Jul 12, 2010 ATLANTA (CIDRAP News) The vital role of preparedness, from diagnostic testing to stockpiling of antiviral medications, was one of the most important lessons from assessments of the world's response to the H1N1 influenza pandemic, the World Health Organization's (WHO's) top flu expert told an international infectious diseases conference yesterday.
Keiji Fukuda, MD, special influenza adviser to WHO Director-General Margaret Chan, said the revised International Health Regulations (IHRs), adopted by the World Health Assembly after the 2004 reemergence of the H5N1 avian influenza virus, pushed countries to be more open when the first novel H1N1 cases emerged last spring in California and Mexico.
"It set a critical precedent and set a tone that was important for the whole global response," Fukuda said in a keynote address on lessons of the H1N1 pandemic at the opening session of the International Conference on Emerging Infectious Diseases (ICEID).
Thomas Frieden, MD, director of the US Centers for Disease Control and Prevention (CDC), and Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), also gave keynote presentations touching on a wide range of infectious disease issues.
Fukuda said it's clear that preparedness activities should include groups outside healthcare, such as transportation and private sector organizations. "It's broader than just health. We can't strictly think of these issues as diseases, we have to think of them as social issues," he said, referring to border and trade issues that arose soon after the pandemic virus emerged.
The IHRs were designed to balance health issues with other global concerns such as trade and business, he said, adding that the regulations represent a paradigm shift toward a more active approach of quickly identifying and containing diseases rather than just trying to keep them from crossing borders.
Preparation for future disease threats should keep moving forward, Fukuda said. "We need to make sure science is the basis for policy decisions," he said. "It will never be the only thing on the table, but it has to be on the table.
Another lesson health officials learned from the H1N1 pandemic is that despite political will and strong private-sector support, efforts were inadequate for rapidly moving pandemic vaccine to low- and middle-income countries, Fukuda said. Early in the pandemic, 99 countries had asked for vaccine, but so far only 61 countries have received 45 million doses, with 22 million more slated for delivery by the end of July, he said.
During the H1N1 response, public health officials learned that they will need to shift their communication strategies to keep up with social networking sites and other forms of citizen journalism such as blogging, Fukuda said, adding that information no longer comes top-down from experts and filtered by the major news media.
The new media have the capacity to shape global perceptions and understanding and have the advantages of being innovative, direct, interactive, and personal, he said. However, he said that without the voice of authority and a filter, the marketplace decides what's good or bad, which can lead to misinformation, confusion, and speculation.
"Whether that's good or bad is irrelevant," Fukuda said. "It's here, and public health must adapt."
On other infectious disease topics, Frieden told the group that public health has had successes on some disease fronts, such as rapid pandemic H1N1 detection and pockets of progress with malaria prevention, but urged his colleagues to focus on basics such as patient-friendly treatments and supervision of healthcare workers' infection control practices.
"The bottom line is there is no substitute for hard work," he said.
Fauci emphasized the importance of continuing to battle infectious diseases, given their ability to reshape society. Emerging diseases such as HIV infection often become established, and sometimes established diseases such as tuberculosis (TB) can resurge in a more dangerous form, such as drug-resistant TB.
"We have to use our knowledge to match the adaptive capabilities of microbes," he said.
However, prevention still looms large, Fauci said, referring to promising new monoclonal antibody findings that might someday lead to an HIV vaccine.
"We need to close the gap between seasonal influenza and pandemic influenza in our preparedness," he said. "We need to do what the CDC recommendsvaccinate everybodyand build better vaccine platforms."
The ICEID, held every other year, is organized by the CDC, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, the WHO, and the American Society for Microbiology. Meeting organizers said they had about 1,600 registrants from about 88 countries.
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