What Can We Learn From Swine Flu?
1. Emergencies like this are opportunities for change. That change can be for the better or for the worse. The president of Mexico, Felipe Calderon, is using the swine flu outbreak to centralize power. He has placed the country under a state of emergency, authorizing the Health Secretary to "inspect and seize any person or possessions, set up check points, enter any building or house, ignore procurement rules, break up public gatherings, and close down entertainment venues. The decree states that this situation will continue "for as long as the emergency lasts." People in Mexico are very, very afraid right now, and they are willing to accept any action that seems like it will end the epidemic, even if it violates their constitution.
2. Public health preparedness is not a boondoggle. Preparing for disasters doesn't come naturally to us; it feels like a waste of money, or superstitiously, it feels like preparing will make the disaster happen. It's hard to focus on hypothetical public health disasters and support preparation with funding. It's the kind of thing that gets cut during budget discussions. Things like swine flu remind us of why we prepare. Emergencies do happen, and preparation makes a difference. Mexico lacked the lab and surveillance capacity to catch swine flu when it first started to spread. If the country had possessed that capacity, things would look different right now.
3. Despite what I just said about Mexico, another thing we have learned is that containment is dead as a response to epidemics. People travel too much and too fast to use isolation and containment to stop an epidemic. At this point, surveillance can provide early warning - tell you where an outbreak starts, and provide warning to health authorities around the world to prepare for outbreaks. Early warning lets us start to develop vaccines, identify treatments, and prepare health facilities to provide care. But the days of keeping a disease in one place are over.
4. We need the WHO. This is when it shines. We need one agency tracking outbreaks of swine flu outbreaks, coordinating responses, and establishing policy. No one is as well suited to do this as the WHO. It's easy to knock their work - and I have been known to do that - but at times like this, the WHO earns its keep with a vengeance.
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