The Flu Fighter

Dr. Margaret Chan is a veteran in the -infectious-disease wars. As Hong Kong's director of health, she faced down an avian-flu outbreak in 1997 and SARS in 2003. Now as director-general of the World Health Organization, she is leading the global battle to survive—and better understand—the H1N1 pandemic, just as a second wave of infection is about to hit the Northern Hemisphere. She recently spoke with NEWSWEEK's Alexandra A. Seno in Hong Kong. Excerpts:

So far the virus has been mild. Is there a danger of people not taking the pandemic seriously?
If you are affected by the disease or know someone who died, it is not going to be mild. Health systems are stressed and health workers are working very hard, and we have not gone into winter yet. We are still in early days.

This is the first pandemic researchers will be able to observe in great detail and in real time. What do you hope the scientific community will achieve?
Two months ago everybody was saying we need two doses of vaccine. [Now] studies confirm that healthy adults may get protection with one dose. But there are still gaps in our understanding about children and pregnant women. We also need to see if there are rare adverse side effects to vaccination.

How should the world improve the way it prepares for pandemics?
I would appeal to countries to invest more resources to strengthen animal-disease surveillance. Look at the new diseases that emerged in the last 30 years. The majority came from animals.

Why have you not recommended more aggressive measures to fight H1N1, like travel bans and trade restrictions?
If every one of the 190 countries reporting cases closed their borders, what would happen to the world economy? We would have a standstill. Border closure will not stop the disease. Some infected patients don't show symptoms. Some countries have controls like temperature screening. But if the patient has no symptoms, that's not helpful. [Although] if countries wish to do so to reassure their people that government is taking action to protect them, and if they can afford it, that is their -prerogative.

The WHO led an initiative that has resulted in nine countries, including the U.S. and France, pledging 10 percent of their pandemic vaccine stockpiles to developing countries. What does this mean?
I have never seen so much sharing. This is a very strong statement about the importance of fairness in sharing scarce resources. This is a way of demonstrating solidarity to deal with a common threat. I hope to see a difference in how we do public health, not just for the pandemic but for other diseases.

How do you view your role as head of the WHO?
I'm a technical person by training. My member states tell me every day: you are honest, you tell the story as it is. That is another way to tell me I'm not a diplomat. It is my duty to advocate for the poor, disadvantaged, and the marginalized. I did a survey among my 193 member states asking, "Do you have access to vaccines?" Eighty-five said, "No way." That is not acceptable.

How is this being addressed?
I got a donation from Roche for Tamiflu, which I distributed to 121 developing countries, and I will continue to send them more. Roche has promised to give me another 5.6 million doses. GSK has promised me 2 million doses. I need vaccines. So I discussed this with industry, and they pledged to give me 150 million. The global capacity under favorable conditions can be 4.9 billion doses. The worst-case scenario is 2 billion doses, so I said, "Anywhere in the middle would be OK. Maybe you guys can make 3 billion doses, and give me 10 percent." I try to make industry and wealthy countries understand their responsibilities.

© 2009