).
• One of the most dangerous things that governments can do in the response to the swine flu is "miscalculate the relative importance of health risks, skewing funding and attention," according to an editorial in the Ottawa Citizen. "Even in the very unlikely event that this new virus does cause a global influenza epidemic like the one in 1918, that would not make it any worse than the existing global epidemics of preventable, communicable diseases that seldom make the headlines and never draw enough funding," such as the "nine million new cases of tuberculosis, 247 million cases of malaria, and nearly three million new HIV infections" each year, the authors write (Ottawa Citizen, 4/28).
• In a Wall Street Journal opinion piece on Wednesday, Henry Miller of Stanford University's Hoover Institution, takes a close look at how conditions in developing countries are conducive to the emergence of flu viruses. "Intensive animal husbandry procedures that place poultry and swine in close proximity to humans, combined with unsanitary conditions, poverty and grossly inadequate public-health infrastructure of all kinds -- all of which exist in Mexico, as well as much of Asia and Africa -- make it unlikely that a pandemic can be prevented or contained at the source." In theory, Miller writes, aggressive use of antiflu drugs, vaccines and quarantines to isolate small outbreaks of an infectious agent can help contain an outbreak can work, but "In places such as Indonesia, China and Mexico, however, the expertise, coordination, discipline and infrastructure are lacking," such an approach is not feasible. Though antiviral drugs Tamiflu and Relenza have been stockpiled, Miller writes, "The danger of using antiflu drugs in poor countries with inadequate public-health facilities such as Mexico is that they may be administered improperly and in suboptimal doses, which would promote viral resistance and intensify an outbreak" (Miller, Wall Street Journal, 4/29). 

Kaiser Family Foundation Global Health Gateway To Track Swine Flu Updates

On our new global health gateway, the Kaiser Family Foundation is monitoring and updating official WHO reports of swine flu cases and swine flu deaths.  In addition, new Global Health Policy Tracker will provide regular updates on what the U.S. government is doing to address the H1N1 virus including congressional hearings, actions by the Obama administration, and more.