Sandman & Lanard: WHO, Pandemic Phases & Public Preparedness

The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT

 

# 7484

 

Last May the internationally known, and highly regarded risk communications team of Dr. Peter Sandman and Dr. Jody Lanard wrote about the CDC’s  messaging on the H7N9 virus threat (see Sandman On H7N9 Risk Communications: Candor, but No Push to Prepare).

 

The Peter M. Sandman Risk Communication Website contains a wealth of invaluable risk management advice, which quite frankly should be second home for anyone involved in public relations or risk communications.

 

Yesterday they posted a letter from pandemic preparedness expert Eric S. Starbuck, DrPH, MPH, (see Paper: Are We Prepared For A Pandemic In Low Resource Communities?) asking (among other things) about the absence of any definitive pandemic phasing information on MERS-CoV and the H7N9 virus on the World Health Organization’s website.

 

As you can see by the graphic at the top of this blog, the H5N1 falls clearly in the `Alert Phase’, but a similar graphic for MERS-CoV or H7N9 are not currently posted on the WHO website.  

 

The closest thing I’ve found is this twitter  statement by Gregory Hartl – spokesperson for WHO – on the H7N9 virus back in April.

 

 

In response Peter & Jody take a detailed look at the World Health Organization’s new (Interim) Guidance on Pandemic Influenza Risk Management (see WHO Unveils New Pandemic Guidance) and how it presumably relates to MERS-CoV and H7N9, and their overall pandemic preparedness messaging.

 

I won’t even attempt to excerpt from this thoughtful 5000+ word analysis, and will instead simply make my strongest possible recommendation that you follow the link below and read it in its entirety.

 

Pandemic preparedness and pandemic stages re H5N1, H7N9, and MERS

 

 

Pandemic preparedness messaging is something I struggle with nearly every day in this blog, and so I know how difficult it can be to find the right `tone’; one that informs without turning people off to the message.

Agencies and organizations like WHO, CDC, ECDC and others also face the inevitable hyping of anything they say by the `tabloid press’. Then, if the worst doesn’t happen (and on the media’s time table), they can expect public excoriation.

 

It may not be `fair’, but it does sell papers. 

 

So their reluctance to come out too strongly before there is evidence of a clear and present danger is understandable. 

 

The suggestion by Sandman and Lanard that `other sorts of agencies – national security agencies, public works agencies, disaster response agencies, etc.’ – who are more used to dealing with the public and disaster response - get involved in the pandemic preparedness messaging makes sense to me.

 

Although you have to dig to find it (and already know it exists), you can find some pandemic preparedness information provided by FEMA, Ready.gov, and Flu.gov.

 

http://www.ready.gov/pandemic

http://www.flu.gov/pandemic/#

 

But I’ve seen no discernable push by either of these websites since the emergence of H7N9 or MERS-CoV to promote enhanced pandemic preparedness for the public.

 

The proactive pandemic preparedness messaging from federal agencies that we saw prior to the 2009 H1N1 pandemic has largely disappeared.

 

I suspect that the prolonged economic downturn has something to do with this, but I fear this may turn out to be penny wise and pound foolish.

 

For my part, I’ll continue to promote pandemic and `all hazards’ preparedness in this blog. 

 

Not because I’m convinced that a pandemic is on the horizon, but because I know that bad things (tornadoes, floods, hurricanes, earthquakes,  and yes . . . pandemics) will happen, often with little warning.

 

And the advantage always goes to those who are best prepared.

 

 

 

And finally, my thanks to Peter & Jody for the very kind mention of this blog in their comment.

WHO: H5N1’s Pandemic Phase Status

The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT

 

# 7410

A little over a week ago the World Health Organization released their (interim) updated guidance on influenza (and other) pandemics (see WHO Unveils New Pandemic Guidance).

 

Among the changes was the announcement of a new, 4 tier, pandemic phase alert system; 

• Interpandemic Phase
• Alert Phase
• Pandemic Phase
• Transition Phase

 

We are currently in the Alert Phase for H5N1, H7N9, and the MERS coronavirus, which places the world’s health agencies in a mixed preparedness and response mode.

 

Yesterday the WHO released the following updated Pandemic Phase assessment for the H5N1 virus, the first since this new system was announced.

 

 

Current WHO global phase of pandemic alert: Avian Influenza A(H5N1)

Current phase of global alert according to criteria described in the WHO Pandemic Influenza Risk Management Interim Guidance

The pandemic influenza phases reflect WHO’s risk assessment of the global situation regarding each influenza virus with pandemic potential that is infecting humans. These assessments are made initially when such viruses are identified and are updated based on evolving virological, epidemiological and clinical data. The phases provide a high-level, global view of the evolving picture.

