WHO Takes Lessons from 2009 H1N1 ‘Swine Flu’ Pandemic

The handling of the 2009 H1N1 pandemic was reviewed at the 63rd meeting of the World Health Assembly, which opened in Geneva on 17th May and closed on 21st May 2010.

“Sometimes… we are just plain lucky”, considered Dr Margaret Chan, World Health Organization (WHO) Director-General, during her opening address to the Assembly. Chan was referring to the 2009 H1N1 ‘Swine Flu’ pandemic. H1N1 was to be discussed during the Assembly, but Chan’s opening remarks emphasized the major focus would be thorough assessment of Millennium Development Goal (MDG) progress. With the approach of the 2015 MDG finish line, “we need to move forward fast” urged Chan.  

In relation to pandemics, Chan assured “there will be more”. Clearly there are no reliable predictions about when we might expect new pandemic outbreaks, so  lessons about the handling and management of the 2009 H1N1 ’Swine Flu’ pandemic should be learned soon. During the Assembly and beyond, the working group charged with reviewing H1N1 has and will continue to investigate the criticisms “levelled at WHO for its management of the pandemic” confirmed Chan.

The WHO Global Influenza Surveillance Network continues to monitor the progress of the 2009 H1N1 influenza pandemic today. Current reports of virus transmission are most frequent in parts of the Caribbean and Southeast Asia. There have now been at least 18,097 H1N1 deaths and the viral infection has been confirmed in 214 countries and overseas territories. However, estimates on the number of infections are no longer given. With Dr Chan’s remarks, it seems that WHO clearly and publicly considers that the worst, or even moderate, fears about the 2009 H1N1 pandemic have not been, and will not be, recognized.

The pandemic influenza preparedness working group is open-ended. During the Assembly the group discussed a recent intergovernmental pandemic influenza meeting, which had been held between 10-12 May 2010.  The group considered that meeting to have been “transparent, substantive, collaborative and an important foundation for future negotiation”. During the Assembly the working group also discussed the increased global access and capacity for developing affordable vaccines and medicines for pandemic influenza. There were 2 resolutions passed in relation to pandemic influenza preparedness and keeping the working group activities open-ended. The first resolution was a request for continued support from the WHO Director-General for ongoing technical consultations and studies, the second was that the working group should report at the 64th World Health Assembly in May 2011.

In concluding remarks, Chan was enthusiastic about the overall achievements of the Assembly. She described the “spirit of collaboration and consensus-seeking”, “the real gift to public health” and the “solid and inspiring guidance” given by Assembly members in relation to the “challenging agenda” which the Assembly presented.

We are certainly fortunate not to have experienced a devastating influenza pandemic in 2009-10 and there is much to be learnt from the handling of the pandemic. In particular, that the risk of disease was largely ineffectively communicated to varied audiences, that fears of disease were disproportionate to available evidence about disease risk, and that the implementation of preventative interventions in the form of vaccines caused so much controversy are all serious causes for concern. These are some of the lessons which need to be learnt if future pandemics are to be handled better. Chan offered assurance that the 2009 H1N1 pandemic experience is one from which WHO and health officials globally can learn to do things better, and from which the WHO, she insisted, is “seeking lessons”. It will be a while before we can know whether the lessons learnt will mean that things are done better. As more pandemics are assured, lessons must be learnt with time to reflect and consolidate, in advance of future international public health emergencies which put those same lessons learnt on trial.