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Brian Edwards CBE
Emeritus Professor of Healthcare Development
University of Sheffield
Health experts from all over Europe met recently in Copenhagen to assess how well Europe was prepared for a possible influenza pandemic. Pandemic flu was, the experts concluded, a real possibility and, if it happened, it would probably affect around 25% of the population. It would be more infectious than ordinary flu and people of every age would be at risk. The last pandemic in 1968/9 killed around 1.4 million people worldwide. The experts concluded that better cooperation between governments and organisations such as WHO would enhance preparedness by strengthening disease surveillance, harmonising control measures and improving risk communication. The citizens of poorer countries with weak health systems would suffer worst, but their weaknesses could put neighbouring countries and perhaps the whole region at risk. A pandemic spread in densely populated Northern Europe would observe no national boundaries, so sensible joint planning and coordinated control would be vital. At their recent meeting, European health ministers agreed to commission a simulation exercise focusing on communication between key players in the event of an outbreak. All countries are stockpiling antiviral drugs that may help, and the traditional flu vaccination programmes are being pushed hard. While these may not protect against new strains, they may reduce their impact and severity. They do not, however, stop a person passing the infection on to others. However, the experts stressed that the new antiviral drugs are only part of the answer to a pandemic. They will slow down an outbreak and allow time for vaccine development. They will also have to be used responsibly to avoid the formation of drug-resistant strains, but how such restraint could be encouraged or imposed is not at all clear. A crucial test of preparedness is the surveillance laboratory capacity, which in some countries is in need of urgent investment.
Cooperation between veterinary and public health services has proved to be vital in the H5N1 outbreaks in South East Asia, and here we hit hard practical issues such as whether farmers are going to be adequately compensated for culled animals. Effective containment of the virus in poultry depends crucially on timely notification and rapid culling. Nobody has yet thought about the economic impact on hospitals, which may be overwhelmed by medical emergencies. During the New Orleans hurricane disaster, a number of public hospitals simply ran out of money and closed.
Even if we escape a pandemic this time, we will have to confront public health problems in the future and the present discussions about collaboration can only be good. They may also give some impetus to wider discussions in Europe about the need for coordinated response mechanisms to natural disasters such as earthquakes and floods. There are still many practical and legal difficulties in operating ambulances and emergency helicopters across national boundaries in Europe. This is proving to be an interesting challenge for the organisers of the 2006 Winter Olympics in Turin. There are, however, some signs of progress, with the French and Spanish governments talking about building a joint hospital in the Pyrenees.
WHO will probably be the first to spot a pandemic developing, but if it does start it will spread rapidly if no action is taken. In those circumstances, European collaboration would face a serious test.