29 April 2009
CO09042 | The Swine Flu Alert: Keeping Asia Safe
Commentary
After years of concern about H5N1 bird flu, the new flu causing global alarm is a pig virus of the H1N1 family. As influenza reports erupt around the world, inevitable questions are arising. Is this the big one? Are we prepared?
Swine flu – the unfolding global health crisis
SINCE NEWS of the swine flu outbreak broke out and the World Health Organization (WHO) declared the virus a Global Health Emergency, swine flu cases had already spread across the world, reaching Europe and the Asia Pacific. In the Asian region, countries like Thailand, China and South Korea have reported suspected cases. Meanwhile in Mexico – the epicentre of the outbreak –as many as 149 people may have already died from the virus.
The WHO indicated that the virus had ‘pandemic potential’, and the Pandemic Alert System was raised from Phase 3 to Phase 4 in just over a week – two steps short of declaring a full pandemic. The WHO is advising all countries to be highly vigilant but have stopped short of recommending travel restrictions or closing borders to trade, since such measures provide very limited or no benefit in reducing disease transmission.
Disease surveillance and information sharing
Since the Severe Acute Respiratory Syndrome (SARS) crises in 2003, the WHO and its member states have established several mechanisms for global and regional disease surveillance. There appears to be enough protocols in place to ensure critical information sharing among countries. The necessity of having an “information hub” as an unofficial information sharing system is clear.
Global level
At the international level, the WHO takes on the role of coordinating core information sharing during the pandemic period. In the event of an outbreak, the Global WHO information sharing system and the International Health Regulations require member states to notify the WHO once a new subtype of human influenza occurs. The WHO and member states would consult to verify and assess critical events and share key information through the WHO general infectious disease information sharing website known as the Disease Outbreak News.
Regional level
At the regional level in Southeast Asia, an information hub already exists under the ASEAN+3 emerging infectious diseases (EID) programme. Since 2007, ASEAN countries have been networking and sharing information on EIDs to improve overall communication within the region. There is an ASEAN+3 EID information website managed by Indonesia, where individual countries can upload national-level information to keep the region informed of developments in member states. The website provides the public with a reliable source of information, which could help avoid speculation and panic.
Aside from regional disease surveillance, partnerships have been built between national governments and civil society to monitor local outbreaks, since civil society actors often maintain a strong presence at grassroots level. With clear communication protocols and the use of surveillance websites, information sharing in the region is more open, when compared to the situation during the SARS crises.
Asia on high alert – regional pandemic preparedness systems
Since the SARS crises, the region appears to be better prepared to deal with the potential spread of swine flu than previously. ASEAN member states have put together regional preparedness systems to address future outbreaks. With the current swine flu situation, ASEAN should urgently activate the regional pandemic preparedness systems to ensure that emergency preparedness plans are in place, and utilise the regional information sharing networks to keep ASEAN governments and the WHO abreast of developments and suspected cases of swine flu in Southeast Asia.
These regional pandemic preparedness systems include: 1) a Regional Framework for Control and Eradication of Highly Pathogenic Avian Influenza (HPAI) established by the ASEAN Ministers of Agriculture and Forestry in 2005; 2) the ASEAN+3 Emerging Infectious Diseases (EID) Programme; 3) the ASEAN-Japan Project on Stockpiling of Tamiflu and Personal Protective Equipment Against Potential Influenza Pandemic; and 4) the ASEAN Project on Pandemic Preparedness and Response.
The ASEAN Task Force on HPAI has developed an action plan with eight priority areas, ranging from disease surveillance and emergency preparedness to information-sharing, public awareness and effective containment measures. The priority areas of disease surveillance, emergency preparedness and information sharing are coordinated by Thailand, Malaysia, and Singapore, respectively. Under the ASEAN+3 EID Programme, regional coordination for early warning and response, laboratory diagnostics and epidemiological surveillance are also in place, and the ASEAN Expert Group on Communicable Diseases monitors the human health aspect of avian influenza.
On the whole, the regional pandemic preparedness systems established in the past 5 years have facilitated information sharing among experts; helped address existing gaps in expertise, capacity and information; and strengthened disease surveillance systems, built hospital isolation units and maintained stockpiles of Tamiflu. The achievements have been substantial, although gaps still remain.
