01 Mar 2006
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One-on-One with Dr. Margaret Chan

Representative of the WHO Director-General for Pandemic Influenza
by Garry Emmons

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Dr. Margaret Chan (PMD 61, 1991) is worried. She believes that a serious human influenza pandemic will almost certainly occur at some time in the near future. Chan is particularly concerned by the avian influenza virus H5N1 that is currently moving across continents and species. “In addition to its geographic spread,” she says, “the virus has extended to affect a wider range of animals than we’ve ever seen before. It’s infecting cats, for example, and has even caused the death of tigers. It has a high fatality rate in humans; we believe that more than half the people who have contracted it have died.”

Chan, who hails from the People’s Republic of China, obtained her medical degree from the University of Western Ontario in Canada. In 1994, she was named Director of Health for Hong Kong, where she began her public-health career in 1978. Chan, who joined the Geneva-based WHO in 2003, was appointed Representative of the WHO Director-General for Pandemic Influenza last year. She also serves as Assistant Director-General for the Communicable Diseases Cluster.

With so much at stake, what keeps Chan focused? “A sheer passion for global health,” she explains, “and the opportunity to do this work as part of the World Health Organization.”

You were Hong Kong’s health director during the 2003 SARS outbreak. What did you learn from that experience?

The SARS experience showed that decisive national and international action, taking full advantage of modern communication tools, could prevent a new disease from becoming endemic to a region. It raised the profile of public health and brought the importance of international cooperation in health to new heights.

SARS — severe acute respiratory syndrome — caused enormous economic damage and social disruption in areas far beyond the outbreak sites. It primed political leaders to understand both the far-reaching consequences of outbreaks and the need to make rapid containment a high priority. SARS stimulated efforts to find ways to lessen the impact of the next international outbreak. Many of these lessons are useful as the world braces itself against the prospect of another human influenza pandemic.

The 1918 influenza pandemic, caused by a mutated avian virus, killed some 50 million people. How does the current threat compare?

First, it’s important to remember that the 1918 flu pandemic was an exceptional event. More people died in 1918 from influenza than in a similar period from any other infectious disease outbreak ever, including smallpox and the plague. Comparisons to 1918 may thus be unfair. What we can say is that the world is now closer to a pandemic than at any time since 1968, when the last influenza pandemic occurred, causing 1 to 2 million deaths.

The H5N1 virus is treacherous — we know that it can jump the species barrier to infect humans and that it is prone to mutation. Indeed, every case of human infection increases the probability that the virus will mutate. We don’t know if or when the H5N1 virus might evolve into a pandemic strain that spreads easily among people, or what its lethality might be. We know only that a pandemic is possible, and that’s why the world must prepare now for the very real threat of a global public-health emergency.

Does WHO currently have all the resources and international cooperation it needs to do its job?

We are greatly encouraged by the increasing support and political commitment in recent months devoted to combating avian influenza, but even more is necessary. Surveillance and early warning are still the weak links in the pandemic-preparedness chain. Countries’ disease-surveillance capacity can be strengthened with support from partners and technical agencies, to go along with their own investment. Compensation for farmers could encourage early reporting of outbreaks.

Without timely information about outbreaks as soon as they occur, the 3 million treatments of the antiviral drug Tamiflu we have ready to dispatch on an emergency basis to contain a pandemic may not be deployed in time.

In the case of H5N1, is enough being done to destroy infected poultry stocks?

As of December, more than 140 million birds had been culled, resulting in $10 billion in losses suffered mostly by poor farmers in developing countries. They have made a huge sacrifice. However, culling as a protective measure occurs unevenly across countries.

Does a market-based system adequately respond to the need for vaccine stockpiles worldwide?

WHO is working closely with vaccine manufacturers to increase their seasonal influenza vaccine-production capacity so that in the event of a pandemic, we could maximize such capacity for producing a pandemic vaccine. We understand that companies may not be inclined to invest significantly in a vaccine for which there is no predictable date for its demand. There is certainly a need for more research into vaccine-production technologies and for greater production capacity, and WHO encourages vaccine firms and national governments to invest in such areas.

How much power does WHO have to compel sovereign nations to make certain preparations or do certain things?

None whatsoever. WHO is a part of the United Nations and is thus a member-state organization. WHO has no authority to compel its members to do anything they are not inclined to do.

Even if only voluntary and supportive, what role can other businesses, particularly multinational corporations, play in the battle against pandemics?

Responding to a pandemic is an enormous challenge that will require great coordination among international agencies such as WHO, national governments, nongovernmental organizations, and the private sector. Businesses can certainly support this response by doing workforce or business-continuity planning and by helping to meet the demands that will be created by a pandemic, such as by increasing production of essential services and products. The networks created by some businesses may also help to disseminate messages during a pandemic, when communication will be vital for countries to respond appropriately.

What percentage of countries are prepared for a pandemic?

No country is completely prepared for a pandemic, and much work remains to be done. However, WHO is encouraged by the number of countries that are developing pandemic-preparedness plans, consisting of a constellation of public-health measures. Simply having stockpiles of antivirals doesn’t mean that countries will be ready to deal with a pandemic. Also necessary is multisector cooperation for steps such as distributing protective masks and promoting proper hygiene, as well as planning for social distancing and quarantine.

Communicating with the public will be essential during a pandemic, not only because antivirals and vaccines will be in short supply, but because there will be tremendous uncertainty and changing information as the situation evolves.

With the explosion in the size and density of global populations, is an increase in potential pandemics inevitable? Does global warming make human pandemics more likely?

The potential for pandemics to arise is linked more to the influenza virus than to global populations. Pandemics happen when a new influenza subtype emerges that has never before circulated in humans. They are rare but recurring events that are essentially due to the tendency of influenza viruses to constantly evolve and mutate.

As for global warming, there has not been any evidence to show that it makes human influenza pandemics more likely.

Aside from pandemics, what are WHO’s chief concerns?

WHO has four major objectives: enhancing global health security by detecting and responding to disease outbreaks; accelerating progress on the UN Millennium Development Goals, which include reducing maternal and child mortality and tackling the global epidemics of HIV/AIDS, tuberculosis, and malaria; preventing noncommunicable diseases, such as cancers and cardiovascular diseases; and promoting equity in health by strengthening health systems worldwide.

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