WHO WHO’s pandemic alert levels. The World Health Organization is declaring the first full-blown flu pandemic in 41 years. The disease, of course, is the H1N1 flu, the new strain that has been spreading in recent months. Raising the pandemic-alert level to Phase 6 from 5 — a move that had seemed imminent — means that the new strain is spreading widely through communities in more than one part of the world. “At this early stage, the pandemic can be characterized globally as being moderate in severity,” WHO said in the statement. A spokesman added that the term pandemic was “measure of the spread of the virus, not the severity of the virus.” WHO Director-General Margaret Chan is holding a press conference. Here’s what she’s saying. 12:10 This virus is entirely new and it is spreading easily. As of today, nearly 30,000 confirmed cases have been reported from 74 countries. With few exceptions, countries with large numbers of cases have good surveillance and procedures in place. Further spread is considered inevitable. On the basis of available evidence and expert assessments of the evidence, “the scientific criteria for an influenza pandemic have been met.” The pandemic alert is going from Phase 5 to 6. “The world is now at the start of the 2009 influenza pandemic.” 12:11 No previous pandemic has been detected so early or watched so closely in real time right at the beginning. The world can reap the benefits of the last five years of pandemic-preparedness efforts. Thanks to close monitoring, thorough investigations and frank reporting from countries, we have some early snapshots depicting the spread of the virus and the range of illness it can cause. 12:12 “This early, patchy picture can change very quickly.” The virus can “change the rules, without rhyme or reason at any time.” 12:13 We have reason to believe the virus will be of “moderate severity,” at least early on. The overwhelming majority of patients experience mild symptoms and make a rapid and full recovery. Worldwide, the number of deaths is small. Every death is tragic, and we have to brace for more. However, we do not expect to see a sudden or dramatic jump in the number of severe or fatal infections. 12:14 The virus affects young people the most. In some countries, there have been severe cases. Most have been in adults between ages 30 and 50. This pattern is significantly different from other epidemics of seasonal flu, in which most deaths are in frail, elderly people. Most severe cases have been in people with underlying chronic conditions, such as asthma, cardiovascular disease, diabetes, auto-immune disorders and obesity. 12:15 About a third of severe infections are occurring in previously healthy young and middle-aged people. Pregnant people are at higher risk. Perhaps of greatest concern, we don’t know how this virus will behave under conditions typical in the developing world. Most cases up to this point have been investigated in comparatively well-off countries. 12:17 “It is prudent to anticipate a bleaker picture as the virus spreads to areas with limited resources, poor health care and high prevalence of underlying medical problems.” 12:18 Countries should prepare for the virus’s continued spread around the world. Countries where outbreaks appear to have peaked should prepare for a second wave of infection. Testing of patients should be limited, since such measures are resource-intensive and can very quickly strain capacities. 12:19 WHO has been in close dialogue with flu-vaccine manufacturers. Supply is expected in the months to come. WHO continues to recommend low restrictions on travel and no border closures. 12:20 The Q&A begins. The change to Phase 6 sends an “important message” to countries that they must maintain continuous vigilance, regardless of the level of infection in their countries. They should prepare for the arrival of the disease. With continuing spread through a country, it’s important to take “mitigation” measures. Focus attention on identifying patients, early treatment, and making sure that vulnerable groups get proper and timely treatment to prevent deaths. 12:22 Calling a pandemic is also a signal to the international community: This is a time where the world’s countries, rich or poor, big or small, must come together to make sure that no countries, because of poor resources, should be left behind without help. 12:24 Chan says she called a meeting yesterday with a group of countries, trying to look at the evidence. She decided to call an emergency committee to examine the

evidence. All member countries, as well as experts on the emergency committee, reviewed the evidence. There was consensus that we have “indisputable evidence” that we are at the beginning of a pandemic. 12:25 Mexico is coming to a “steady state.” They are only seeing “sporadic cases and small outbreaks.” 12:26 This virus is very unpredictable. This doesn’t mean Mexico should let down its guard. The virus can come back in a second wave. 12:27 We look at a group of indicators, such as the number of deaths and the number of people getting seriously ill, and the impact of the new disease on countries. Severity can be viewed in two ways. We’re reviewing the situation in different countries within the WHO, and we give a global assessment. But we also encourage each country to look at their own situation to make a national assessment on severity. 12:28 WHO’s Keiji Fukuda chimes in. He says the WHO has looked at the clinical features of the infection. Most people develop self-limited illness and don’t need specialized medical care. They get better. But there have been a number of people who have developed serious illness, ended up on respirators or died. While some of these are occurring in different age groups, most are taking place in younger people. This is different from regular seasonal flu, and about half are in people who were previously healthy. 12:29 We’ve also looked at how countries’ health systems are coping. In some places they’ve been stressed, but in general they’ve been able to cope. So the level of assessment of severity at this time is that it is “moderate.” 12:31 Chan is speaking again. Since day one of the emergence of this new virus, WHO has been working to provide technical support to countries, including investigation on the ground (such as in Mexico), and sending diagnostic kits to labs around the world. We’ll continue to do that. We also have sent anti-viral drugs to many countries. 12:33 We’ve been in regular discussion with vaccine manufacturers in developed and developing countries. They are close to the end of finishing their seasonal vaccine production, so they are prepared to start full-scale production of H1N1 pandemic vaccine. Clearly, making the vaccine is a business decision. Some started earlier. There are vaccine companies that don’t make seasonal flu vaccine, so they have already started production. There are also companies that have several plants. It is a patchwork of different approaches. It is very clear now that we will get in touch with them urgently and assist them in any way we can. 12:35 No country has pandemic vaccine for the next few months. Normally it takes 4-6 months to make vaccine. So before September, no country will have vaccine. Even when we get into September and beyond, there will be limited supply of vaccine. The challenge will be to decide who will get the vaccine — which countries and groups within countries. 12:36 A vaccine expert speaks. We expect the first doses of the vaccine available sometime in September. At that time, the number of doses will be very small, and in the following weeks and months, there will be more. When enough evidence is available in the coming weeks, we will make policy recommendations on which populations should be prioritized in terms of getting the vaccine. 12:38 Fukuda speaks. To take the alert level back down from Phase 6: At some point, a lot of people will have been infected, and we’ll begin to see immunity in the population. It will circulate and become more like a seasonal flu virus. At some point, the alert-level will fall. When you’re talking about flu, you’re talking about a “marathon,” not a “sprint.” 12:39 Chan speaks. The virus is “pretty stable.” Viruses in different countries look very similar. At any sign of change in the virus, we will need to inform the world. 12:44 Chan says she’s not an economist and doesn’t have a crystal ball, so she can’t answer a question on how this alert level will affect the global economy. 12:46 Roche has donated 5 million courses of Tamiflu to us, and we have dispersed all of them. We are receiving a second donation: 5.6 million doses. Part of that is pediatric formulations. Over time, we will send those out. 12:46 The press conference is over.

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Live Blog: WHO Declares Flu Pandemic