WHO will redefine pandemic

23 May 2009

pandemic-influenzaThe World Health Organization, whose duties include directing and coordinating authority for health within the United Nations system, will soon be writing science textbooks.

That statement isn’t true, of course. But it was my reaction to reading the latest announcement from Geneva:

Bowing to pressure, the World Health Organization announced Friday that it would rewrite its rules for alerting the world to new diseases, meaning the swine flu circling the globe will probably never be declared a full-fledged pandemic. Dr. Keiji Fukuda, the deputy director general making the W.H.O. announcement, said that he could not predict exactly what the new rules would be but that criteria would include a “substantial risk of harm to people,” not just the geographic spread of a relatively benign virus.

Apparently members of the United Nations don’t like the fact that WHO has been using ‘pandemic’ to describe the global spread of the new H1N1 influenza strains. They feel that the word pandemic implies that the virus is lethal and capable of causing many deaths – like the 1918 strain of influenza. Problem is, the new H1N1 strain isn’t any more lethal than seasonal strains of the virus. Apparently using the p-word gets everyone frightened as pandemic preparedness plans shift into gear.

According to the virology textbooks (one of which I wrote), the word pandemic means ‘global epidemic’. Even wikipedia has a benign definition: “A pandemic (from Greek παν pan all + δήμος demos people) is an epidemic of infectious disease that spreads through populations across a large region; for instance a continent, or even worldwide.”

I can already see how the WHO edict will influenza future versions of textbooks. For example, the current edition of  Clinical Virology states “Over the past 300 years, at least six pandemics of influenza have probably occurred, including three well-characterized ones in the 20th century”. In the next edition, this will have to be rewritten: “Until recently, at least six pandemics of influenza have probably occurred, including three well-characterized ones in the 20th century. In 2009, a new strain of H1N1 influenza emerged and spread globally, but it was not considered a pandemic by the new WHO rules”.

WHO redefining pandemic is absurd. Pandemic is an epidemiological definition that has nothing to do with virulence. A pandemic of influenza occurs when a new viral strain emerges to which the population has little or no immunity. Although pandemic is most frequently associated with influenza virus, other infectious agents may cause worldwide epidemics. The world is currently in the midst of an AIDS pandemic, one of the worst in history.

WHO should leave textbook writing to others. To paraphrase Andre Lwoff, a pandemic is a pandemic. The word implies nothing about virulence – and has little to do with politics.

  • las

    It is absurd. I'll sign a petition as one who will have to backpedal and sputter while teachng this!

  • http://www.virology.ws profvrr

    It's worse than re-classifying rhinoviruses as enteroviruses!

  • http://www.TrackerNews.net/ J.A. Ginsburg

    I agree it's silly to redefine “pandemic.” However, it would be helpful to refine the WHO scale to distinguish between a pandemics that aren't especially virulent and ones that are. While we're at it, the current scale focuses on influenza pandemics. Given the experience with SARS and all the research to develop better ways to quickly identify novel unknown pathogens (see Ian Lipkin's lab), wouldn't it be wiser to change to “pandemic” and include a section with background about influenza pandemics?

  • michael

    Severity is a separate scale than the pandemic scale.

    But they could divide the top rung of the pandemic scale by severity to approximate the short term risk scale the pols. press. and public crave.

  • Harry Calohan

    “Although pandemic is most frequently associated with influenza virus, other infectious agents may cause worldwide epidemics.”

    Let us not forget that since 1993 WHO proclaimed a Global TB Emergency, nor have they ever lifted that specter.

  • Brian

    “I can already see how the WHO edict will influenza (sic) future versions of textbooks.”
    A little freudian slip there? :-)

    We could push back at WHO and tell them to always pair epidemic or pandemic with severity.

    But, we might have to bow to this and come up with a new word to mean pandemic.
    How about:
    totimorbus, omnimorbus, cunctimorbus
    or
    omnidemic, totidemic, cunctidemic

    From roots in latin (and a bit of greek.)
    totus, quislibet, quamtotius, omnipotens, omnis, cunctus

  • Harry Calohan

    “Although pandemic is most frequently associated with influenza virus, other infectious agents may cause worldwide epidemics.”

    TB, is in fact, by itself, an ongoing PANDEMIC in this world at this very moment: (see http://globalhealth.kff.org/Diseases/TB.aspx)

    STATE OF THE PANDEMIC
    There were more than 9 million new cases of TB, and approximately 1.8 million deaths from the disease in 2007, the most recent year for which data are available. The World Health Organization estimates that there are 13.7 million people living with TB. In 2007, out of an estimated 9.3 million new TB cases worldwide, 1.4 million were among people living with HIV and there were 500,000 cases of multi-drug resistant TB (MDR-TB).

