INSIGHT

Helmut Fritsche

IT HAS been claimed that the novel influenza A/H1N1 virus can be traced back to a giant pig factory farm run by the American Smithfield Corporation in Vera Cruz, Mexico. Be that as it may, its emergence has had the Geneva-based World Health Organisation declaring swine flu to be a “public health emergency of international concern”.

Fears of a swine flu pandemic (or global epidemic) appear, however, to be abating. The Mexican Health Ministry has agreed to the reopening of restaurants in Mexico City, and burritos and salsa are once more a feature of daily life. There is, however, no place for complacency. Cases of swine flu have been officially reported from 30 countries already. It could well be that a second wave is possible, and that the virus could mutate.

Swine flu is by no means the only “killer” flu. Annually, 250000 to 500000 people die from seasonal influenza. Novel flu strains spread fast, because no-one has built up a natural immunity to them yet, and because it takes months for suitable vaccines to be produced. Some 40 million, for example, died of Spanish Flu from 1918-1919, and some two million died of Hong Kong Flu in 1968.

Such catastrophic fatalities have alerted researchers and, indeed, politicians, to respond to similar outbreaks rapidly and effectively. The swift response to A/H1N1-flu has undoubtedly prevented a possible pandemic. The world is lucky – but then the world has never been better prepared. There are anti-virals and vaccines for use against existing strains of influenza, and new ones are being created and mass-produced daily.

People are undoubtedly still being infected by the swine flu virus, but the number is significantly less than originally anticipated. The symptoms are generally very mild, and the best defence against it is, basically, a strong immune system. The battle against the current outbreak has thus effectively been won, but the war is by no means over.

World governments have reacted to the emergence of swine flu in a disciplined and effective manner – rather than with just the ineffectual warnings that they used to issue in the past. In addition, rapid communication throughout the world is now possible, and medical practitioners can be alerted more timeously than they were in the past.

There is a centre for the control of epidemics and pandemics in Stockholm, for example, and South Africa has its own National Institute for Communicable Disease.

The Sars (severe acute respiratory syndrome) epidemic of 2002-2003 was handled in a totally different manner. China, which was most badly affected, hid the extent of the epidemic from the rest of the world and thereby slowed the response to it accordingly. Within a matter of weeks Sars spread from the Guangdong province of China to some 37 countries across the world.

Transparency and rapid response are crucial to the effective management of epidemics and the Sars epidemic would have been far less disastrous had the rest of the world been notified right away. In the recent outbreak of swine flu, however, China has been a front runner in the management of the disease. There have been no signs and symptoms of panic reported.

The man in the street has behaved responsibly, as well, and has heeded the guidelines and information given by health authorities, tourism associations, airlines, etcetera. Without this co- operation, those providing the guidelines would find themselves in the invidious position of Cassandra, the true prophetess of Troy, who accurately predicted misfortune coming, and warned others of it, but was fated by the gods to have no-one take heed of her.

The question arises – have the warnings pertaining to swine flu during the past eight weeks been overdone and alarmist? It is hard to say. Whether it is a killer virus or a relatively harmless one can never be established at the outset. What is certain, however, is that further outbreaks of the disease will occur. In a perfect world, each and every new virus that is identified could and should be used as training for a global prevention system.

The WHO emphasises that the danger of an epidemic of swine flu still exists, and researchers and scientists working on the virus responsible for it have to decide whether the outbreak in Mexico is merely the first wave, and whether a further wave is yet to come.

In addition, even if swine flu itself is considered to be relatively mild, how important is the development of a vaccine against it?

The world is in urgent need of companies who are willing and able to manufacture vaccines rapidly and cost- effectively in order to deal with diseases which, on account of globalisation, are becoming more and more the responsibility of the whole world, rather than just that of the area affected.

Dr Helmut H Fritsche is honorary secretary and spokesperson for the South African Medical Association Border Branch