Chronicle of a Pandemic Foretold: Lessons from the 2009 Influenza Epidemic

Abstract

The A(H1N1) influenza epidemic provided the first indication of the effectiveness of the pandemic preparations that countries and international organizations initiated in the wake of the 2003 SARS epidemic. In the case of SARS, China was criticized for not reporting the outbreak quickly enough. This led to new reporting requirements under WHO regulations. In the case of the 2009 influenza epidemic, Mexico and the United States complied with their obligations to report outbreaks to the WHO as soon as they detected a problem. Nevertheless, this reporting was delayed due to the timing of the outbreak, which coincided with regular influenza season. The WHO declared a public health emergency of international concern within 48 hours of laboratory confirmation that the Mexican and US viruses were a new strain. While the WHO issued recommendations against trade and travel restrictions, a significant number of countries chose to ignore those recommendations. What was most worrying was the decision of many countries to apply more severe restrictions against Mexico than against the United States. The initial lack of access to accurate testing equipment severely hampered Mexico’s ability to confirm quickly the cause of deaths and illness. Moreover, Mexico kept the world informed of every development in the epidemic with honesty and transparency, in accordance with WHO guidelines and regulations. This led to the perception that Mexico’s epidemic was far worse than the US epidemic. While Mexico initially reported suspected cases on a daily basis, the United States limited its release of information to confirmed cases. This reinforced the perception that Mexico was much more seriously affected and the likely point of origin. Once Mexico had the capacity to test samples, it limited its release of information to confirmed cases, as the United States had done from the beginning. The response of many countries to Mexico’s open and transparent reporting in this case may undermine WHO reporting requirements and encourage countries to be less open regarding future public health threats of international concern. Thus, the response of some countries to Mexico’s exemplary handling of this situation may increase the health risks to all people in future pandemics.

Keywords: Mexico, Swine flu, Influenza, A(H1N1), World Health Organization, Infectious Disease Outbreaks, International Health Problems, Infectious Disease Reporting, Communications Strategy, Economic Factors, World Trade Organization

JEL Classification: H5, H55, H56