Overall, there is a greater understanding that pandemic preparedness requires the involvement of not only the health sector, but the whole of society, since there is no single magic bullet which can control a flu pandemic. A combination of interventions could be highly effective at reducing transmission and saving many lives. It is highly essential that ASEAN activates the regional systems it has set in place when responding to the current swine flu situation, ensuring that the level of risk management is appropriate to the risk.
Implications and the way forward
Estimates of the potential consequences of a severe global pandemic include a death toll of as many as 70 million people and an estimated global economic loss of three trillion US dollars. In Asia, the economic impact of swine flu could be long-lasting if more deaths are claimed or if the disease spreads. Consumer confidence is likely to decline and the global economic recovery will be at risk. As a global trading powerhouse, Asia is particularly vulnerable to such changes. The outbreak has come at a time when many national economies are in recession and already facing challenges from the financial crisis – having a robust continuity plan in place could make or break companies.
Many of the measures being activated in the Asian region were set up during the outbreak of SARS. Airport checks across the region have been stepped up and medical facilities have been put on high alert for any patients showing flu-like symptoms. Indonesia, Japan, Malaysia, Singapore and Vietnam are screening passengers at checkpoints for fever and flu symptoms, many using devices that had been put in place to monitor SARS and bird flu over the last few years, although health experts have questioned the effectiveness of such measures.
Despite the improvements, the WHO has warned against complacency; every country in the world is at risk. It is now essential to have a multi-sectoral and comprehensive regional response, ensuring that continuity plans are in place in all essential sectors – health, defence, law and order, finance, education, transport, telecom, energy, food and last but not least, water. Governments should keep monitoring the situation closely, working with colleagues at regional and global levels to get updated information and take appropriate steps if and when necessary.
About the Authors
Mely Caballero-Anthony, Julie Balen and Belinda Chng are respectively Associate Professor and Head, Post-doctoral Research Fellow, and Programme Officer at the Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies (RSIS), Nanyang Technological University.
Commentary
After years of concern about H5N1 bird flu, the new flu causing global alarm is a pig virus of the H1N1 family. As influenza reports erupt around the world, inevitable questions are arising. Is this the big one? Are we prepared?
Swine flu – the unfolding global health crisis
SINCE NEWS of the swine flu outbreak broke out and the World Health Organization (WHO) declared the virus a Global Health Emergency, swine flu cases had already spread across the world, reaching Europe and the Asia Pacific. In the Asian region, countries like Thailand, China and South Korea have reported suspected cases. Meanwhile in Mexico – the epicentre of the outbreak –as many as 149 people may have already died from the virus.
The WHO indicated that the virus had ‘pandemic potential’, and the Pandemic Alert System was raised from Phase 3 to Phase 4 in just over a week – two steps short of declaring a full pandemic. The WHO is advising all countries to be highly vigilant but have stopped short of recommending travel restrictions or closing borders to trade, since such measures provide very limited or no benefit in reducing disease transmission.
Disease surveillance and information sharing
Since the Severe Acute Respiratory Syndrome (SARS) crises in 2003, the WHO and its member states have established several mechanisms for global and regional disease surveillance. There appears to be enough protocols in place to ensure critical information sharing among countries. The necessity of having an “information hub” as an unofficial information sharing system is clear.
Global level
At the international level, the WHO takes on the role of coordinating core information sharing during the pandemic period. In the event of an outbreak, the Global WHO information sharing system and the International Health Regulations require member states to notify the WHO once a new subtype of human influenza occurs. The WHO and member states would consult to verify and assess critical events and share key information through the WHO general infectious disease information sharing website known as the Disease Outbreak News.
Regional level
At the regional level in Southeast Asia, an information hub already exists under the ASEAN+3 emerging infectious diseases (EID) programme. Since 2007, ASEAN countries have been networking and sharing information on EIDs to improve overall communication within the region. There is an ASEAN+3 EID information website managed by Indonesia, where individual countries can upload national-level information to keep the region informed of developments in member states. The website provides the public with a reliable source of information, which could help avoid speculation and panic.
