麻豆传媒

DOOMSDAY visions of curfews, sealed borders, travel bans and scuffles over food are a long way from materialising in the current crisis. But if the World Health Organization declares a pandemic, countries could bring in draconian measures to isolate and treat infection, prevent further spread and keep societies functioning.

On Monday 27 April, the global threat level rose to 4 on a 6-point scale (see diagram), escalating the WHO strategy to prevent further spread of the virus beyond Mexico, where the epidemic originated. It remained on 4 as 麻豆传媒 went to press.

During the first three phases, the WHO expects governments simply to be prepared for an epidemic and to minimise risk 鈥� by monitoring farms closely for emergence of new flu strains, for example. From 4 and up, the key goal is to isolate regions of infection from infection-free areas. Tougher measures, such as declaring a state of emergency, would only be possible if the WHO declares a full phase-6 pandemic.

However, investigations by 麻豆传媒 suggest that global preparedness for a pandemic is extremely patchy. Unsurprisingly, poorer countries are least prepared, but even in richer regions there are serious gaps: a of 30 European nations found that, on average, countries had in place only half of the measures expected by the WHO. The biggest gap was in preparedness to keep society functioning beyond its health system, to ensure continued provision of electricity, transport, banking, food and policing.

鈥淢ultisectoral planning is the vital thing,鈥� says co-author of the survey, Sandra Mounier-Jack of the London School of Hygiene and Tropical Medicine (LSHTM). Of the 30 nations, only 12 had such plans.

The , including Germany, France and the UK, had plans in place to ensure key workers would keep industries and services going. Most also met the WHO demand for simulations and drills.

Preparedness is also high in south-east Asian countries and Australasia. Officials in these regions contacted by 麻豆传媒 had conducted drills, for example, and all had thermosurveillance machines available for airports to spot fever in travellers. Many had learned lessons from the SARS outbreak of 2003 (see 鈥淐ase study鈥�).

In Africa, however, just 35 out of 53 countries have pandemic plans, and of these, 鈥渕ost lack a coherent strategic approach鈥�, says Paul Coker of LSHTM, who evaluated the plans of African countries in 2007. Moreover, he says, for the majority of African countries the emphasis has been on strengthening detection and containment of bird flu in animals, not on handling a human flu pandemic.

As southern-hemisphere countries are now entering their flu season 鈥� when some flu viruses spread more easily 鈥� they may be particularly vulnerable if the Mexican swine flu turns pandemic. 鈥淚n one month, we will be right in the Australian winter, while the Northern hemisphere will be going into summer,鈥� says .

In developing countries already struggling with the toll of HIV, TB and malaria, 鈥渁n influenza pandemic would represent a profound challenge to already overstretched health systems鈥�, Coker warns.