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THE SITUATION ROOM
World Health Organization Press Conference
Aired April 29, 2009 - 16:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
WOLF BLITZER, HOST: Swine flu rapidly spreading right now from human to human in a growing number of U.S. states and indeed around the world. Now the first person dies in the United States and some experts fear there will be more.
The day Americans have been waiting for, at least a lot of them, President Obama's 100th day in office, from fixing the economy to keeping Americans safe. We're assessing how he's doing what he's done and what grades you give him. And many Republicans give the president an F. Michael Steele, the head of the Republican National Committee, he's here, he calls the president's agenda destructive. I'm Wolf Blitzer, you're in THE SITUATION ROOM.
We're standing by to go to Geneva, Switzerland, momentarily the head of the W.H.O., the World Health Organization, the director general Margaret Chan. You're looking at these live pictures, she's about to make an announcement. We're going to have live coverage on what's going on amid fears. A lot of fears that the world could be getting closer to some sort of pandemic as far as the swine flu is concerned. As soon as she starts speaking, Margaret Chan, director of the World Health Organization, we'll go there live for this announcement. More than 100 U.S. schools right now have been closed due to confirmed or probable swine flu cases as a precautionary measure.
More than 50,000 students in the United States have been told to stay home. Don't go to school. And a U.S. marine in California has now tested positive for swine flu along with three military family members in the San Diego area. This as swine flu is rapidly spreading as we said from human to human. Dr. Sanjay Gupta, our chief medical correspondent standing by. Sanjay, the announcement that we're expecting to hear from the World Health Organization, we're not exactly sure what they're going to say, right now there's a level four as far as fears of a pandemic, the worst level would be a five -- excuse me, a six, but there's some concern about what's going on right now. Give us some perspective if in fact Dr. Margaret Chan announces that they're going to raise this threat level.
DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT (via telephone): Yeah, sure, Wolf, there are several different phases of this pandemic grading. This is a system that's only been around for five years and when you go through the various phases, it indicates the more likelihood of this virus spreading and more specifically spreading via human to human contact. What we know now is it's at level 4, that there is evidence that this can spread human to human, as opposed to just animal to human, for example, which is one of the things with avian flu.
If you go to level five, it basically shows that you're having more countries involved. That's the big distinction the level five is the scope at which this human to human transmission is occurring. It is still not a full blown pandemic, but if it is a level 5 they go on to say that there's enough evidence now that a pandemic is imminent and that the appropriate communication strategies and planning strategies and all that should start to take place. It's a call for action and an indication of human to human transmission still is larger.
BLITZER: I want to show our viewers this graphic that the World Health Organization has prepared. I'm going to walk through our viewers precisely these six phases in terms of a possible pandemic. Phases one through three, they say predominantly animal infections, few human infections, phase four, and that's the phase the World Health Organization has deemed the world to be in right now, there is sustained human to human transition, as it's called.
Now phases five and six, they label as a pandemic, but if you read between the lines, in phase five it says it's characterized by human to human spread of the virus into at least two countries in one World Health Organization region while most countries will not be affected at this stage, the declaration of phase five is a strong signal that a pandemic is imminent, those are the words of the World Health Organization. Phase six which is the worst level is the pandemic phase characterized by community level outbreaks and at least one other country and a different World Health Organization region in addition to the criteria defined. If they're going to go up from a phase four Sanjay to a phase five, according to the World Health Organization, phase five, and let me repeat it, is a strong signal that a pandemic is imminent. Explain Sanjay what a pandemic means.
GUPTA: A pandemic basically means that a virus, or a pathogen of some sort is spreading around the world and its demonstrated sustained human to human contact. So it means that it could spread from human to human in a sustainable way. It's not just a random way which is an indication of some of the years past. Now one thing I pointed out, Wolf, this particular grading scale is relatively new. I tried to go back and sort of evaluate some of the things that had happened in recent news. For example, SARS, when SARS was going on, this grading system didn't exist, but SARS probably would have been a grade four. Avian flu, which is something that did happen when this grading system was in place that was a grade three. So that just gives you a little bit of a scale of reference here as to what we're talking about.
BLITZER: We heard just a little while ago and our viewers may have seen it live here on CNN, the secretary of homeland security, Janet Napolitano said for several days now, they have been working under the assumption that this could in fact go to a phase six which would be a formal pandemic declared around the world. I think Margaret Chan, there she is, she's walking into the news conference right now in Geneva, Switzerland, she's the director general of the World Health Organization and she's going to be making a statement and telling us precisely what's going on from their perspective. She's going to sit down, make the statement. Let's listen in to Dr. Chan. DR. MARGARET CHAN, DIRECTOR GENERAL, WORLD HEALTH ORGANIZATION: Good evening, or good night. Sorry to bring you out at this time of the day. Friends of the media, ladies and gentlemen, based on assessments of all available information and following several expert consultations, I have decided to raise the current level of influenza pandemic alert from phase four to phase five. Influenza pandemics must be taken seriously, precisely because of their capacity to spread rapidly to every country in the world.