Aside from regional disease surveillance, partnerships have been built between national governments and civil society to monitor local outbreaks, since civil society actors often maintain a strong presence at grassroots level. With clear communication protocols and the use of surveillance websites, information sharing in the region is more open, when compared to the situation during the SARS crises.
Asia on high alert – regional pandemic preparedness systems
Since the SARS crises, the region appears to be better prepared to deal with the potential spread of swine flu than previously. ASEAN member states have put together regional preparedness systems to address future outbreaks. With the current swine flu situation, ASEAN should urgently activate the regional pandemic preparedness systems to ensure that emergency preparedness plans are in place, and utilise the regional information sharing networks to keep ASEAN governments and the WHO abreast of developments and suspected cases of swine flu in Southeast Asia.
These regional pandemic preparedness systems include: 1) a Regional Framework for Control and Eradication of Highly Pathogenic Avian Influenza (HPAI) established by the ASEAN Ministers of Agriculture and Forestry in 2005; 2) the ASEAN+3 Emerging Infectious Diseases (EID) Programme; 3) the ASEAN-Japan Project on Stockpiling of Tamiflu and Personal Protective Equipment Against Potential Influenza Pandemic; and 4) the ASEAN Project on Pandemic Preparedness and Response.
The ASEAN Task Force on HPAI has developed an action plan with eight priority areas, ranging from disease surveillance and emergency preparedness to information-sharing, public awareness and effective containment measures. The priority areas of disease surveillance, emergency preparedness and information sharing are coordinated by Thailand, Malaysia, and Singapore, respectively. Under the ASEAN+3 EID Programme, regional coordination for early warning and response, laboratory diagnostics and epidemiological surveillance are also in place, and the ASEAN Expert Group on Communicable Diseases monitors the human health aspect of avian influenza.
On the whole, the regional pandemic preparedness systems established in the past 5 years have facilitated information sharing among experts; helped address existing gaps in expertise, capacity and information; and strengthened disease surveillance systems, built hospital isolation units and maintained stockpiles of Tamiflu. The achievements have been substantial, although gaps still remain.
Overall, there is a greater understanding that pandemic preparedness requires the involvement of not only the health sector, but the whole of society, since there is no single magic bullet which can control a flu pandemic. A combination of interventions could be highly effective at reducing transmission and saving many lives. It is highly essential that ASEAN activates the regional systems it has set in place when responding to the current swine flu situation, ensuring that the level of risk management is appropriate to the risk.
Implications and the way forward
Estimates of the potential consequences of a severe global pandemic include a death toll of as many as 70 million people and an estimated global economic loss of three trillion US dollars. In Asia, the economic impact of swine flu could be long-lasting if more deaths are claimed or if the disease spreads. Consumer confidence is likely to decline and the global economic recovery will be at risk. As a global trading powerhouse, Asia is particularly vulnerable to such changes. The outbreak has come at a time when many national economies are in recession and already facing challenges from the financial crisis – having a robust continuity plan in place could make or break companies.
Many of the measures being activated in the Asian region were set up during the outbreak of SARS. Airport checks across the region have been stepped up and medical facilities have been put on high alert for any patients showing flu-like symptoms. Indonesia, Japan, Malaysia, Singapore and Vietnam are screening passengers at checkpoints for fever and flu symptoms, many using devices that had been put in place to monitor SARS and bird flu over the last few years, although health experts have questioned the effectiveness of such measures.
Despite the improvements, the WHO has warned against complacency; every country in the world is at risk. It is now essential to have a multi-sectoral and comprehensive regional response, ensuring that continuity plans are in place in all essential sectors – health, defence, law and order, finance, education, transport, telecom, energy, food and last but not least, water. Governments should keep monitoring the situation closely, working with colleagues at regional and global levels to get updated information and take appropriate steps if and when necessary.
About the Authors
Mely Caballero-Anthony, Julie Balen and Belinda Chng are respectively Associate Professor and Head, Post-doctoral Research Fellow, and Programme Officer at the Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies (RSIS), Nanyang Technological University.
