the health organization is asking drug makers to start making vaccine as quickly as possible, with the hope of having some batches ready by September. Efforts to make a vaccine are under way, and stockpiles of antiviral drugs have been opened. But the agency does not recommend closing borders or restricting travel.In my judgment this statement acknowledges an aspect of the dominant culture that contradicts science for the people. Vaccines must be asked for from organizations that structurally must make a profit. For many of us the dream is that there be organizations that will make vaccines because their societal role, the ethic that drives them, the spirit that moves their leaders and their scientist staff is to serve the people as distinct from making a profit. Good science is no guarantee of ethical behavior.
[log in to unmask]">I find it interesting that outside of a few notable exceptions and the usual conspiracy theorizing, health officials are getting widespread credit for doing exactly what they should be doing in this situation. Perhaps there is hope that a science for the people will at least be based on science. Wish I could say the same for the current health care debate.
June 12, 2009News Analysis
To Flu Experts, ‘Pandemic’ Confirms the ObviousBy DONALD G. McNEIL Jr. and DENISE GRADYIt came as no surprise on Thursday when the World Health Organization declared that the swine flu outbreak had become a pandemic.
The disease has reached 74 countries, and probably met the technical definition of a pandemic — or global spread — weeks ago. Nearly 30,000 cases have been reported, but disease experts think hundreds of thousands or millions of people have actually been infected.
So the agency made official what had become obvious: that the H1N1 virus is spreading quickly in different parts of the world, and its chief, Dr. Margaret Chan, said, “Further spread is considered inevitable.”
The announcement does not mean that the illness, which has been mild in most people, has become any worse. The term pandemic reflects only the geographic spread of a new disease, not its severity. Pandemics typically infect about a third of the world in a year or two, and sometimes strike in successive waves.
“Globally, we have good reason to believe that this pandemic, at least in its early days, will be of moderate severity,” said Dr. Chan, director general of the health agency. So far, 144 people have died from H1N1.
The decision to raise the pandemic alert from Phase 5 to Phase 6, its highest level, is meant to signal to countries to step up their efforts to deal with the disease.
It also means that the health organization is asking drug makers to start making vaccine as quickly as possible, with the hope of having some batches ready by September. Efforts to make a vaccine are under way, and stockpiles of antiviral drugs have been opened. But the agency does not recommend closing borders or restricting travel.
“This is not a surprise,” said Dr. Thomas R. Frieden, the new director of the Centers for Disease Control and Prevention. “For all intents and purposes, the United States government has been in Phase 6 of the pandemic for some time now.”
Even though the disease has been relatively mild in most people so far, governments must not relax, Dr. Chan said. For one thing, she explained, the virus could change at any time and become more severe.
In addition, the illness may take a greater toll when it reaches poor countries with higher rates of malnutrition, AIDS and other diseases that can lower people’s resistance to infection. Dr. Chan said rich countries should help poor ones less able to protect themselves.
Even in developed countries, the virus can cause severe and sometimes fatal illness in pregnant women, babies and people with underlying problems like asthma, heart disease, diabetes, obesity and autoimmune diseases. Dr. Frieden said people in those risk groups should seek treatment if they have a fever of at least 100.4, and a cough or a sore throat.
A third to half of the severe and fatal cases have occurred in young and middle-aged people who were previously healthy. In contrast, seasonal flu tends to kill the frail elderly.
The severity of the new virus does not even approach that of the 1918 one, which killed 40 million to 50 million people worldwide. But even the milder flu pandemics took serious death tolls. The one in 1957 killed two million people, and the 1968 pandemic killed about one million. Seasonal flu, by comparison, kills 250,000 to 500,000 people a year.
Countries that have not yet had cases must anticipate them and prepare their health systems to treat patients, Dr. Chan said. Countries in the early stages of outbreaks should try to contain the disease, she said. Those further along, like Mexico, should not let their guard down even if the disease seems to be waning, she added.
“The virus can come back in a second wave,” Dr. Chan said. “When you’re over the first wave, start preparing for the future.”
The W.H.O. has been questioned sharply for weeks as to why it would not go to Phase 6 even though the spread of cases, first in Britain and Spain, then in Japan, Australia and Chile, seemed to meet its pandemic definition: the sustained community spread of a novel virus in two different W.H.O. regions.
Dr. Chan has indicated recently that she thought a pandemic was under way, especially as cases in Australia quadrupled in a week, but she wanted to consult with countries that had large outbreaks and then with a panel of experts on Thursday.
From early reports in Mexico and the United States, scientists have said that H1N1 appears to have roughly the same 0.6 percent death level as the 1957 Asian flu. The 1918 flu killed about 2.5 percent of those infected.
But in 1918, antibiotics did not exist, and many people died of secondary bacterial infections. In 1957, antiviral drugs did not exist, and mechanical ventilators were less common.
Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said this year’s flu is not acting like the 1957 one, which quickly faded into a seasonal pattern. There would normally be no flu cases in the United States in June, but flu hospitalizations are increasing in Minnesota, he said.
Flu levels continue to be high in New York and New England, and especially in Massachusetts, the C.D.C. said.
Denise Grady contributed reporting.
Contributing Correspondent, Science
Adjunct Professor of Journalism,
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