The World Health Organization (WHO) and its director-general received high praise for the handling of the H1N1, or ‘swine flu’ pandemic. The pandemic has spread to 39 countries and nearly 8500 persons, and appears to be no more lethal than a normal seasonal flu. Despite the positive press for WHO and health agencies throughout the world, this H1N1 outbreak reveals fundamental shortcomings in our preparedness for a major, and more lethal, pandemic.
The WHO has served three functions during the H1N1 pandemic:
- It has shared information on the spread of the virus, and communicated the threat levels based on this information.
- It has consistently spoken out against unilateral measures, like travel restrictions, which are not based on science, will not curb the epidemic, but could have other costs.
- WHO has maintained a small stockpile (5 million doses) of antiviral drugs. WHO is distributing these drugs to vulnerable countries, and is working with manufacturers and donors with stockpiles to share these with countries in need.
These actions – facilitating communication, promoting policies based on science, and facilitating resource transfers for collective action – are critical, and were the core purposes of the earliest international cooperation on health.
But with the exception of information-sharing, WHO’s performance has been far from stellar. WHO has not been able to limit unilateral measures lacking a scientific basis, nor has it demonstrated the functioning infrastructure to redistribute medicines and vaccines to curb an epidemic.
Even on information-sharing, WHO has been criticized for creating alert levels based on the spread of the disease, with no regard for its virulence. WHO has not been able to curb unwarranted restrictions on travel and trade (of pork especially). There have been lapses where science has not guided efforts to prevent the international spread of infectious diseases, such as Egypt’s calls to slaughter all pigs.
More worrying, WHO’s efforts at maintaining a stockpile of antiviral drugs are far from adequate to prevent the spread of disease. Had this been a more virulent pandemic, it is clear that the global supply of these drugs would not have been redistributed effectively to slow or stop an epidemic. These shortcomings are not a failure of WHO or its staff, but of a lack of authority given to WHO on areas outside of the mandatory reporting of infectious disease.
The 2006 International Health Regulations gave the organization a strong ‘command and control’ authority when it comes to reporting of disease. Difficulties in case reporting during SARS made this international agreement necessary and possible. Mandating case reporting is an important step in the earliest stages of a potential pandemic, like H5N1 (avian influenza).
But today’s H1N1 pandemic shows that once a pandemic is active, WHO’s ability to facilitate international cooperation is constrained. International agreement is needed not only to report cases, but to coordinate policies based on scientific knowledge, and to make supplies available where they are needed.
The earliest international cooperation in health, during the 19th century, focused on minimizing costly unilateral restrictions on trade (mostly the quarantine of ships in the Mediterranean), and ensuring that science guided international efforts to prevent the spread of infectious disease. WHO has inherited the legacy of these International Health Regulations, but it has lost the convening ability to coordinate policy on restricting trade and borders. The need for WHO to promote a scientifically-based and cooperative international response to emerging infections has never been greater. Likewise, the need for WHO to redistribute supplies to where they are most needed would be great in a true pandemic. But the organization is not designed to do so, nor is such redistribution occurring on a scale that could curb the spread of disease.
The H1N1 virus appears at present to be no more deadly than the seasonal flu. The public attention given to the virus can open the doors for empowering WHO to robustly lead a global response to a more lethal epidemic, when it does arise.
[...] an analysis on the WHO’s response to the H1N1 pandemic can be found here, its operative message [...]