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H1N1 Virus Update: Latin America's Experience Shows Communication, Surveillance Are Critical

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  • Communication and public health surveillance are critical for an effective response to the H1N1 flu virus
  • The Bank “stands ready” to help any country with assistance, including purchasing H1N1 vaccine
  • The Bank, the UN and the WHO are working to increase countries’ pandemic readiness through strengthening health systems
  • Preparing health systems to handle infectious disease threats is beneficial for coping with regular health challenges, and potential emergencies

September 23, 2009 —Latin America’s experience with the H1N1 virus in the last six months has revealed that early, aggressive and honest communication with the public and a strong public health surveillance system are critical in mounting an effective response to the virus.

So says Keith Hansen, World Bank Sector Manager for Health in region, where the virus has spread rapidly in the last several months during the southern hemisphere’s winter season.

The World Bank announced April 28 it would back Mexico’s fight against the virus with $205 million in fast-disbursing funds. Since then it has supported more than a dozen countries in the region and “stands ready” to help any country with financial, technical or programmatic assistance, including purchasing H1N1 vaccine when it becomes available, says Hansen.

After the virus was discovered in Mexico, the government updated the public daily with information and took other measures, such as closing schools and encouraging people to stay home, that have been seen as helping to limit cases and deaths. Most other countries of the region have followed suit, says Hansen.

In addition, as the virus spread throughout the region, it became apparent that a good public health surveillance program was needed to track and respond to the epidemic, he says.

Such a system is not just a matter of counting people but observing “what kind of people are getting infected, how quickly, how long they stay sick, getting a sense of how long they’re infectious, is the disease changing, and of course, most important, where is it having the most severe impact and being ready to treat those who are most severely affected,” says Hansen.

Such measures pay dividends in that they also help strengthen health systems to deal with regular health challenges as well as emergencies and pandemics, says Hansen. Health projects in Brazil and Argentina, for instance, have been set up to fast-track funds to communities’ most urgent medical needs as well as enhance pandemic preparedness.

The World Bank is part of a global partnership led by the World Health Organization and its regional bodies in Latin America (Pan American Health Organization). WHO said August 28 that H1N1 has become the dominant influenza strain in most parts of the world and that large numbers of people in all countries remain susceptible. The impact of the pandemic during a second wave of the virus could worsen as larger numbers of people become infected, according to WHO.

The World Bank has been working with the United Nations and WHO to increase countries’ pandemic readiness, in part through strengthening human and animal health systems—an effort that began as a response to the avian flu virus.

David Nabarro, Senior UN Systems Coordinator for Avian and Human Influenza, said last week the UN and World Bank plan to work together to help developing countries acquire H1N1 vaccine and to continue to support pandemic preparedness in general.

“The whole purpose of the work we’re doing is to prepare health systems to deal with all kinds of infectious disease threats, particularly those that come from the animal kingdom. And that means that the work we’re putting in place now is the kind that will have a beneficial impact whatever kind of health threat might occur.”

Adds Hansen: “The goal is not to just chase the disease du jour, but to really be prepared for what else may be coming down the pike, and strengthening countries overall in their readiness.”

Q&A with David Nabarro, Senior UN System Coordinator for Avian and Human Influenza, September 15, at World Bank in Washington.

How concerned should we be about a second wave of H1N1? Are countries prepared for it? What have we learned from the first outbreak that will help us prepare for the second wave?

The issue is that we really do need to be prepared for the possibility that this virus will either become more serious in the degree to which it causes death, or will change so that it actually becomes a different virus, and we end up with subsequent waves that end up causing more difficulty. Are we prepared for this? Well, we’ve certainly had a lot of opportunity to get ready because of the work we did on avian influenza. What have we learned so far? Perhaps most importantly we’ve learned that a pandemic—even a relatively mild one—can cause significant absenteeism, as well as illness and death even among quite young people, and so it is very important that we don’t get complacent about its impact on people’s health or indeed on businesses.

Are we afraid there could be a mingling of the avian flu and H1N1 viruses?

There have been instances where genetic material moves from one virus to another—when you have two viruses in one host, whether that be a human or an animal—and so yes there is concern, as I think we would always have with a virus, that there may be some reassortment of genetic material. What we can’t do is say how likely this is, and so we’re in the unfortunate situation of having to prepare for potentially more serious issues in a situation of great uncertainty. What that means is, we need to take actions to be ready, actions that might well prepare us for other kinds of public health emergencies as well as this one.

There is a vaccine on the way. What are the challenges that countries face in acquiring this vaccine? And will it be effective?

Well, firstly it does look as though effective anti-H1N1 vaccines are now beginning to come off the production line. They will need to be subject to some testing once they’re available to ensure that they are safe. And then countries will need to access them. Now they’re not cheap, so therefore wealthier nations will find it easier to access vaccines than poorer nations. And so one of the issues we’re looking at very hard at the moment is how to enable poor countries to access a basic minimum of vaccine for their health personnel and other essential staff.

Is this something the UN will work with the Bank closely on?

We have been discussing that just today – is how the UN and the World Bank can work together on this issue, as we have on other issues to do with influenza and pandemic preparedness.

And is strengthening health systems in general a big part of this approach?

The whole purpose of the work we’re doing is to prepare health systems to deal with all kinds of infectious disease threats, particularly those that come from the animal kingdom. And that means that the work we’re putting in place now is the kind that will have a beneficial impact whatever kind of health threat might occur.

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