As the world’s influenza experts gathered this week in Geneva, Switzerland, to determine next year’s vaccine composition, recent outbreaks in the Democratic Republic of the Congo and in Madagascar illustrate the threat influenza presents to developing nations.
Until now, the health impact of influenza on the developing world has received scant attention. But people in these countries are often at greater risk of death from influenza than people in other countries. Developing world populations may be malnourished; they may have other diseases such as AIDS which compound their risks; protection with influenza vaccination is often unavailable; armed conflict may force them from their homes spreading the virus and making treatment difficult; and the health services available to them are often inadequate. In this environment, influenza can be devastating. This was demonstrated by an influenza epidemic that began in Madagascar last summer. Before it ended, that outbreak killed more than 800 people and severely strained the country’s health care system. The virus which caused that epidemic appears to be sweeping across Africa. In the Democratic Republic of Congo, the Ministry of Health now reports that 1.5 million people have been stricken and over 2,000 killed. And it is not over.
“Influenza is a global threat,” says WHO’s Director General Dr Gro Harlem Brundtland. “It already kills up to a million people each year, and sooner or later it will ignite a pandemic. We can meet this challenge with a strong global surveillance system and a robust health infrastructure, or we will suffer the consequences. Today, we are not ready for the next influenza pandemic. Preparedness has to start now. The situation is urgent.”
The first line of defense is WHO’s Global Influenza Surveillance Network, a partnership of 112 National Influenza Centres in 83 countries. It constantly monitors reports of outbreaks like those in Africa. It also draws on expertise and laboratory capacity in four WHO Collaborating Centres for Reference and Research on Influenza in Atlanta (USA), London (UK), Melbourne (Australia) and Tokyo (Japan). This combined surveillance and laboratory network helps WHO monitor influenza activity in all regions of the world and ensures that virus isolates and information are sent rapidly to the WHO Collaborating Centres for immediate strain identification. But the surveillance network still has geographical gaps in the developing world.
The recent outbreaks in Africa illustrate the need for a strong influenza response everywhere. But major problems persist, and not only in the developing world. Only one nation has a completed influenza plan, Canada. Vaccine coverage is low especially among vulnerable populations, including the elderly. In the most advanced countries, immunization rates can be as low as 10% in high-risk groups, and in the developing world rates can drop to zero.
Recognizing the need to reduce the impact of annual epidemics and prepare to respond to the next influenza pandemic, WHO’s Executive Board has recommended to the Fifty-sixth World Health Assembly the adoption of a plan to coordinate activities. At the Assembly, to be held in May in Geneva, WHO will ask its members countries to enhance the surveillance network, to push for greater vaccine coverage, to support research to improve vaccines, and to begin designing national influenza policies.
Preparedness begins, for the individual, with an annual vaccination. Today, the composition for next season’s influenza vaccine was announced. The influenza experts in Geneva recommended that the influenza vaccine for 2003-2004 (Northern Hemisphere) contain the following three components:
- an A/New Caledonia/20/99(H1N1)-like virus
- a B/Hong Kong/330/2001-like virus
- a decision on the A(H3N2) component has been deferred until 26 February 2003, to allow analysis of late breaking data.
All WHO recommendations are published in WHO’s Weekly Epidemiological Record (WER) and communicated to public health authorities, national control authorities and influenza vaccine manufacturers.