Jun 18, 2007 TORONTO (CIDRAP News) Ten years after H5N1 avian influenza first began to raise fears of a potential pandemic, the world has a stronger set of tools to contain that virus and similar threats, but also a fresh awareness of humanity's vulnerability to fast-spreading diseases, experts said yesterday at an international conference on flu.
The Options for the Control of Influenza Conference takes place in Toronto this week on the 10th anniversary of the first human cases of H5N1 flu, which were discovered in Hong Kong between May and December 1997, and one month after the multi-country odyssey of an Atlanta lawyer infected with an almost untreatable form of tuberculosis.
But the conference's opening ceremonies yesterday evening also came 2 days after the World Health Organization's (WHO's) new International Health Regulations took effect. The voluntary contract marks the first time that the WHO's 193 member states have agreed to immediately acknowledge and attempt to control any public health emergenciesin their own country or any other territorythat could provoke international concern.
"We really are not much further ahead today than we were in 1918," Dr. David Heymann, the WHO's assistant director-general for communicable diseases, said in the conference's keynote address. "We don't have the vaccines we need. . . . We have some antivirals. But we do have one thing that we did not have in 1918, and that is the International Health Regulations, that now provide for proactive collective action for the H5N1 threat to global public health security."
The new rules, which were enacted in 2005 and became effective Jun 15, update an earlier and much weaker set of regulations that have been in force since 1969. In a change from the earlier ruleswhich emphasized control of only cholera, plague, and yellow feverthey commit WHO members to monitoring all potential public health threats, and particularly emphasize smallpox, polio, SARS, and novel flu strains, including H5N1.
Heymann said the old rules "were actually a very passive system" and "a system which countries did not adhere to. Very few countries would report diseases under the International Health Regulations because when they reported those [three] diseases, or any other diseases for that matter, they were penalized with decreased trade and decreased tourism."
During the 2003 SARS outbreak, for instance, Southeast Asia lost an estimated $18 billion in gross domestic product and possibly $60 billion in revenues and demand, Heymann said.
The new regulations improve on the old not only by emphasizing more diseases but also by committing states to building up their public health infrastructure so they can detect and respond to outbreaks, and to maintaining real-time surveillance of health information so that it can be transmitted to the WHO within 24 hours.
The new rules also encourage countries to enforce disease control at their borders while respecting the rights of international travelers. And they reinforce countries' responsibility to report and contain disease by allowing states to look over each other's fences: For the first time, the WHO will accept reports of outbreaks not only from national governments but also from third parties ranging from Internet search engines to other states.
Conference attendees said the porousness of borders to disease has been sharply underlined by two recent events: the emergence on the Wales-England border of an H7N2 strain of avian flu that infected at least four humans and killed a number of poultry despite being judged "low pathogenic," and the saga of Andrew Speaker, who detoured through several countries so that he could obtain treatment in the United States for his newly diagnosed case of extensively drug-resistant tuberculosis (XDR TB).
"It is important to maintain vigilance and not get so focused on one threat, like H5N1, that we don't miscue on the emergence and virulence of another," Dr. David Butler-Jones, Canada's chief public health officer, said at the conference opener. He called the XDR TB patient's four-country odyssey "a stark reminder of our collective vulnerability to communicable diseases. . . . The world seems to continue to be smaller, with diseases having no respect for borders, cultures or politics."
Jun 15 CIDRAP News story "New global disease-control rules take effect"