 

As pandemic viruses emerge, countries and regions face different risks at different times. For that reason, countries are strongly advised to develop their own national risk assessments based on local circumstances, taking into consideration the information provided by the global assessments produced by WHO. Risk management decisions by countries are therefore expected to be informed by global risk assessments, but based on local risk assessments.

 

The current WHO phase of pandemic alert for avian influenza A(H5N1) is: ALERT

Alert phase: This is the phase when influenza caused by a new subtype¹ has been identified in humans. Increased vigilance and careful risk assessment, at local, national and global levels, are characteristic of this phase. If the risk assessments indicate that the new virus is not developing into a pandemic strain, a de-escalation of activities towards those in the interpandemic phase may occur.

 

Please consult the interim guidance document for complete information on pandemic phases:

• Pandemic Influenza Risk Management - WHO Interim Guidance

More information on avian influenza H5N1 in humans can be found at the:

• Influenza at the Human-Animal Interface (HAI) page

---

¹ The IHR (2005) Annex 2 includes “human influenza caused by a new subtype” among the four specified diseases for which a case is necessarily considered “unusual or unexpected and may have serious public health impact, and thus shall be notified” in all circumstances to WHO.

 

While news of H5N1 has been eclipsed in recent months by the emerging H7N9 avian flu virus in China and MERS-CoV on the Arabian peninsula, H5N1 remains endemic and a threat in a number of countries, including Egypt, Indonesia, Vietnam and China.

As the WHO indicated at the end of March (2 days before we learned of H7N9) in WER: Update On Human Cases Of Influenza At Human-Animal Interface, the risks posed by the H5N1 virus, along with other emerging influenza viruses, remain very real. 

 

In the discussion portion of that report, the authors write:

 

Influenza viruses are unpredictable. Their constant evolving nature raises concerns that these viruses could adapt or reassort with other influenza viruses, thereby gaining potential to become more transmissible to or more pathogenic in humans.

 

Continued monitoring of the occurrence of human infections with non-seasonal influenza viruses and ongoing characterization of the viruses to assess their pandemic risk are therefore critically important for public health.

 

Close collaboration with animal health partners allows information regarding viruses circulating in animal populations and human populations worldwide to be shared to improve assessment of global influenza risks to health.

 

WHO continues to stress the importance of global
monitoring of influenza viruses and recommends all
Member States to strengthen routine influenza surveillance. All human infections with non-seasonal influenza viruses should be reported to WHO under the International Health Regulations (2005).

WHO To Review Pandemic Status Tomorrow

 

 

# 4611

 

 

On June 1st the World Health Organization will convene a special teleconference with their influenza advisory committee to decide on the current status of the pandemic.   We should have some word later in the day as to what they decide.

 

Here is the Reuters report.

 

Experts to review status of flu pandemic on Tuesday

GENEVA

Mon May 31, 2010 2:23pm BST

GENEVA (Reuters) - An expert panel that advises the World Health Organization on pandemics will meet Tuesday to decide whether to declare the H1N1 flu outbreak over.

 

The WHO said in a statement Monday that its emergency committee will begin a teleconference at 1200 GMT Tuesday and results will be posted later in the day on its website.

 

Earlier this month, a WHO spokesman said the committee would consider three main options.

 

These would be to conclude that the pandemic was still in force and retain the WHO's current phase 6 on its 6-level pandemic scale; state that pandemic had moved into a transitional "post-peak" phase; or declare that the pandemic was over.

 

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WHO To Review Pandemic Status

 

 

# 4560

 

 

A month shy of 1 year since the WHO (World Health Organization) raised the world’s pandemic alert level to phase 6, experts are waiting to see if the virus has peaked and the pandemic can be declared over, or is perhaps in a `post-peak’ phase.

 

 

The most recent numbers from the WHO continue to indicate a steep drop-off of flu cases around the world, with the peak activity recorded last October.

 

 

Although flu activity has remained low in the Southern Hemisphere, officials would like a little more time to see if that begins to rise before changing the alert phase.

 

None of this means that we are done with novel H1N1.

It appears to have largely (but not completely) replaced the existing seasonal A strains, and will likely circulate as our new `seasonal’ flu for years to come.  

 

Over time, it may drift antigenically, and could become either more or less virulent or perhaps change its host preferences and begin to affect the elderly more.  

 

Influenza viruses are notoriously unpredictable.

 

This from Reuters.

 

 

 

WHO panel to review H1N1 pandemic status in coming weeks

GENEVA

Tue May 11, 2010 7:14am EDT

GENEVA (Reuters) - An expert panel advising the World Health Organization on pandemics will review the status of the H1N1 virus later this month or in early June to decide whether the swine flu pandemic is over.

 

The Emergency Committee is waiting for the onset of winter in the southern hemisphere before making its recommendation, spokesman Gregory Hartl said.

 

That meant the 15-member independent panel would probably meet at the end of May or in early June, after the WHO's governing World Health Assembly next week, he told a briefing.

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