WHO's pandemic phasing committee

Many readers here know that WHO has a pandemic phasing arrangement, and there has been much confusion and consternation about why they have or have not "called" phase 4. In a characteristically informative article, Helen Branswell of Canadian Press gives some of the details, including the names of some of those who will advise WHO on whether to change the warning level.

In short, WHO has established a committee of experts to help them determine the phasing. Branswell says the committee has about 20 experts, including some stalwarts of the influenza science establishment:

The list of 20 or so international disease experts includes leading avian influenza expert Dr. Robert Webster of St. Jude's Research Hospital in Memphis, Tenn., Dr. Ab Osterhaus, a veterinary virologist at the Erasmus University in Rotterdam, and Dr. Nancy Cox, director of the influenza division at the U.S. Centers for Disease Control in Atlanta.

Dr. Theresa Tam, director of the Public Health Agency of Canada's respiratory infections division, is also on the committee, which convened for the first time Monday in Geneva.


Membership is drawn from the six administrative regions of the World Health Organization: Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean and the Western Pacific.

Other members of the task force include Dr. Maria Zambon from Britain's public health agency; Dr. Martin Cetron, head of the global migration and quarantine division at the CDC; Masato Tashiro, director of Japan's National Institute of Infectious Diseases; and Russian virologist Dmitri Lvov. (Branswell, Canadian Press)

It sounds like this committee is just getting organized and is hammering out matters of process and logistics. With flu season upon us and sporadic bird flu cases appearing against a background of widespread poultry infection over half the globe, this committee is needed.

But it is a big committee, its governance and independence aren't yet clear and whether it will be proactive or reactive even less so. We don't know who will lead it or how independent the leadership will be from WHO, if at all.

We fear the committee will find itself in the position of the French revolutionary in the uprising of 1848 who was seen desperately running after the insurgents in the Jardin de Luxembourg gasping, "I'm their leader, I must follow them."

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You would think that this group would have far more important things to do,in the run-up to a pandemic worse than 1918, then to spend the extraordinary amount of time required to be a political pawn of the World Health Organization.

Is the World Health Organization now contracting out decision making as well?

'Oh, it is a tangled web that we weave'.

If you can't even fulfill the minimal political mandate that you have...then get out of the way and let someone with a brain and a heart take over.

Why was the only person on the ethical high-road...Dr. David Nabarro...not empressed into duty as the new head of the World Health Organizatiion...

that was the only way we could have a chance in the matter.

Tom. Had it been a group more removed from the situation, I'm sure people would have complained as well.

The WHO can do nothing right in some people's eyes. Just like each of us do our best in our jobs, I think they are doing their best in theres. This is undoubtedly, the most concerning issue this agency has ever seen, with immediate and global consequences. I for one, am glad they are taking it seriously, yet cautiously.

"I'm their leader, I must follow them" - can we make this the big production number that brings everyone to their feet in the Les Mis-like "WHO: the Musical"?

This is a very serious panel. I would be very surprised to see schism and fracture from this group, even setting aside the high profiles of its members which usually lead to such infighting. They may have been summmoned to lend weight to the "we are all in this together" nature of the fight ahead.

Also from a practical standpoint, if these 20 can agree then later blame will be more evenly spread around and much harder to assign to any individual entities - the WHO, nation state members, and individual scientists included. Since we've seen sometimes disabling fear from each of those parties, the authority and existence of this panel may be a very good thing.

I think it is a smart move. I also think that the situation is very serious for them to have made such a move. TomDVM you are right - all these scientists have plenty of work on their own.

great ! So this is the first panel of 20 members
to estimate the probability of a pandemic, so WHO
can adapt its phases according to the danger. (?)
Reminds me to the swine flu 1976, when CDC formed
2 such panels, one came up with 10%-25% for the probability
of a pandemic, the other one with 40%.
Are the names of the other members known ?
Will they tell us about their votes ?
Is this a first sign that they are considering to go to phase 4 (and have a suitable justification for this) ?

