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Can an influenza pandemic really be contained?
Editorial
Can an influenza pandemic really be contained?
www.thelancet.com Vol 367 March 18, 2006
Of course, spread of H5N1 among the world’s poultry is not, in itself, a serious danger to human health. But with more birds infected, the opportunities for the virus to jump from poultry to humans expand, and so too does the possibility that mutations will emerge, which will enable transmission between humans. The huge geographical area over which that change could happen—and the high likelihood that it will be in rural areas of Africa or southeast Asia—are important stumbling blocks to WHO’s plan to dispatch emergency teams. Furthermore, the disease will be particularly difficult to spot if it emerges in countries that are already coping with high burdens of HIV/AIDS, tuberculosis, malaria, and respiratory infections, as many African nations are. But H5N1’s continuing spread has other, less obvious, implications. What avian influenza has shown most clearly is that unqualified political will and billions of dollars of cash are not enough to neutralise such a serious threat to global health. The key question donors should be asking is why. An argument put forward to explain difficulties in making progress towards the Millennium Development Goals could help provide a reason. Blaming lack of political will for not achieving targets in global health encourages the illusion that complex health issues can be overcome with merely the right mindset and commitment. Reducing the complex social determinants of health into simple cause-and-effect models that emphasise international interventions ignores the importance of strong and effective health systems populated by a cadre of well-trained health workers. Perhaps the most important omission when global-health problems are viewed in terms of international, rather than local, politics is that communities where the disease is likely to arise become victims, rather than controllers, of their own fate. Pascoal Mocumbi, former Prime Minister of Mozambique, said of poverty reduction efforts that “empowerment of communities enables people to build their lives, as agents of change and not simply objects of charity”. This maxim applies equally to disease control. Without creating and sustaining robust communityhealth systems, efforts to halt an influenza pandemic are likely to fail. ■ The Lancet
Rights were not granted to include this image in electronic media. Please refer to the printed journal Panos Pictures
A slew of cautious caveats accompanied WHO’s announcement on March 8 that a revision of its rapid response and containment strategy for pandemic influenza—on which the world is reliant to halt an outbreak in its early stages—had been agreed at a meeting in Geneva during the 3 previous days. Over the next few months, teams of experts will participate in training exercises all over the world; these individuals will become a rapid-reaction force that will, it is hoped, stamp out human-to-human transmission of a potential pandemic strain of influenza as soon as the first cases are identified. WHO is reticent about the plan’s chances of success. Although SARS was contained successfully, the justifiable, if theoretical, concern now is that pandemic H5N1 influenza could escape human control. WHO Director-General Lee Jong-wook added to the mood of fear when, in a speech during a visit to Africa last week, he warned the continent’s governments that they cannot rely on international support to protect them from a pandemic. In Kenya, which has not yet reported cases of H5N1 in birds, Lee urged ministers to set aside money to respond to a pandemic because, he predicted, the US$1·9 billion pledged at an international meeting of donors in Beijing, in January, may not materialise soon enough. “Every country, no matter its health standing, must prepare against the possibility of the advent of a potential new deadly threat—human pandemic influenza”, he said. H5N1 has been discovered in Africa at a time when there is unprecedented international agreement on the methods for, and importance of, stopping H5N1 in its tracks. There is also clear continuing commitment by international donors to helping the poorest countries in the world fend off the disease. Yet rather than being a comfort, the scale of the support coupled with its apparent ineffectiveness is a serious worry. Cases of H5N1 have already been confirmed in Nigeria, Niger, Cameroon, and Egypt. And Kenya, where Lee delivered his warning, is now especially vulnerable since it lies along the route taken by migratory birds travelling between Europe and South Africa, and is a frequent stopping-over point. Lee’s assertion that countries should take responsibility for their own preparations is a tacit admission that massive global commitment may not be enough to obviate the risk.
875
Can an influenza pandemic really be contained?
www.thelancet.com Vol 367 March 18, 2006
Of course, spread of H5N1 among the world’s poultry is not, in itself, a serious danger to human health. But with more birds infected, the opportunities for the virus to jump from poultry to humans expand, and so too does the possibility that mutations will emerge, which will enable transmission between humans. The huge geographical area over which that change could happen—and the high likelihood that it will be in rural areas of Africa or southeast Asia—are important stumbling blocks to WHO’s plan to dispatch emergency teams. Furthermore, the disease will be particularly difficult to spot if it emerges in countries that are already coping with high burdens of HIV/AIDS, tuberculosis, malaria, and respiratory infections, as many African nations are. But H5N1’s continuing spread has other, less obvious, implications. What avian influenza has shown most clearly is that unqualified political will and billions of dollars of cash are not enough to neutralise such a serious threat to global health. The key question donors should be asking is why. An argument put forward to explain difficulties in making progress towards the Millennium Development Goals could help provide a reason. Blaming lack of political will for not achieving targets in global health encourages the illusion that complex health issues can be overcome with merely the right mindset and commitment. Reducing the complex social determinants of health into simple cause-and-effect models that emphasise international interventions ignores the importance of strong and effective health systems populated by a cadre of well-trained health workers. Perhaps the most important omission when global-health problems are viewed in terms of international, rather than local, politics is that communities where the disease is likely to arise become victims, rather than controllers, of their own fate. Pascoal Mocumbi, former Prime Minister of Mozambique, said of poverty reduction efforts that “empowerment of communities enables people to build their lives, as agents of change and not simply objects of charity”. This maxim applies equally to disease control. Without creating and sustaining robust communityhealth systems, efforts to halt an influenza pandemic are likely to fail. ■ The Lancet
Rights were not granted to include this image in electronic media. Please refer to the printed journal Panos Pictures
A slew of cautious caveats accompanied WHO’s announcement on March 8 that a revision of its rapid response and containment strategy for pandemic influenza—on which the world is reliant to halt an outbreak in its early stages—had been agreed at a meeting in Geneva during the 3 previous days. Over the next few months, teams of experts will participate in training exercises all over the world; these individuals will become a rapid-reaction force that will, it is hoped, stamp out human-to-human transmission of a potential pandemic strain of influenza as soon as the first cases are identified. WHO is reticent about the plan’s chances of success. Although SARS was contained successfully, the justifiable, if theoretical, concern now is that pandemic H5N1 influenza could escape human control. WHO Director-General Lee Jong-wook added to the mood of fear when, in a speech during a visit to Africa last week, he warned the continent’s governments that they cannot rely on international support to protect them from a pandemic. In Kenya, which has not yet reported cases of H5N1 in birds, Lee urged ministers to set aside money to respond to a pandemic because, he predicted, the US$1·9 billion pledged at an international meeting of donors in Beijing, in January, may not materialise soon enough. “Every country, no matter its health standing, must prepare against the possibility of the advent of a potential new deadly threat—human pandemic influenza”, he said. H5N1 has been discovered in Africa at a time when there is unprecedented international agreement on the methods for, and importance of, stopping H5N1 in its tracks. There is also clear continuing commitment by international donors to helping the poorest countries in the world fend off the disease. Yet rather than being a comfort, the scale of the support coupled with its apparent ineffectiveness is a serious worry. Cases of H5N1 have already been confirmed in Nigeria, Niger, Cameroon, and Egypt. And Kenya, where Lee delivered his warning, is now especially vulnerable since it lies along the route taken by migratory birds travelling between Europe and South Africa, and is a frequent stopping-over point. Lee’s assertion that countries should take responsibility for their own preparations is a tacit admission that massive global commitment may not be enough to obviate the risk.
875