“Next to a nuclear holocaust, a severe influenza pandemic
is the only phenomenon that could affect the whole of humanity,” says
Tamman Aloudat, senior officer for health in emergencies
at the International Federation.
A medical doctor, Aloudat is not given to hyperbole, but
as a key member of the International Federation’s task
force coordinating the Movement’s response to the H1N1
influenza pandemic, he understands how easy it is for the
virus to flourish in today’s globalized world. In 1918,
he notes, the Spanish flu pandemic, caused by a form of the
H1N1 strain of flu, killed as many as 50 million people and
infected up to 40 per cent of the world’s population.
“Back then there was no global air travel, but records
show that remote communities in Africa were infected,” he
says, “so today the virus can spread much faster and
The influenza virus mutates quickly and new strains are
constantly emerging. Since 1918 there have been three deadly
flu pandemics — defined by the World Health Organization
(WHO) as widespread transmission of the virus in at least
two major zones of the world.
The latest pandemic, announced by WHO in June 2009 in response
to the outbreak of a new strain of H1N1 in Mexico, was the
first in 41 years.
But while the new strain — a mix of bird, swine and
human genetic material — took the world by surprise,
influenza experts had been preparing for a pandemic for the
past several years.
Since December 2007, the International Federation, together
with the United Nations and non-governmental organizations
(NGOs), has been working with governments around the world
on response and preparedness plans to be delivered to communities
the moment a pandemic struck.
“Our experience at the International Federation in
delivering public health messages and training communities
affected by the outbreak of avian flu in 2005 helped us prepare
for H1N1,” says Robert Kaufman, head of the International
Federation’s influenza unit. He cautions that H1N1,
which spreads between humans and for which few people have
immunity, is a much more worrying disease.
As soon as the first cases of H1N1 were announced in Mexico
in April, the Mexican Red Cross launched a public information
campaign, distributing 2.2 million leaflets and 200,000 posters
and supplying more than 100,000 face masks.
“People took the threat very seriously and were grateful
for everything we could give them,” says Isaac Oxenhaut,
head of the Mexican Red Cross relief operation. “No
one complained about the curfew or the closure of restaurants,
bars and parks and there was a really strong sense of solidarity.
Over the two-month peak infection period, the number of volunteers
doubled from 12,000 to 25,000.”
Mexico bore the brunt of the crisis at a time when little
was known about the new strain of H1N1.
By July 2009, laboratories confirmed that more than 10,000
cases and 119 deaths had been reported in Mexico. But the
spread was slowing down and the worst believed to be over,
at least during the first wave of infection.
“What we saw in Mexico,” says Aloudat, “was
that people took the public information messages about avoiding
crowds, washing their hands and covering their nose when
sneezing very seriously. This really helped curb the spread
of the disease and underlines the importance of the role
played by National Societies in getting across effective
messages that change people’s behaviour.”
Mexico gave the world an early warning. Between April and
July, the virus spread to more than 100 countries, killing
429 people and infecting more than 130,000 others. By July,
130 out of 186 National Societies responded to the pandemic,
advising governments, disseminating public health messages,
transporting patients to hospitals, securing blood banks
and coordinating civil society partners.
In Italy, for example, teams of volunteers were out in force
at airports and seaports, giving out information and helping
the Ministry of Health carry out spot checks on passengers.
“To begin with people were puzzled and not that interested
but when they understood the risks they began to listen and
act on our advice,” says Ulrico Angeloni, head of
the H1N1 taskforce for the Italian Red Cross.
Preparing for potential
Making the public aware of the risk without panicking them
is a delicate balancing act.
By mid-2009, the first wave of infection was moderate,
with most patientsexhibiting mild symptoms and most severe
or fatal infections occurring in people with underlying chronic
health conditions. But experts were watching what happened
during the winter months in the southern hemisphere and whether
the virus would mutate into something more deadly.
In September, the International Federation launched ‘Your
best defence is you’, a health promotion campaign thatoutlines
five steps that everyone should take: wash your hands; cover
your mouth; keep your distance; separate sick people; and
dispose of waste.
Aloudat says that in many countries H1N1 is a potential
rather than an actual risk. “We know that it is likely
to be one of the worst crises in the past 100 years but it
also might not be.” It is this ‘might be, could
have’ aspect of the pandemic that is proving a challenge
for the Red Cross Red Crescent. “Governments don’t
respond well, the media gets bored and the public don’t
take the risk as seriously as they should unless they experience
it themselves,” says Aloudat. All of which, he adds,
results in a culture of complacency and indifference.
Expect the unexpected
The lack of certainty over the severity of the pandemic
is also proving a headache for Red Cross Red Crescent emergency
response teams. H1N1 is not yet at pandemic levels in the
United Kingdom and the director of operations at the British
Red Cross, Margaret Lally, says the challenge is to be flexible
enough to prepare for the unexpected and plan for various
“We could be looking at either 25 or 50 per cent of
the population infected either moderately or, if the virus
mutates, more severely. All we know is that the virus is
on a long, slow and relentless march towards us this winter,” she
The International Federation is working with NGOs and the
business community on contingency plans in the event of disruption
to vital services such as health care, telecommunications
and water and electricity supplies due to sickness. Mexico
lost an estimated 0.5 per cent of its gross domestic product
during the few days that the capital was effectively shut
Developing world at risk
Even a moderate pandemic could spell disaster in developing
countries where health systems are already severely strained
due to the burden of disease, poverty and natural disasters.
“It is vital that these countries invest in preventative
measures such as public information campaigns because antiviral
drugs or future vaccines are not likely to reach them in
time and in the quantity needed,” warns Kaufman.
Faced with a myriad of health problems, many governments
don’t have the time or resources to respond to a problem
whose severity is not yet known due to weak surveillance
In May, the International Federation launched an initial
appeal for US$ 4.4 million to improve National Societies’ ability
to respond to H1N1. But only 3 per cent of funds were raised — a
reflection, according to International Federation spokesman
Jean-Luc Martinage, of how donors prefer to fund their own
national preparedness programmes and are reluctant to invest
in those in the developing world.
It is an approach that frustrates Aloudat. “H1N1 does
not stop at national borders,” he says. “It is
a global threat to humanity, but we are not yet seeing global