  • Matt Dubuque

    Now it looks like they are hell bent on dumbing down the entire planet. Heaven help us all.

    A few years back of course, we could no longer eat French fries, because the French opposed invading Iraq on false pretenses. So we had “freedom fries” instead.

    Then of course this recent outbreak wasn't really “swine” flu was it, even though any virologist would tell you it was.

    And no, this is no pandemic.

    Orwell would be proud.

    The weren't content with dumbing down the US. Now the whole planet must become stupid.

  • Harry Calohan

    Exactly. And that is why I take issue with WHO and the CDC for that matter, for keeping the far worse TB pandemic presently going on worldwide under wraps.

    It is obvious that ever since the US Salmonella outbreak, whose origins were obvious from the get go, the CDC has become a political arm for whatever administration happens to be in power. And in many ways, WHO also operates in a similiar politically charged atmosphere.

  • http://www.breastpumpdeals.com/brands/avent-breast-pumps.html Isis

    Well said Mate!

  • http://www.dailykos.com/user/Snowy%20Owl Snowy Owl

    I agree with the emerging imperative consensus from the WHO and specifically from Keiji Fukuda and Ms Chan.

    The Historical term pandemic as you rightly express means indeed what it means, that is not the actual problem of WHO.

    First thing first

    If you go to India or China you get to understand what the word pandemic evoque for them, it is a collective historical trauma.

    Just recognising this put the world pnademic out of the mainstream declaration even if technically it would be right to call it so each time it happenned.

    But technics must not overruled Cultures, technical terms that trigger traumatic evocation in the population is agianst the first Medical Rule, you shall do no harm.

    SO if I follow your line here, you are in fact making a statement that technical terms should prevail despite the consequences in many countries, despite the fear it will generate, despite the rise of anxiety and therefore very sad reflexes done by those who are already struggling to stay alive.

    Doc Fukuda have done Doctors without borders a couple of years in India, he has work in a San Francisco clinic when Aids was a strong preoccupation, he therefore knows the consequences.

    Of course, in Ivory Towers, thecratically speaking the world pandemic seems obvious to be the chosen one to write and declare but it would simply be inhumane for now.

    First do no harm.

    Snowy Owl

  • http://www.dailykos.com/user/Snowy%20Owl Snowy Owl

    Keiji Fukuda said WHO agreed with the countries that the phase system needs to more accurately reflect the impact the virus is having on populations.

    From his Doctors without Borders experience in India, among others, Keiji Fukuda is well aware of the psychological harm a declaration of a pandemic can have on some Cultural collectivities that had suffered in previous pandemics (from those of smallpox and others among the First Nations of the American Hemisphere or among Indians of India in 1918 for example).

    It is quite easy for someone who has a meal a day, enough water and access to informations and a doctor to acknowlege a true technical pandemic, but what about those who are barely surviving, stress to the max, and experience epidemics on an on, loose child and families and are historically traumatised by epidemics and pandemics.

    If this pandemic is “mild” as Academics state wouldn't it be arrogant that to be technically relevant to declare a World Wide Pandemic for the sake of Technical accuracy, thus disregarding the damage that such presumptuous and Non-Humanitarian Statement would cause?

    Are there still a lot of academic that do not care about the effects of their statements among populations.

    The first Medical rule is Do not Harm isn't it?

    May Technical Aristocrat in their Ivory Towers learns to Care about population more than their technical accuracy.

    Because if they just want to be technically accurate it means that Science tries to overrule Cultures and Populations.

    The Backlash could bring Science Authority back to the Middle Age.

    Just be Humanitarian and first do no harm.

    Snowy Owl

    http://scienceblogs.com/effectmeasure/2009/05/s

  • Lisa Frost

    I have a student who peaked a 109 degree fever with likely this (though our state is not entirely testing in schools at this point) and anther who was immune compromised and it went to the bottom of the lungs instantly. We will see next year.

  • Harry Calohan

    109 degree fever and radiologic events at the base of the lungs has nothing to do with Influenza.

  • Teeny

    Bah, the ignorance of the masses shouldn't influence textbook definitions. They haven't changed the meaning of weight to what is actually mass, just because Joe Bloggs thinks that weight is measured in grams.

  • http://www.flutrackers.com SnowyOwl

    Keiji Fukuda said WHO agreed with the countries that the phase system needs to more accurately reflect the impact the virus is having on populations.

    From his Doctors without Borders experience in India, among others, Keiji Fukuda is well aware of the psychological harm a declaration of a pandemic can have on some Cultural collectivities that had suffered in previous pandemics (from those of smallpox and others among the First Nations of the American Hemisphere or among Indians of India in 1918 for example).

    It is quite easy for someone who has a meal a day, enough water and access to informations and a doctor to acknowlege a true technical pandemic, but what about those who are barely surviving, stress to the max, and experience epidemics on an on, loose child and families and are historically traumatised by epidemics and pandemics.

