WHO: swine flu ‘pandemic’ near

The H1N1 swine flu virus looks likely to be officially declared a pandemic by the World Health Organisation in the next few days following an upsurge of confirmed cases in Australia.

Thanks to the outbreaks in Mexico and the United States, H1N1 is currently defined as being at Phase 5 - "sustained community level outbreaks in two or more countries in one WHO region" - one level short of full pandemic status. For Phase 6 to be declared, there would have to be evidence that H1N1 was spreading within a country outside the Americas WHO region.

Last week Keiji Fukuda, WHO's acting assistant director-general, told a press conference that outbreaks in many countries in Europe, Asia and South America - including Australia, Japan, the UK, Spain and Chile - were "in transition, moving from travel-related cases to more established community types of spread".

As of yesterday, the H1N1 virus had infected more than 26,500 people in 73 countries, according to the WHO. However, these are only laboratory-confirmed cases and the true figure is likely to be in the hundreds of thousands.

Tracing the spread of swine flu in Europe has been particularly difficult because until recently only people returning from infected areas and their close contacts were being tested for H1N1. Anyone displaying flu-like symptoms who did not match these criteria was effectively ignored. Britain's Health Protection Agency only change its rules last week to recommend testing any patient with flu symptoms.

But in the past month 1,200 cases have been confirmed in Australia where laboratory testing has been more widespread. None of the cases has proved fatal, but many children have been kept away from school and the entire Brisbane Broncos rugby league squad and staff have been held in quarantine while one of their number is tested for H1N1.

‘We are getting close to knowing that we are in a pandemic situation’

Because Australia is in a different WHO region to Mexico and the United States, the eventual declaration of a pandemic would seem to be a formality. However, there is resistance to a formal declaration from certain countries who fear it will spread needless panic. Britain and Japan are among those who have put pressure on the WHO to move the goalposts so that any pandemic declaration would have to take into account severity of the disease as well as its geographical spread.

But the WHO has refused to budge, arguing that the precautionary measures it expects countries to take are the same for Phase 5 as for Phase 6 and that the severity of flu outbreaks can fluctuate unpredictably.

However, the WHO has been keen to play down the significance of 'pandemic' status. Yesterday, Fukuda said that although "we are getting close to knowing that we are in a pandemic situation... it does not mean that the severity of the situation has increased or that people are getting seriously sick at higher numbers than before."

His boss Margaret Chan, WHO's director-general, put it more plainly: "Level 6 does not mean that we are facing the end of the world."

Editor's note: Following the publication of this piece, the WHO declared after an emergency meeting on June 11 that it was upgrading swine flu to Phase 6, declaring H1N1 to be a pandemic.