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Nations urge World Health Organization to change H1N1 assessment

GENEVA (AP) - China, Britain, Japan and other countries urged
the World Health Organization on Monday to be very cautious about
declaring the arrival of a swine flu pandemic, fearing that a
premature announcement could cause worldwide panic and confusion.
WHO bent to their wishes.

As the agency opened its annual meeting, WHO Director-General
Dr. Margaret Chan said she had listened carefully to the concerns
of member states and would follow their instructions.

Britain's Health Secretary Alan Johnson warned that raising the
flu alert to phase 6 - the highest level - could needlessly trigger
costly and potentially risky actions such as a switch from seasonal
to pandemic vaccine even though the virus so far appears to be
mild.

"We need to give you and your team more flexibility as to
whether we move to phase 6," Johnson said.

Right now the alert level is at phase 5, meaning a global
outbreak is "imminent."

Chan repeated her warning that the new swine flu virus continues
spreading rapidly and could pose a grave threat to humanity even
though the fatality rate was low, with 76 deaths out of 8,829 cases
and no major outbreaks outside North America.

"A new influenza virus with great pandemic potential, the new
influenza A (H1N1) strain, has emerged," she said. "This virus
may have given us a grace period, but we do not know how long this
grace period will last," Chan said. "No one can say whether this
is just the calm before the storm."

A pandemic announcement would likely have severe economic
consequences: it could trigger expensive trade and travel
restrictions like border closures, airport screenings and
quarantines, as countries not yet affected struggle to keep the
virus out.

Governments may also fear outbreaks of mass panic, social
disruption and increased pressures on their health systems. Under
public pressure, extraordinary measures such as large-scale pig
slaughters like the recent one in Egypt could be taken, whether or
not they are scientifically justified.

Among the countries urging WHO to reconsider its pandemic scale
was Mexico, which has suffered the most deaths and virtually shut
down its economy for several days in response to the outbreak.

"People don't understand what 4, 5 or 6 means," Mexico's
Health Minister Jose Angel Cordova told reporters. "They think
that when you go to a higher level things are worse."

"Flexibility will very much help the economy," he added.

U.S. Health and Human Services Secretary Kathleen Sebelius told
The Associated Press she wanted more information on the proposal
before taking a position, but that she was impressed how many
countries supported it.

Dr. Richard Besser, acting director of the U.S. Centers for
Disease Control and Prevention, told the WHO meeting that the
outbreak is "not winding down" in the United States and
"widespread transmission" continues. He also said the epidemic
was not over in Mexico.

Speaking a day after New York school assistant principal
Mitchell Wiener died of swine flu, Besser said the world needed to
maintain its vigilance against the virus.

At least 40 countries have now confirmed cases, with Japan
reporting the largest jump to over 130 in the space of four days.
Most of the new cases involved high school students in the western
prefectures of Hyogo and Osaka who had not traveled overseas.

Spain and Britain have the highest numbers of cases in Europe,
reporting 103 and 101 cases, respectively.

Britain's health secretary said that while the country was
concerned about the outbreak, it was still far below the number one
would expect for seasonal influenza.

"We could have declared a pandemic in order to enhance the
protection to our people from flu, and because we've done that we
could cease further production of seasonal flu vaccine," Johnson
told The AP.

Seasonal flu kills hundreds of thousands of people worldwide
each year. Stopping vaccine production for that strain could
actually lead to more deaths that would occur from swine flu, he
said.

Johnson said considerations other than just the geographic
spread of the virus were important.

"Severity is a part of it," he said.

"It's certainly something we will look at very closely," Dr.
Keiji Fukuda, WHO's flu chief, said of the proposal to include
other factors when determining the alert level.

So far the virus appears to be mild, though scientists are
concerned that many of the more severe symptoms have turned up in
younger people. Flu is normally most dangerous to babies and the
elderly.

Chan also noted that the disease could combine with other flu
strains currently circulating around the world, including the
lethal H5N1 bird flu virus that has so far struggled to transmit
among humans.

The signal for starting pandemic vaccine production has yet to
be given, but it is essential that countries use their stockpiles
of drugs wisely, she said.

"Manufacturing capacity for antiviral drugs and influenza
vaccines is finite and insufficient for a world with 6.8 billion
inhabitants," Chan said. "It is absolutely essential that
countries do not squander these precious resources through poorly
targeted measures."

Chan and U.N. Secretary-General Ban Ki-moon are scheduled to
meet with senior representatives of pharmaceutical companies
Tuesday to discuss the vaccine question. The U.N. declined to name
the companies but major vaccine producers include Sanofi-Aventis,
GlaxoSmithKline and Baxter International.

Key questions that need to be answered include: how soon can a
pandemic vaccine be produced, and how much of it will be available
to each country. Many governments, including Britain, have already
signed large advance orders, potentially depriving poorer countries
of a chance to buy their own stock.

Johnson said his proposal for WHO to consider carefully the
impact before moving to phase 6 was not an attempt at interfering
with the global body's decision-making powers. The choice on moving
to the highest level would remain with WHO and its medical experts,
he said.

"A scientific argument put to politicians is a very effective
argument."

(Copyright 2009 by The Associated Press. All Rights Reserved.)


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