    If this pandemic is “mild” as Academics state wouldn't it be arrogant that to be technically relevant to declare a World Wide Pandemic for the sake of Technical accuracy, thus disregarding the damage that such presumptuous and Non-Humanitarian Statement would cause?

    Are there still a lot of academic that do not care about the effects of their statements among populations.

    The first Medical rule is Do not Harm isn't it?

    May Technical Aristocrat in their Ivory Towers learns to Care about population more than their technical accuracy.

    Because if they just want to be technically accurate it means that Science tries to overrule Cultures and Populations.

    The Backlash could bring Science Authority back to the Middle Age.

    Just be Humanitarian and first do no harm.

    But yesterday via CIDRAP (http://www.cidrap.umn.edu/cidrap/content/influe…)

    WHO may redefine pandemic alert phases
    Excerpt:
    In response to concerns from various governments about the possible effects of declaring a full-scale influenza pandemic, the World Health Organization (WHO) will call on outside experts to consider whether to revise the agency's definitions of pandemic alert phases, a WHO official announced today.

    snip

    At the WHO's annual meeting last week, several countries, concerned about potentially causing undue alarm, urged the WHO to go slow on moving to phase 6. Noting that most H1N1 cases have been mild, they argued that the pandemic phases should reflect not only the geographic extent of the disease, but also its severity.

    Today Dr. Keiji Fukuda, the WHO's assistant director-general for health security and the environment, said the agency would call on scientists and public health experts to consider whether to change the phase definitions.

    “What we're currently doing at WHO is trying to take a look at the interventions and see what kind of adjustments might be made to make sure the definitions really meet the situation,” Fukuda said at a news teleconference. “To do this, we will be asking scientists and public health people who really have a good perspective on the issues to help us think this through.”

    He said he hopes this can be accomplished within the next few weeks.[ end quote]

    Finally on track and geting to the next station.

    I hope they not only consider tranmission pace, CFR but also, required hospitalisations, Infrastructures Capacity and Resources and Cultural Specificities.

    I feel lighter with this decision of the WHO.
    cf: to
    http://scienceblogs.com/effectmeasure/2009/05/s

    Thank you for your Precise Work and taking the time to Share your Knowledge.
    Snowy Owl

  • thor183

    Well, I don't understand the concern here. Why would you revise a textbook definition because a political organization modified its alert system? Even if its misusing the term “pandemic” in the process, so what? Its not like this doesn't happen all the time anyway. The scientific meanings of words are often different from their colloquial meanings.

  • http://www.virology.ws profvrr

    It's not just the alert system they will modify, it's the very meaning
    of pandemic. According to WHO, the new H1N1 virus might not rate being
    a pandemic strain, even though it may cause a worldwide epidemic.
    Having textbooks calling it a pandemic and not WHO will lead to a
    great deal of confusion. Students will ask, 'why are you telling us
    that the 2009 H1N1 was a pandemic strain when WHO says it wasn't?” WHO
    can modify their alert system, but they can't change the meaning of
    pandemic. They will have to use other terminology.

  • thor183

    I see your point. Even so, I wouldn't link your science to the decisions of a political body. Certainly, try to persuade them not to tinker with scientific terms. But, in the end, they will do what they will do. If you let it modify your science, where will it end? If TB worsens to an extent that it becomes an embarrassment to member nations and they pressure WHO not to classify it to be a pandemic, will you re-write the textbooks again?

  • http://www.virology.ws profvrr

    Most certainly, we will not rewrite textbooks based on what WHO
    decides. I agree that scientists need to advise WHO on this issue, but
    WHO, as you say, tends to do as it wishes. As I learned from dealing
    with them for many years.

  • Lisa Frost

    Sure it does, I've had about a third of my class out sick last week, and one of the girls who eats lunch in the room every day just tested positive via her personal physician for 'swine' as the kids still call it. This is hitting lung, brain and intestine hence people dying of pneumonia and the extreme headaches my kids are reporting.

  • Lisa Frost

    and to clarify 1/10th were significantly ill, 2/10th just under the weather

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  • hans Kloss

    WHO has changed its rules already then i.e. removed the things that you apparently did not like. One thing that you possibly could have taken into account: definitions of pandemic is not only politics as it influences the way governements act but has a lot to do with money too – the actions of said governments cost money and lots of it. COnsequently there are people that earn this money while it is being spent. Think of this before you start blathering again.

  • Dejan_f

    So did WHO change the meaning of the “pandemic” or not?

  • http://www.virology.ws profvrr

    No, they did not. They must have heard me complaining.

  • http://www.virology.ws profvrr

    No, they did not. They must have heard me complaining.

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