Is the world prepared for the next flu pandemic?

The risk of a new flu virus spreading from animals to humans and causing a pandemic is a constant reality. The question is not whether or not there will be a new flu pandemic, but when it will occur. Tedros Adhanom Ghebreyesus, director-general of the WHO, presented a global strategy against the Influenza dated from 2019-2030. A very ambitious initiative designed to prevent and combat this disease. 

His words are more than justified, as influenza is one of the greatest threats to global public health: there are nearly one billion cases each year, of which between 290,000 and 650,000 are fatal. In fact, it was the cause of the 1918 pandemic, one of the greatest health crises in history. WHO strategies are focused precisely on avoiding such a scenario.

The Spanish Flu

It is estimated that between 1918 and 1920 some 500 million people suffered from the so-called Spanish flu. Various studies suggest that it could have originated in the United States, France or China. Between 50 million and 100 million of those affected have died, almost 5% of the world's population. In barely two years, it caused more victims than those which have been attributed to the HIV virus, which has caused around 39 million deaths since the 1970s.

Since then, there have been three other influenza pandemics, in 1957, 1968 and 2009, but none on the scale of the one that happened in 1918.

WHO experts acknowledge that such outbreaks are unpredictable. For example, in 2003, the re-emergence of the Avian Influenza A(H5N1) virus in Asia showed that it could be transmitted from animals to humans. However, it did not become a pandemic at that time, as the virus did not retain a permanent ability to spread from person to person.

In 2009, the strain that caused the H1N1 swine flu, which started in Mexico, spread rapidly around the world. It is estimated that between 105,000 and 395,000 people died from it. Although some seasonal flu epidemics can cause even more deaths, this case convinced health authorities that we were ill-prepared to respond effectively to such cases.

In 2011, the 194 WHO Member States created the Pandemic Influenza Preparedness Framework - also known as the PIP Framework - to strengthen the sharing of potentially pandemic influenza viruses through a network of laboratories, allowing them to be studied in detail, and to promote access to vaccines, especially from developing countries, to address potential threats. Vaccine strains are selected by WHO twice a year; once for the influenza season in the northern hemisphere and once for the influenza season in the southern hemisphere.

A planetary flu plan

The latest strategy of the World Health Organization (WHO) is the most comprehensive and far-reaching strategy developed to date to contain this virus. It aims not only to strengthen existing prevention mechanisms but also to set guidelines to improve each country's response to a pandemic.

In essence, the WHO approach has two objectives. The first is to improve surveillance and response systems, as well as prevention, treatment and means to prepare for future crises. To achieve this, each country must develop a specific programme tailored to its needs that also contributes to global health security.

The second is to design better tools to prevent, detect, control and treat influenza, from vaccines to antivirals, and to ensure that all countries have access to them. As WHO Director-General Tedros Adhanom Ghebreyesus points out, thanks to the partnerships and actions taken in recent years, we have never been so prepared for the next pandemic. However, it is still not enough. "The PiP Framework - the tool that brings together governments, industry and WHO for a global response - needs to continue to work effectively to facilitate access to vaccines and treatments and to help countries prepare for pandemic influenza through contributions from manufacturers.

Expert opinion

Raúl Ortiz de Lejarazu is head of the Microbiology and Immunology Service at the Hospital Clínico in Valladolid.

"The truth is that we are not sufficiently prepared to face a flu pandemic since we have to take into account that the organization to contain a phenomenon of this type has to be global; not only in rich countries but also in those with more limited resources. The Achilles' heel in this situation is the availability of vaccines: the producing countries are always the first to have access to them, while those in the developing world are usually the last.

It is not possible to know which strain of influenza will be circulating, so in the event of a pandemic, it will take four to five months to produce the vaccine. In the early stages, only antiviral drugs will be available. That is why, while the vaccine is being manufactured, containment measures need to be taken, such as diagnosing people, treating them and isolating them. Three such crises occur every century. One has already occurred in this century, but according to the WHO, another may occur before 2030.

Adapted from an article in Gaceta Medica written by Sandra Pulido

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