Expert says strike force may not be able to slow pandemic
Posted on Tue, Nov. 29, 2005
By DAVID BROWN
The Washington Post
GENEVA - They don't like it when visitors to the new Strategic Health Operations Center at the World Health Organization call it ''the war room.'' It's not the right metaphor for an organization whose purpose is to preserve life and that also happens to be headquartered in a neutral country. Instead, they call it the ''SHOC room.''
Nevertheless, this underground space filled with electronic maps and video screens is where WHO may someday launch the equivalent of a commando attack against pandemic influenza.
Curiously, the man who will command it doesn't have a lot of confidence the assault will succeed.
''The issue for us is that influenza will be very difficult to slow down and stop,'' said WHO physician Michael Ryan, as he sat in the quiet operations center this month after a meeting that brought 600 experts here to plan for a possible global epidemic of flu.
''Our primary advice to countries,'' he said, ''is to prepare for this eventuality: emergence, silent or otherwise, of a pandemic virus that spreads worldwide more quickly than we have the capacity to contain, in a series of waves, with a very high attack rate on the population.''
He is one of many flu experts who believe the world is closer to a pandemic now than anytime since 1968, when the Hong Kong flu killed about a million people worldwide. There were two other pandemics in the 20th century: the 1957 Asian flu, which killed more than 2 million, and the epochal Spanish flu of 1918, with at least 50 million deaths, according to a recent recalculation.
A surgeon by training who has his specialty's typical assertiveness, the 41-year-old Ryan runs WHO's Global Outbreak Alert and Response Network. Over the next three months, he plans to assemble a medical strike force that could be sent on six hours' notice to any place a potential pandemic emerges.
But his job -- and that of many others at WHO -- is to also prepare the world for the strike force to fail. That means countries should have written plans for what to do in the event of pandemic influenza, which probably would cause illness in one-quarter of the population over a few months and kill an unpredictable number.
Specifically, governments need to decide beforehand what to tell their citizens about how to protect themselves; whether to ban gatherings or travel; how to ration hospital beds and medical equipment; and how to dispose of a potentially large number of bodies.
About 60 percent of nations have pandemic plans. The U.S. government released its 396-page document, with more details to come, this month.
The current threat is influenza A/H5N1, a strain of avian influenza that emerged in Hong Kong in 1997, was extinguished and emerged again. Since late 2003, it has killed 150 million birds and, by WHO's official count, has infected 125 people and killed 64.
It does not have the ability to be easily transmitted from person to person. If it were to gain that capacity through genetic mutation or reassortment with another flu strain, however, H5N1 would probably cause a pandemic, as virtually everyone on Earth is susceptible.
