Doubts over WHO’s original flu ‘inheritance’

Call it the flu gap, or second flu wave, or world pandemic: the World Health Organisation says H1N1 swine flu broke out worldwide in 2009.

But before it could get under way, the WHO put in place a worldwide definition of “fully vaccinated”, blocking the flu from spreading.

As we all know, that was an empty defence. Other sources have determined that around a third of the total, including pregnant women, should be vaccinated.

So how does the WHO now see its original, stubbornly well-founded title for flu? “We might modify that,” said its acting director-general, Bruce Aylward, on 17 April. His reasoning? H1N1 is the worst flu virus on record, even worse than H5N1 bird flu, and possibly understating its reach.

He went on to describe how 16.2% of Americans hadn’t been vaccinated and as many as 288,000 had flu-related hospitalisations and 15,000 had died in 2009 and 2010.

The WHO has enough money for a steady commitment to prevention, he said. And though all communicable diseases have a chance of being broadly shared by people of all incomes, simple precautions like getting immunised for the winter can help.

“When you look at long-term financial costs of preventable illness, of diabetes, of cancer, of heart disease, of stroke,” he said, “they’re enormous.”

Could a group of scientists be involved in an experiment in the next 10 years that finds a vaccine for H1N1 that stops it from spreading? They certainly need a wide enough field of view.

“The idea of getting new vaccines does really appeal to me,” Aylward told reporters. Then he quickly added: “Ideally, there will be testing that shows we have vaccines which make the disease subside over time.” The WHO will be soliciting proposals for small-scale experiments with vaccines that don’t protect against multiple pathogenic agents, he said. He did not mention how such experiments might work.

A one-drug vaccine would be ideal, he said, as would “really hitting at the agent itself.” In some cases, in already-high-risk populations, “you’d only have one vaccine on hand,” he added. “So you’d have to shorten the treatment interval, or you’d have to delay the dosage and wait until the infection subsides.”

However, it would not be possible to make a one-drug vaccine in a time-critical period, including a pandemic. A vaccine against a virus that keeps incubating for six weeks or more would “almost certainly” have to run counter to WHO’s standard definition, which accounts for viruses that enter the body before anybody has actually been vaccinated, he said.

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