Containment of the swine flu virus is probably not feasible, and efforts need to focus increasingly on mitigation, according to a public health expert in an editorial published on bmj.com yesterday (30 April 2009).
Interestingly, almost all cases reported so far have been in developed countries with robust surveillance systems, writes Richard Coker, Professor of Public Health at the London School of Hygiene and Tropical Medicine.
He says it is unclear whether this is because populations at risk have travelled preferentially from Mexico to those sites, or more pessimistically, whether cases are now occurring in countries with less well developed surveillance systems and not coming to international attention.
This new strain is, at this stage, sensitive to antiviral drugs, he says. However, although many developed countries, including most of Western Europe and the US, have sizeable stockpiles of antiviral drugs, most low and middle-income countries have low or nonexistent stocks.
According to Professor Coker, such countries have limited health system resources to call on in the event of a pandemic; they have not stockpiled antiviral drugs in anything like the numbers needed for mitigation purposes and they are unlikely to receive an effective vaccine early, he explains.
Professor Coker also points out that, now world attention is focused on H1N1 swine flu, it is easy to forget the threat still posed by H5N1 and other strains of flu. And immunity to H1N1 will not offer protection to H5N1 if that also becomes readily transmissible between humans, he warns.
As H1N1 spreads to areas where H5N1 is endemic, he asks, do we face an even greater challenge – that of reassortment of these two viruses and the threat of another pandemic?