On the positive side, the world is better prepared for an influenza pandemic than any time in history. Preparedness measures undertaken because of the threat from H5N1 influenza were an investment and we are now benefiting from this investment. For the first time in history, we can track the evolution of a pandemic in real time. I would like to thank countries who are making the results of their investigations publicly available. This helps us understand the disease.
I am impressed by the work being done by affected countries as they deal with the current outbreaks. I also want to thank the governments of USA and the government of Canada for their support to W.H.O. and to Mexico. Let me remind you, new diseases, by definition are poorly understood. Influenza viruses are notorious for their rapid mutation and unpredictable behavior. W.H.O. and health authorities in affected countries will not have all the answers immediately. But we will get them. W.H.O. will be tracking the pandemic at the epidemiological, clinical and virological levels. The results of these ongoing assessments will be issued as public health advice and make publicly available.
All countries should immediately now activate their pandemic preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza like illness and severe pneumonia. At this stage effective and essential measures include heightened surveillance, early detection and treatment of cases and infection control in all health facilities. This changed to a higher phase of alert, it's a signal to governments, to ministries of health and other ministries. To the pharmaceutical industry and the business community that certain actions now should be undertaken with increased urgency and at an accelerated pace.
I have reached out to donor countries to unite to the (INAUDIBLE) alliance, the World Bank and others to mobilize resources. I have reached out to companies manufacturing anti-viral drugs to assess capacity and all options for ramping up production. I have also reached out to influenza vaccine manufacturers that can contribute to the production of a pandemic vaccine. The biggest problem, the biggest question right now is this, how severe will the pandemic be, especially now at this spot. It is possible that the full clinical spectrum of this disease goes from mild illness to severe disease. But we need to continue to monitor its evolution and get more specific data and information to answer more precisely this question.
But we know from past experience, we also know that influenza may cause mild disease in affluent societies and affluent countries but more severe disease with higher mortality in developing countries. No matter what the situation is the international community should treat this as a window of opportunity to ramp up preparedness and response. Above all this is an opportunity for global solidarity as we look for responses and solutions that benefit all countries, all of humanity. After all, it really is all of humanity that is under threat during a pandemic. As I have said, we do not have all the answers right now but we will get them. We will get them with the support of our partners. Thank you.
UNIDENTIFIED MALE: You will state your organization and your name when you ask a question. First question? There is translation I believe in Russian, English, French, Spanish and so if you would prefer that language to your original language, use that please. Thank you very much. Go ahead.
UNIDENTIFIED FEMALE: Dr. Chan, in the absence of vaccine available currently and the readiness of rush to respond to your call today, how much more Tamiflu do you need and if you could refresh our memories, how much was available when the SARS and other incidents happened and what is the maximum you need now? Thank you.
CHAN: Thank you. Thank you for that question. Yes, indeed, at this point in time we do have the pandemic vaccine. Now we know from early tests that the new H1N1 virus is sensitive to Tamiflu as well as Relenza. But these two medicines we name are effective and I have talked to both companies and others that are able to manufacture them to find out exactly what is their production capacity. Just to give me a sense of how much of that can be made available to the W.H.O. and at affordable price so that we can procure them in preparation to help developing countries.
Now I cannot give you a specific answer as to how much is available. And as you well know, some of this information is available on the website of the company. It tells you their manufacturing capacity. So you may need to go to that site to get the total manufacturing capacity. Now how much does W.H.O. have? And thanks to Roche in preparation for the H5N1 thread we got a donation of total of 5 million doses and some of that we have disbursed already to some countries, countries that were reporting human cases from the H5N1.
So we have used up a portion of that 5 million. I think at this point in time -- in W.H.O. possession, I'm confining to this donation alone is in the range of about 3.5 million doses. It's just an estimation, but I will keep that stock available to be disbursed to countries in need. But clearly that's not enough and that's why we need to talk to the companies and hope that we can get donations and also get donor support to procure Tamiflu to support countries in great need, ok?
UNIDENTIFIED MALE: Next question from the BBC.
UNIDENTIFIED FEMALE: Dr. Chan this is all quite dramatic, we're very grateful to hear from you, but I just wonder whether you have any words to people watching this to kind of reassure them. I mean I'm sure the W.H.O. doesn't want to create any kind of panic. CHAN: I think your question is entirely appropriate. Yes, it is important for us to tell the story like it is. But we all know that pandemic influenza especially caused by new virus like this one is evolving rather quickly. And that's why when there's information available, it is my duty to share it with my member states and with the general public to you. I have to say it is important for us to take this very seriously and to maintain our vigilance to track the virus as it evolves. We should be anxious, I know the community is anxious and I appreciate how they feel and that's why we work very hard with countries at breakneck pace to make sure we get the best available information to you. But it is important that we should not overkill and we need to maintain a level of calmness and so that we will continue to manage this in a rational manner.
