OPINION:The World Health Organisation was given new powers in 2007 to deal with emergencies
FOLLOWING THE outbreak of cases of swine fever in Mexico and the United States, the director general of the World Health Organisation (WHO) declared on April 25th that these events constitute a public health emergency of international concern under the International Health Regulations (IHR) 2005.
Such an emergency refers to an extraordinary public health event which is likely to constitute a public health risk to states, through the international spread of disease and one which requires a co-ordinated international response.
Swine flu is a highly contagious disease in pigs caused by a flu virus and spread in the manner normally associated with the flu virus. People usually get swine flu from infected pigs, although human to human transmission has occurred in some instances. The concern is that evidence of widespread human to human transmission can lead to an influenza pandemic. Of additional concern in this outbreak is that the WHO reports that this virus has not previously been detected in pigs or humans. The viruses appear to be sensitive to some anti-flu medicines but resistant to others which are normally effective. Whereas only mild flu-like symptoms have been reported by those infected in the US, the outbreak in Mexico has resulted in more than 150 deaths. An important task for public health experts will be to determine the reason for this difference in response.
The WHO maintains a phased approach to pandemic alerts. As of last night, the current outbreak is at phase five of a six-phase process. The WHO is seeking further information from the authorities in the states affected to determine what further action may be needed.
The effective handling of such public health emergencies and the full engagement of the WHO has only been possible since the enactment of the IHR 2005, which came into force in May 2007. The powers of the WHO under older regulations were extremely limited. Following the Sars epidemic in early 2003, it became clear that the IHR needed reform. The Sars outbreak commenced in China. It is now widely accepted that the authorities there failed to disclose to the international community the nature and extent, and method of transmission, of this disease. As a result when the disease spread to Canada medical practitioners, confronted with the symptoms, thought they were dealing with pneumonia. Thus they did not take the necessary precautions to protect themselves against exposure to Sars which had the effect of spreading the disease quickly, particularly in Toronto. Those who contracted the disease invariably died. A some short time later Sars came to Europe. However by this time more information was available and there were only two fatal cases of Sars in the EU and these were contracted outside Europe.
The World Health Assembly of the WHO resolved in May 2003 that the International Health Regulations must be reformed. The new regulations reinforced the requirement for member states to inform the WHO about potential public health emergencies. However, the most powerful and controversial reform was the provision of a mandate to the WHO to seek verification of unofficial reports of events with potential international implications. In addition, the power was given to the WHO to require collaboration and assistance in dealing with the emergency. These provisions had sovereignty implications for many member states.
Having been asked to act as a special envoy of the WHO, my task was to visit various countries and convince governments of the need for reform.
The adoption of the IHR in 2005 now provides a sound legal basis for the WHO to encourage the transparent exchange of information, the operation of an effective rapid alert system, and the operation of collaboration of member states to ensure that prompt and effective action is taken to deal with an emergency.
The international health community is particularly vigilant for the spread of zoonotic diseases which skip the species boundary and spread from animals or birds to the human population. For some time we have been living with the threat of avian influenza. So far, it seems that the transmission of this disease to humans has been directly from the bird population. There does not seem to be any evidence of human to human transmission. The mutation of the avian flu virus to facilitate human to human transmission could trigger a health pandemic posing a much greater threat to human health than the current swine flu epidemic. The WHO will now be looking for any signs of a mutation of the current virus which facilitates a more widespread human to human transmission. Careful monitoring will also detect whether the deadly avian flu virus is present in the mix. The handling by the WHO of this outbreak will be an important test of its new powers under the IHR 2005.
David Byrne is a former attorney general, and was an EU commissioner for health and consumer protection, and WHO special envoy.