May 22, 2009 (CIDRAP News) – The World Health Assembly ended today with no indication that the World Health Organization (WHO) would raise the pandemic alert level from 5 to 6, which sparked questions about why the group is holding back in the face of mounting global numbers of those infected with the novel H1N1 influenza virus.
Keiji Fukuda, MD, the WHO's assistant director-general for health security, told reporters today at a media briefing that some countries, particularly those that have had limited community transmission of the new virus, aired concerns during the health assembly that raising the pandemic alert level to 6 would unduly alarm the public, given the mild degree of illness seen in most patients who have had the new flu.
WHO officials have previously said that sustained community transmission in more than one geographic region would prompt a move to the highest level, which is 6. Apart from countries in North America, Britain and Spain have both shown some degree of sustained community transmission.
The WHO has considered the comments from the countries along with its goals of making sure countries are as prepared as possible and has decided to hold off on raising the level, Fukuda said.
A number of important preparedness actions are already under way, he said. For example, countries have activated their pandemic plans, communicated and collaborated on response issues, and taken appropriate control measures. Also, efforts to develop a vaccine and boost antiviral production are well under way, he said.
"The real issue is what is it that countries need to be doing now?" he said.
Fukuda said decisions about raising the alert level require a degree of flexibility. "There's nothing like reality to tell you if something is working or not. Rigidly adhering to something is not useful—you have to adapt to the situation," he said.
The WHO would raise the pandemic alert level if it determines that the risk to the world has increased, for example a change in clinical severity or a more serious population-level effect on a country. However, he said the WHO has not set any new criteria that would trigger a move to level 6.
In her closing comments to the World Health Assembly, Margaret Chan, the WHO's director-general, acknowledged concern about the global pandemic alert level. "I have listened closely to your concerns. Phases 5 and 6 are virtually identical in terms of the actions they launch. Intensified preparedness, also by industry, are already fully under way," she said.
"But even the best-laid plans need to be fluid and flexible when a new virus emerges and starts changing the rules," Chan said, adding that the world is in the early days of the novel flu epidemic and that health officials need more information before making sweeping recommendations.
May 22 closing remarks at the 62nd World Health Assembly
May 18 CIDRAP News story "WHO is urged to go slow on declaring pandemic"