Given the widespread presence of the swine flu virus across many countries, containment is probably not feasible, and efforts need to focus increasingly on mitigation, says a public health expert in an editorial published on bmj.com today.
Interestingly, almost all cases reported so far have been in developed countries with robust surveillance systems, writes Richard Coker, Professor of Public Health at the London School of Hygiene and Tropical Medicine. It is unclear whether this is because populations at risk have travelled preferentially from Mexico to those sites, or more pessimistically, whether cases are now occurring in countries with less well developed surveillance systems and not coming to international attention.
This new strain is, at this stage, sensitive to antiviral drugs, he says. However, although many developed countries, including most of Western Europe and the US, have sizeable stockpiles of antiviral drugs, most low and middle income countries have low or non-existent stocks.
So, is the world well prepared, he asks?
Well, not necessarily. Analyses of national strategic plans around the world show that although most countries now have plans, many countries, especially developing countries, will struggle to put them into operation.
This is because they have limited health system resources to call on in the event of a pandemic; they have not stockpiled antiviral drugs in anything like the numbers needed for mitigation purposes (and if they had, they might struggle to mobilise them effectively); and they are unlikely to receive an effective vaccine early (if at all), once it is produced in large amounts, he explains.
Analyses have also highlighted strategic inconsistencies. For example, evidence shows that border screening is an ineffective means of control, and the World Health Organisation is resisting calls to issue recommendations for travel restrictions. However, several countries including the UK (and the European Union) have recommended restrictions on travel.
Professor Coker also points out that, now world attention is focused on H1N1 swine flu, it is easy to forget the threat still posed by H5N1 and other strains of flu. And immunity to H1N1 will not offer protection to H5N1 if that also becomes readily transmissible between humans, he warns.
As H1N1 spreads to areas where H5N1 is endemic, he asks, do we face an even greater challenge - that of reassortment of these two viruses and the threat of another pandemic?