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On alert for H1N1


Complacency is one of the main barriers to fighting the spread of pandemic flu.


“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 wider.”

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.

Mexican model

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 scenarios.

“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 says.

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 down.

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 systems.

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 action.”

Mexican Red Cross volunteer Erasmo Martínez distributes protective masks in Mexico City.



The epidemic divide is available at


What is the new flu?

What is it? It is a new version of the H1N1 virus which caused the 1918 flu pandemic.
What are the symptoms? Initial symptoms are similar to seasonal flu such as fever, body ache, headache, runny nose, sore throat and cough, and occasionally vomiting and diarrhoea.
Who are the most vulnerable? Young people, particularly those under the age of 25 and people with underlying chronic conditions such as diabetes, asthma and obesity.
What can you do to protect yourself? Good personal hygiene (such as washing hands frequently), covering nose when sneezing, avoiding crowds and staying home when sick.


A new campaign reminds people that we each have the ability to protect ourselves and our families.





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Claire Doole
Claire Doole is a freelance journalist based in Geneva.



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