The World Health Organization (WHO) is a globally respected co-ordinating body for international public health. Its publications and recommendaitons bring together reliable evidence from across the globe and governments often act accordingly, budget permitting. Of course, as a UN agency, politics does enter into it in the sense that the World Health Assembly, the WHO’s governing body, consists of individuals nominated by member countries.
The WHO have principally been in the global news in the past ten years in relation to emerging (i.e. new) respiratory tract infections. The media have placed enormous attention on these: SARS, H5N1, and the 2009 H1N1 pandemic. None of these have turned out to cause as many deaths as ordinary seasonal flu. There is now a popular sentiment that these are ’scares’ – doctors in this scenario are either bumbling incompetents who place too much attention on a case of the sniffles, or shills for Big Pharma participating in a great vaccine scam. This is, of course, nonsense.
The reason that the WHO have been extremely cautious is because of the 1918 H1N1 pandemic. This killed somewhere on the order of 40 million people, most of them young adults. Modern experiments in mice using a virus reconstituted from preserved lung samples have shown that this strain was a completely novel form of flu transmitted wholesale from birds and that it is still deadly to this day. Its deadliness was previously thought to have been partly caused by malnutrition in WWI, but these experiments demonstrate that it was actually a particular combination of the 8 genes of H1N1-1918’s genome. If a similar cross-species transmission event were to reoccur, there is no reason to think it couldn’t be just as deadly.
Because their spread can be extremely quick, respiratory tract infections are the single most alarming infectious disease for health experts. SARS was frightening because it was a new virus about which little was known. This year’s H1N1 was initially unpredictable in behaviour, with a relatively high death rate in Mexico but low elsewhere. H5N1 initially spread by direct contact with birds and had an extremely high death rate – a worrying parallel with the initial outbreak of H1N1 in 1916 – which was followed by adaptation to humans and the 1918 pandemic. At the time of their initial appearance, these were all extremely worrying developments. That is why the WHO has always been cautious. A segment of the public’s perception, however, is that it is over-cautious.
Which leaves us with a difficult question – how can we reduce the ‘boy who cried wolf’ effect?
References – to be added