As the current swine flu virus is present in several countries, trying to contain it is probably not feasible any more. Efforts should now focus mainly on mitigation, according to a public health expert in an Editorial published in the British Medical Journal (BMJ) today.

Richard Coker, Professor of Public Health, London School of Hygiene and Tropical Medicine, points out that nearly all cases reported so far have been in developed countries with comprehensive surveillance systems. There could be two reasons for this, Coker explains:

  1. Perhaps the populations at risk have travelled preferentially from Mexico to those sites.
  2. People are being infected in countries with less well developed surveillance systems – we just do not know about them.

Coker stresses that this new strain is still currently sensitive to antiviral drugs. Although the USA, Canada, Western Europe and other developed countries have good stockpiles of antiviral drugs, this may not be the case in several low and middle income countries.

Although most countries have contingency plans, many developing countries may find it hard to put them into operation. Developing countries tend to have limited health system resources to call on if a pandemic arrives. They may not have sufficient stocks of antiviral drugs to effectively mitigate the spread. Even those that do may find it extremely difficult to mobilize them successfully. If an effective vaccine is eventually produced, developing countries are not likely to receive them early enough, or in amounts that really matter.

Evidence has indicated that border screening is not an effective way of controlling the spread of infection. The World Health Organization is not keen to recommend travel restrictions. Nevertheless, several countries, especially in the European Union, have recommended restrictions on travel.

Now that all the focus is not the H1N1 swine flu virus, it is easy to ignore the threat still posed by the H5N1 bird flu virus, and some others. Immunity to the H1N1 swine flu virus will not offer any protection against the H5N1 bird flu virus if the bird flu virus became easily transmissible among humans one day.

Finally, Coker wonders what might happen if the current swine flu virus becomes endemic in parts of the world were the bird flu virus is more common. Will the two viruses meet and exchange genetic material? Would the exchange of genetic material create a new virus and another pandemic threat?

“Editorial: Swine flu”
BMJ online
Link to abstract