The following is an edited excerpt from and interview with Dr. Margaret Chan, conducted in late 2005...

At the moment there isn’t the super lethal human-to-human form of H5N1 out there. Why all the fuss?

At this point in time, two of the three criteria for a pandemic exist. Number one: we have a new virus. Number two: this virus is able to jump to humans directly. The third thing we are waiting to see is if there is efficient human-to-human transmission. That would be the last criteria that would bring us into a pandemic.

It is important that we should act on early signals. If we are not prepared, clearly we will see huge health as well as economic impacts. If we are better prepared, we will reduce the health impact as well as the social and economic disruption.

Is there a gap between what the public understands to be the potential of this and the reality of what it could eventually be?

With the exception within certain communities, the awareness of the potential risk of a pandemic is not very high. There is still a lot of work that needs to be done to bring these communities into proper focus.

What would happen if several cities in Vietnam came down with major outbreaks of H5N1?

If what we are seeing is human-to-human transmission in several cities in a certain country, we need to do a very quick assessment to find out whether or not this is due to efficient human-to-human transmission. If indeed the cases are related to contact with sick poultry, the risk is less than if we have epidemiological evidence pointing to the fact that there is efficient human-to-human transmission.

If we are seeing several clusters demonstrating increased human-to-human transmission, the WHO will need to move very quickly and work with that country – we can ship antivirals into the first affected area, and use the antivirals to treat the people. What is more important is to treat the people that have been in contact with them; the contacts or the family members.

How close are we to a pandemic?

Nobody has the answer to this question. The unique nature about the influenza virus is its great potential for changes, for mutation.

We have learned from history that pandemic influenza in the past century took the world by surprise. This is perhaps the only time when we are beginning to see some early warning signals.

We are seeing avian influenza causing deaths in poultries in many countries in Asia; we are seeing some human infection. At this point in time they are very limited and we do not see strong evidence to support human-to-human transmission. But clearly the risk is there and we need to get ourselves prepared.

Some experts are predicting that the coming pandemic could be far worse than 1918. How would that change our lives?

I don’t really wish to paint such a gloomy picture. It is important for us to look at the evidence and not take the alertness attitude. Nor should we be complacent about getting prepared for a pandemic. We have been asked time and time again about how many people will get sick, and how many deaths there will be. But based on past sort of experience, we are seeing a lot of mortality and morbidity with the 1918 pandemic, but we are also seeing a less severe situation with the 1957 and the 1968 pandemics.

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If this strain breaks out in let’s say in Southeast Asia next fall, what could we expect to see here in North America?

There is a lot of attention focusing on countries in Asia. But I have to emphasize this point: the next pandemic does not have to start in Asia. It could start in any part of the world. In respect of which part of the world it is happening in, it will become a global problem, given the very high volume of international travel and the high population density compared to 40 years ago when we had our last pandemic.

How does influenza affect the body and how quickly it is transmitted?

The usual symptoms could include fever, cough, and muscle ache. The mode of transmission is by airborne droplets, and contact of body fluids. It can be quite mild, but in people with chronic disease or with a compromised immune system, the disease could be quite severe.

How prepared are governments at this stage?

At this point, we understand that there are about 50 countries that have pandemic influenza preparedness plan. But you know these plans vary in terms of their scope and in terms of their depth. We would be happy to work with member states to fast track this process.

What would happen inside the WHO if the pandemic were to strike?

Within WHO head office here, we have the strategic operation centre. And this is the technology platform, and this is the place where all the technical people and other support departments would come together to examine the data that is being collected on a daily basis. That information and data is very useful to help us analyze what is happening on the ground. This is what we call doing the risk assessment.

Based on those risk assessments, WHO needs to come out with timely information, to help policymakers to make decisions. The WHO headquarters is very well connected with our regional offices, our country offices, and we could make connections with our member states to advise them on the latest position as the pandemic risk is concerned. This is the kind of thing that we would need to do on a daily basis, and we are already doing that. We have a daily meeting here, to analyze the intelligence and the information and send out the appropriate information.

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From a policy standpoint, how do you go on planning for the unimaginable?

Pandemic influenza is by nature an international issue; it requires an international solution. So the WHO and other UN organizations would need to work together with the countries that are being affected and with the support of developed countries to provide the necessary in-kind or in-cash support to mitigate or reduce the risk. These are the sorts of things that are ongoing now, and WHO is meeting with many partners to see how we can work together to rise above this challenge. It’s not an easy challenge.

What kind of powers does the WHO have for this possible situation?

The WHO is the lead agency in health in the United Nations system, and clearly we have very important functions to play. First, to provide timely and evidence-based advise, information and guidelines to help member states to formulate their policies. Second, we have an important role to play with our coordinating and convening power. In certain areas, for example, to fast track pandemic vaccine production, we would have an important role to play.

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