PIxie, anon: The plans to have this expert panel go back a long ways. This was part of the pandemic phase system. I'm not sure what panel they were using before this one, but this isn't a sudden departure from the plans or the system, itself.

Revere - yes, I am not convinced that this is an emergency meeting that has been called. I apologize if my post came off that way. I realize that just the logistics involved in getting these guys to Geneva makes it likely that the meeting has been in the works for a while. Why the panel was convened now, rather than this time last year, or this time next year, is one question I would like to see answered, however. I'm not convinced the timing is a non-issue.

Right now, not much additional information is available about the panel for public consumption, either in the press or on the WHO website. There are still unanswered questions, whether about the still unnamed panel members or details about how they will proceed from here (which they may be working on as we speak). I am hopeful we will learn more shortly, and I hope that the media beyond Helen Branswell will begin to follow the story.

Pixie: The timing of the meeting only surprised me in one way. I thought this had all been set up long ago, and was a bit taken aback that it hadn't. I agree with you that the timing isn't random. Flu season is coming and everyone knows that the other shoe could drop at any time. They are getting ready to handle it. If nothing catastrophic happens they will at least have been prepared. On paper. I'm still not convinced that this panel will work as advertised. It is very big and has a lot of players.

They are bailing the Titanic with a spoon...it doesn't matter whether they have one spoon or twenty spoons...

They could have done a lot of things five years ago that would have made a difference...but they were to busy smoking what they were supposed to be selling...they spun themselves into believing it wasn't going to happen...it didn't matter (remember the 2-7 million estimate in Jan 2005)...that is only one example of a serious ethics problem at the highest levels of the World Health Organization.

...I've got news for them...its all over...nothing you do now is going to make one bit of difference...too little too late...

...if you don't think this is all about window dressing and covering there ***...talk to me in twelve months.

The WHO is like insurance...it works really good till you actually need to make a claim.

I thought I would do a bit of research on Dr Theresa Tam -

found this quote from the Jan 27, 2006 Vancouver Sun which does NOT give me the 'warm & fuzzies!!

But, "we really have no idea how this virus will behave next if it undergoes some mutation."

The updated influenza pandemic plan will include recommendations for the use of masks. Droplets, or larger "blobs" of secretions primarily spread flu. General surgical masks should be enough should a pandemic happen, Tam says.

"Public health experts feel that putting a mask on an ill person when they're coughing or sneezing and have to move around ... is a sensible thing to do.

"Having well people milling about on the streets wearing masks all the time, we don't know if it's effective or not."

'''The public focus will be on hand hygiene,''' Tam says.
Oh dear!!! I think she has rather a long way to go!!

I tend to agree with Tom DVM...if this flu blows into a pandemic then basically we are pretty well screwed, no matter how many people they put on a panel to tell us we are. I've noticed a trend in Henry Niman's articles on the most recent cases of H5N1: those who don't get treated early generally die, and those that survive do so only because of massive doses of tamiflu. This means that without tamiflu the death rate right now would be much higher than it already is, and in a pandemic situation we won't have a fraction of what we would need to treat the exposed and infected. (Of course there are those recent cases turning up that demonstrate H5N1 is sometimes so mild as to be asymptomatic...but so far these appear to be in the minority.) Anyway, I am wondering if anyone has computed what H5N1's lethality rate would be without these tamiflu treatment interventions? The way the new cases are taking off now in Indonesia I have the feeling phase 4 is about to be declared...about 6 months too late.

By mary in hawaii (not verified) on 26 Sep 2006 #permalink

Mary in Hawaii - Another possible new wrinkle in the wider use of Tamiflu is that we are now seeing cases that linger in the hospital for weeks before either expiring or recovering enough to go home. There are too few of these cases to be stastically significant at the moment, but it is a new trend that does not bode well for what will already be an overtaxed health care system should a panemic arrive. I don't think that when they first began to think of Tamiflu as a cure, that they were thinking about caring for these patients for up to a month in hospital (with the patient outcome even then still being unclear).