By BETSY MCKAY
The World Health Organization's chief laid the groundwork Sunday for her agency potentially to declare a new strain of A/H1N1 swine flu a pandemic, saying such a move doesn't necessarily mean the disease is highly lethal or that it will sweep the entire globe.
"There is a lot of misunderstanding in terms of fear and death," Margaret Chan, the United Nations public health agency's director-general, said in an interview. "It doesn't mean death in big numbers is going to happen."
A week and a half after learning that a new strain of swine flu was causing outbreaks in Mexico and infections in the U.S., the WHO chief is now faced with the distinct possibility that she will have to formally declare the disease a pandemic, once it begins spreading in a sustained way in other parts of the world beyond the Americas. WHO protocols will compel that to happen, she said, even though thus far the strain isn't producing the deadly sort of scourge most people associate with the word "pandemic" and in fact looks to have exacted a lighter death toll in Mexico than authorities there originally believed.
As the disease has spread quickly over the past 11 days, the agency has raised its global pandemic alert level twice, to phase 5 -- signaling outbreaks in more than one country in one of the agency's geographical regions -- from phase 3. Its highest level is a phase 6, meaning community outbreaks are occurring in at least three countries in at least two of the WHO's regions. The disease is spreading within communities in the U.S. and Mexico, and case counts are mounting in Canada. Public health officials have said sustained transmission hasn't been seen elsewhere yet, but is likely to emerge in countries that already have multiple case counts.
Dr. Chan said she couldn't say when the agency would raise the alert level to phase 6. "That is very unpredictable," she said. "We will continue to monitor and watch very carefully."
"Phase 6 is a signal to all public health authorities in the world that they need to activate their pandemic preparedness plans," Dr. Chan said. But "it doesn't mean every country in the world will be affected by this wave of infection," she said. Additionally, "we know fully from the data that most people make a full recovery and some people don't even need to take medicine."
But signs that the virus thus far seems to produce predominantly mild disease don't mean countries can afford to let down their vigilance, she stressed. The WHO acted appropriately in raising the global alarm over the new strain because no one can predict whether it will morph into a more dangerous form at a later point after its initial emergence at the tail end of this flu season, she said. An initial outbreak of the 1918 flu in the spring was followed by a second, far deadlier wave which killed millions of people as it swept the globe, she noted.
"We cannot overreact and we cannot be complacent either," she said. "We haven't seen the full spectrum of the disease.
"It may come back. The world should prepare for it."
Moreover, even seasonal flu takes a hefty toll, she said. "We should not forget that even with seasonal flu about half a million people die each year from complications."
As of Sunday, the new flu had spread to 17 countries and sickened 787 people, according to the WHO, which counts only cases that have been confirmed by a laboratory test. Those cases include 506 infections in Mexico, with 19 deaths -- far lower than Mexican authorities originally believed. The U.S. has reported 160 infections and one death.
While the world overall is much better prepared for a pandemic than just a few years ago, many poor, developing countries remain particularly exposed, she said. The WHO said this weekend it's dispatching antiviral medications to many poor countries that lack supplies.
Write to Betsy McKay at betsy.mckay@wsj.com
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