The pandemic is over. Now what?

By Scott Rosenstein

Last week, the World Health Organization (WHO) announced the end of the H1N1 pandemic (swine flu) and the beginning of the “post-pandemic phase.” Upon hearing this momentous news, governments around the world did … nothing.

A handful of media outlets carried the story. Some of the more ambitious blogs took the opportunity to update their big pharma conspiracy theories and hawk their own end of the world naturopathic remedies. But the most telling aspect of the announcement was in how little anybody cared. The alert system, which was set up to coordinate the global response to pandemic threats, failed to achieve that task and created a level of anger and cynicism that could obstruct coordination on future global health challenges for years to come.

As fear of swine flu swept across borders last year, many governments launched pandemic response plans that were linked to the WHO’s alert system, a process developed over many years of tinkering that had never faced a real world test. As swine flu spread and the WHO moved to phase 4, these governments ramped up their surveillance activities and began mobilizing healthcare resources. When the system went to phase 5 — sustained human-to-human transmission in at least two WHO regions — emergency response plans were accelerated, and preparations for vaccination began. When the WHO chose to advance to phase 6 (the highest threat level) in June 2009, many countries had committed themselves to prepare for the worst, which included the acquisition and distribution of vaccines, antivirals, and other emergency goods. Many countries were ill-equipped to follow through on this costly plan.

But many people believed that, costly as they may be, emergency responses were absolutely necessary. The image of a modern day influenza pandemic included near or complete paralysis of the global supply chain in a world where most daily activities, including work and education, were significantly curtailed and human beings were living in near seclusion to limit the spread of the virus. That’s not how it played out, of course. “Mild” pandemics happen, and by June 2009, it was becoming increasingly clear that that’s what was happening in this case.

It was also clear that the world lacked a coherent definition of pandemic-not a trivial point when millions of lives and billions of dollars are at stake. Does a pandemic have to be a threat that humans have never before seen? How widespread must it be to qualify? Must it cause substantial human illness and death? If so, what constitutes substantial? Thousands of deaths worldwide? Millions? Is obesity a pandemic? The WHO made matters worse by presenting differing definitions on its website and within official prepared­ness documents.

In the months that followed, WHO officials continually tried and failed to communicate to the public that the various alert levels represented how easily the virus spread, not how deadly it was. The disconnect between the alert system and the public perception continued to widen as summer wore on, and many poorer nations began to reduce their preparedness efforts as wealthy countries squabbled over access to limited vaccines for populations that were becoming less and less interested in taking them. A growing perception that the WHO was ringing a false alarm fed anti-vaccine sentiment. As I wrote in this space six months ago, the WHO’s communications failure became a catalyst for spurious claims that this institution’s actions were carried out to serve the needs of pharmaceutical companies instead of global public health.

Flash forward to August 2010: The WHO announces the end of the pandemic, and virtually no one notices. European countries that responded to WHO alerts with heavy spending continue to face criticism. Countries like Poland that refused to purchase any pandemic H1N1 vaccine claim vindication, and there is real concern that growing skepticism could cripple plans to prepare for a future pandemic.

Like it or not, the need for an organization that can coordinate a global response to a transnational public health crisis remains. For now, there are no viable alternatives to the WHO. This institution’s first challenge on the way to restoring its credibility is to help create a more unified definition of a pandemic. Considering some of the semantic vagaries currently surrounding this debate, this will not be an easy task. Next up will likely be an adjustment to their alert system to help health officials distinguish their mild and severe influenza response plans.

A successful effort on both fronts won’t silence skeptics and critics. But perhaps the next time the WHO makes an announcement, a few more people will show up to listen. Presuming, of course, we are not all dead.

Scott Rosenstein is a global health analyst at Eurasia Group.