Pandemic definition
WHO tweaks the meaning before proclaiming H1N1 flu pandemic

The original pandemic definition had two important words removed shortly before the World Health Organisation (WHO) on 11 June 2009 declared the current H1N1 flu outbreak to be a "pandemic".

This is the first "flu pandemic" this century and the first in 41 years, after the 1968 Hong Kong flu.

When I wrote an earlier article about the pandemic definition, I mentioned that the WHO spells out three conditions that must be met before a disease will be declared a pandemic:

• There must be a disease new to a population - or at least a disease that had not surfaced for a long time.
  
  
• This disease must be caused by disease-causing agents that infect humans, causing serious illness.
  
  
• The agents must spread easily and sustainably among humans.

I did not realise it at the tiime and I only just recently found out (in late July) that the pandemic definition had been changed by the WHO just before they declared the "pandemic" on June 11. The original definition contained two other conditions -- there must be a high morbidity and a high mortality rate.

In other words, a lot of people have to fall seriously ill, and a lot of them have to die. This, of course, did not happen with the H1N1 flu. Although many people caught the illness, most experienced only mild symptoms. Only a small percentage became seriously ill, and a smaller percentage died.

At the time of the pandemic declaration, nearly 30,000 people in 74 countries had been infected but only 144 people died. The death rate works out to less than 0.5 percent, which is very low. In contrast, the diseases SARS (severe acute respiratory syndrome) had a death rate of about 15 percent -- although SARS was not declared a pandemic because few people got infected.

By changing the pandemic definition, the WHO has made it easier to classify the 2009 flu outbreak as one. This, however, adds fuel to criticisms that the WHO seems overly eager to declare a pandemic.

One vocal critic is epidemiologist Tom Jefferson. Below are excerpts from an interview that Jefferson did with the German newspaper Spiegel, published on 21 July 2009:

SPIEGEL: Do you consider the swine flu to be particularly worrisome? Jefferson: It's true that influenza viruses are unpredictable, so it does call for a certain degree of caution. But one of the extraordinary features of this influenza -- and the whole influenza saga -- is that there are some people who make predictions year after year, and they get worse and worse. None of them so far have come about, and these people are still there making these predictions. For example, what happened with the bird flu, which was supposed to kill us all? Nothing. But that doesn't stop these people from always making their predictions. Sometimes you get the feeling that there is a whole industry almost waiting for a pandemic to occur. SPIEGEL: Who do you mean? The World Health Organization (WHO)? Jefferson: The WHO and public health officials, virologists and the pharmaceutical companies. They've built this machine around the impending pandemic. And there's a lot of money involved, and influence, and careers, and entire institutions! And all it took was one of these influenza viruses to mutate to start the machine grinding... SPIEGEL: Do you think the WHO declared a pandemic prematurely? Jefferson: Don't you think there's something noteworthy about the fact that the WHO has changed its definition of pandemic? The old definition was a new virus, which went around quickly, for which you didn't have immunity, and which created a high morbidity and mortality rate. Now the last two have been dropped, and that's how swine flu has been categorized as a pandemic.

It may seem overly cynical to suggest that the pandemic definition was changed and a pandemic declared simply because there is big money involved. But Jefferson is not alone in expressing this view.

One cannot deny the fact that there is, truly, very huge sums of money involved. Governments around the world have already placed huge orders for flu vaccines and anti-viral drugs worth billions of dollars. And this is despite the fact that:

• flu vaccines are generally not very effective, especially in protecting children and the elderly who are most likely to catch the flu
• flu vaccines may produce serious side effects that include the crippling disease, Guillian Barre Syndrome
• antiviral drugs like Tamiflu and Relenza are, at best, effective only in reducing flu symptoms by one day, which, considering that the typical flu patient experiences symptoms for 10 days, works out to an improvement of a mere 10 percent
• antiviral drugs also produce serious side effects, including bizarre behaviour and suicide.