Swine flu: so far, so good

The prospects of a severe global swine flu pandemic appear to be diminishing. Informed reporting can take some of the credit.

When the first reports of swine flu — so described because of its apparent origins in pigs, but since renamed less provocatively as A(H1N1) — appeared in Mexico last month, the prospect of a global pandemic set alarm bells ringing in medical and political circles around the world.

So far our worst fears have failed to materialise. Yesterday (14 May), although 61 people have died — out of more than 6,000 infected — 56 of these have been in Mexico where the outbreak originated. And many parts of the world, including Africa and South Asia, have yet to confirm any cases at all (see Severe swine flu projections divide scientists).

But this doesn’t mean we can be complacent. Initial outbreaks of a relatively benign form of flu have often been followed several months later by a much more virulent strain as the virus mutates. This was the case in 1918 when ‘Spanish flu’ killed perhaps as many as 100 million people worldwide.

And it is widely acknowledged that, if this happened again, people in developing countries could be most at risk. This is partly because closer living conditions help a contagious virus spread rapidly, but also because many countries lack diagnostic facilities, anti-flu treatments and vaccinations.

Bridging the gap

To its credit the WHO, which is leading the global responses to the pandemic, has prioritised equitable treatment for developing countries.

Led by Margaret Chan — who came to international prominence in 2003 as Hong Kong’s chief medical officer in charge of a campaign against the SARS virus — the WHO has been twisting the arms of vaccine producers to ensure enough vaccine will be available, at affordable cost, for rich and poor alike.

Its success will not be known until next week, when the main vaccine manufacturers meet in Geneva, Switzerland, to discuss a decision due this Friday (14 May) on whether to switch vaccine production from conventional flu to vaccines against the new virus.

Last week the WHO’s director for vaccine research, Marie-Paule Kieny, said the agency was already taking steps behind the scenes to ensure that, if a major vaccine programme is launched, manufacturers will take developing countries’ needs fully into account (see WHO ‘will ensure poor receive swine flu vaccine’).

Home investment

And some developing countries are already planning their own vaccine production programmes. Indonesia, for example, is building research facilities to produce a single vaccine for both the swine and bird flu viruses. Health authorities cannot confirm when they will be able to start making a vaccine, but construction of at least one facility is almost finished.

Pharmaceutical companies and government research institutions in India have similarly agreed this week to explore whether they have the capability and technology to produce a domestic vaccine in case a second wave of A(H1N1) hits later this year.

There is a long way to go, of course, before these countries can equal the production capacity of the developed world. But their willingness to invest in key technologies — spurred, no doubt, by the prospect of growing markets in other developing countries — is welcome.

Their efforts are made easier by the US Centers for Disease Control in Atlanta, Georgia, which is releasing free samples of the A(H1N1) virus essential for vaccine production. This welcome openness of the US authorities stands in contrast to the tight control of intellectual property usually encountered in the global pharmaceutical industry.

Informed reporting

It is not too fanciful to suggest that informed media coverage — helped by instant and comprehensive online reporting — has contributed to the current state of affairs.

Admittedly some headlines have inflated the pandemic’s severity, which may have provoked an excessive response from some public authorities. Egypt, for example, has been criticised for its decision to slaughter all its pigs — roughly 300,000 — earlier this month.

But in general, reporting has been responsible and accurate, neither underplaying nor exaggerating the threat, whilst scrutinising issues such as the need to treat the developing world fairly.

It seems that the lessons of earlier pandemics have been well learned. Chan herself is familiar with these; public concern in China over the SARS outbreaks was only exacerbated by attempts to restrict media coverage (see China must do yet more to promote scientific openness). And the WHO, burned by injudicious comments from one of its top officials during the bird flu epidemic, has been more measured in its comments (see Bird flu: the role of science journalists).

There are still lessons to be learned from the current outbreak, such as the time it took Mexican authorities to recognise the new strain, or the lack of adequate diagnostic facilities in many parts of the developing world, particularly in Africa.

But if the case for vigilance remains high, so does that for recognising the critically important role of an informed media in monitoring how public health authorities perform in developed and developing countries alike.

David Dickson
Director, SciDev.Net