Director of WHO statement on H1N1 situation

"The only thing that can be said with certainty about influenza viruses is that they are entirely unpredictable. No one can say, right now, how the pandemic will evolve."

On the supply of antiviral medication:
"Global manufacturing capacity, though greatly increased, is still not sufficient to produce enough antiviral medication and pandemic vaccines to protect the entire world population in time."

What we know from history:
"influenza pandemics have encircled the globe in two, sometimes three, waves. During the previous century, the 1918 pandemic, the most deadly of them all, began in a mild wave and then returned in a far more deadly one. In fact, the first wave was so mild that its significance as a warning signal was missed."

Assumption:
"the world today is much more alert to such warning signals and much better prepared to respond."

The full text of her speech is worth reading:

Statement made at the Secretary-General’s briefing to the United Nations General Assembly on the H1N1 influenza situation.

Via videoconference from Geneva, Switzerland
4 May 2009

H1N1 influenza situation
Dr Margaret Chan
Director-General of the World Health Organization

His Excellency, Mr Miguel d’Escoto Brockmann, President of the General Assembly, Mr Ban Ki-moon, Secretary-General of the United Nations and your staff, Excellencies, ladies and gentlemen,

First and foremost, let me thank Mr Secretary-General for inviting me to join this briefing. Let me thank the President for giving me this opportunity. I am speaking to you from the SHOC room in Geneva.

Our hearts go out to all people in all countries affected by the new H1N1 influenza virus.

Ladies and gentlemen,

Let me try to give you an overview of the current situation, of where we stand right now, and where the world may be heading.

Influenza pandemics are caused by a virus that is either entirely new or not known to have circulated among humans in recent decades. This means, in effect, that nearly everyone in the world is susceptible to infection. It is this almost universal vulnerability to infection that makes influenza pandemics so disruptive.

Large numbers of people falling ill can be highly disruptive to economies and to the functioning of routine medical services.

As of right now, WHO has received reports of 1003 confirmed cases of H1N1 influenza from 20 countries on four continents. I wish to thank all countries reporting H1N1 cases to WHO for their cooperation and transparency.

All countries have acted in a very responsible manner. A special thank you goes to Canada and the USA who, alongside WHO, have assisted Mexico, especially with laboratory testing.

The world is in phase 5 now. This means that we need to maintain a high level of vigilance and monitor further international spread of the virus, and further spread in countries that are already reporting cases.

We do not know how long we have until we move to phase 6, which indicates we are in a pandemic. We are not there yet. The criteria will be met when we see, in one region outside North America, clear evidence of community-level transmission.

Although we face many uncertainties, we do know some things, which I want to share with you now.

Some of this knowledge comes from the behaviour of past pandemics. Other knowledge is specific to the new H1N1 virus and comes from the cases we are seeing in different countries and a look at the virus in the laboratory.

This helps us understand the situation, right now. However, experience during past pandemics warns us that the initial situation can change in many ways, with many, many surprises.

Historically, influenza pandemics have encircled the globe in two, sometimes three, waves. During the previous century, the 1918 pandemic, the most deadly of them all, began in a mild wave and then returned in a far more deadly one. In fact, the first wave was so mild that its significance as a warning signal was missed.

As we are seeing, the world today is much more alert to such warning signals and much better prepared to respond.

The pandemic of 1957 began with a mild phase followed, in several countries, by a second wave with higher fatality. The pandemic of 1968 remained, in most countries, comparatively mild in both its first and second waves.

At this point, we have no indication that we are facing a situation similar to that seen in 1918. As I must stress repeatedly, this situation can change, not because we are overestimating or underestimating the situation, but simply because influenza viruses are constantly changing in unpredictable ways.

The only thing that can be said with certainty about influenza viruses is that they are entirely unpredictable. No one can say, right now, how the pandemic will evolve.

This places health officials, at national and international levels, in the difficult position of needing to make far-reaching decisions urgently, yet without the kind of solid scientific back-up we normally like to have.

Ladies and gentlemen,

As you may know, several efforts have been made to estimate the impact of an influenza pandemic on the global economy today. These estimates vary greatly depending on the assumed virulence of the virus.

But all estimates agree on one point. The greatest disruption of the economy will come from the uncoordinated efforts of the general public to avoid infection. Again, it is incumbent upon us to issue advice and try to calm anxiety in the midst of great scientific uncertainty.

WHO is well prepared with plans that have been rehearsed, at headquarters and with its offices in all regions of the world. WHO is collecting information as the situation evolves and making this information public. Vigilance and solid data are critical at this stage.

In terms of preparedness, the world is also fortunate to have the revised International Health Regulations. This treaty, which is designed to protect public health, also has provisions aimed at preventing undue interference with international trade and travel.

In this regard, let me make a strong plea to countries to refrain from introducing measures that are economically and socially disruptive, yet have no scientific justification and bring no clear public health benefit.

Rational responses are always best. They are all the more important at a time of economic downturn.

If this pandemic begins with a mild wave, this will give countries and industry an opportunity to build up stocks of vaccines, antiviral drugs, and other essential supplies.

But let me be frank. Global manufacturing capacity, though greatly increased, is still not sufficient to produce enough antiviral medication and pandemic vaccines to protect the entire world population in time.

This is the reality. But we can acquire the data that guides the wise and targeted use of these interventions, conserves supplies, and, in the case of antiviral medicines, reduces the risk of drug resistance.

An influenza pandemic is a global event that calls for global solidarity. As the chief technical and administrative officer of WHO, it is my job to do whatever is possible to ensure that developing countries are not left without protection.

It is my duty to help ensure that people are not left unaided simply because of the place where they were born. I am working aggressively and constantly with the pharmaceutical industry to ensure access to affordable drugs and pandemic vaccine, should that be required.

Again, let me thank all countries, and all partners, also within the UN system under the leadership of the Secretary-General, for helping us maintain our vigilance, as we gear up our response.

Thank you.