(INAUDIBLE QUESTION IN SPANISH)
CHAN: Thank you for that question. Yes indeed. First and foremost I would like to commend the Mexican government for being very open, transparent and committed to working with W.H.O. very cooperatively. And in fact, W.H.O. experts and also the U.S. and Canada experts coming and becoming part of the W.H.O. team, many of them are already on the ground supporting the country's efforts to find out a lot of the information that are important for the world to understand about this disease. As we are speaking now, they are working at breakneck pace, actually for many days without sleep. I was just on the phone talking to the leadership of the country. Mr. President Calderon and I know, you know, talk about the work that has gone into this, I commend the president for his leadership, for his openness and commitment to share information with the international community. It is this kind of political support with the international communities rallying behind this that is important to help us to get to the bottom of understanding this disease.
UNIDENTIFIED FEMALE: Dr. Chan, can you tell us a little bit more about the basis for your decision after consulting with the different regional groups, have American authorities been able to confirm to you sustained human to human transition and can you just tell us a little bit more about how you came to this decision.
CHAN: Yes, indeed, before I explain to you the reasons why we move from phase four to phase five, since you asked about the U.S. government, I also would like to take this opportunity to pay tribute to the U.S. authority for what they have done. And in fact, the U.S. government as I said, in my opening statement, not only are they helping the W.H.O., they are also reaching out to support the investigation that is ongoing in Mexico. And W.H.O. have to say the U.S. CDC, the HHS and also under the leadership of the President Obama they have done everything, you know, required and deal with this matter in a serious and robust manner. And I think they have just pitching their response at the right level.
Now under what conditions do we raise the level from four to five? As you well know, the world scientists over the years have developed a very good indicator or benchmark for us to distinguish the different phases of the pandemic alert. Pandemic level five of the pandemic alert require us to satisfy the criteria that first we need to demonstrate human to human transmission in a sustainable manner and that is causing community spread. And we are seeing this in definitely in Mexico and we are, as the information emerged from the U.S. authority and we are also seeing that and when we see two countries in one W.H.O. region, you know, providing evidence to that effect, we are moving into phase five. Both U.S. and Mexico are in the Americas region of the World Health Organization. Thank you.
UNIDENTIFIED MALE: Thank you, next question.
UNIDENTIFIED MALE: I have two questions. First on the exact qualification, let's say of level five in your guidance book, it says that a pandemic is in this case imminent. Now you said that the big question is about the severity of where the pandemic is. Are you already considering then that we are in a pandemic situation? Can you clarify this to us? And secondly, what else does it need for government -- for example decide to break a patent on for example Roche Tamiflu due to a situation of pandemic. What else does the world need for government to say well this is the case to break a patent and produce locally? Thank you.
CHAN: I will take the second question and I'll give the first question to Dr. Keiji Fukuda, because he's sitting here not answering one question yet, so I need a little bit of rest. On the question of patents, I'm sure you appreciate very much Roche has offered a license to several manufacturers in different countries and to that extent, you know, I think as a company, it has demonstrated, (INAUDIBLE) social responsibility. And of course, if countries are members of the W.T.O., it is within the prerogative of each country as they see fit how to exercise their authority and the prerogative under the WTO regulations, including the (INAUDIBLE) regulation. But as I said, as I said, you know, when and what the country is going to decide it is their decision. Dr. Fukuda?
DR. KEIJI FUKUDA, ASSISTANT DIRECTOR GENERAL, WORLD HEALTH ORGANIZATION: Thank you, Director General. I'm happy to give you a rest, give your voice a rest. So in terms of the question about the pandemic situation, if you remember going from three to four meant that we saw that the virus able to transmit from person to person and to sustain transmission in that way, and we have seen that. And in the decision to go from four to five, this is really based on continuing analysis of the information as it has become available. And when you look at the criteria for going from four to five, we see that five is really considered a situation in which the likelihood is very high to imminent or inevitable.
Now I think in this situation, five and six represent periods of time when the virus is beginning to spread from country to country and become established. And basically five can be interpreted to mean we are earlier in that process, phase six can be interpreted to mean that it is establishing itself in more countries and in more regions and so this is how we're looking at it. The second part of your question was about the severity. Right now, you know we see clinical cases which are relatively mild in many countries and we see some severe cases largely in Mexico, but we also have had a death reported in the United States. And right now, we now know that the full spectrum of this disease can go from very mild to fatal illness. The real uncertainty is when you get infected, how often are people going to develop mild illness, how often are they going to develop severe illness and I think this we will know as the situation unfolds and as investigations continue. Thank you.
UNIDENTIFIED MALE: Dr. Chan I would like to ask you whether you have spoken to world leaders to consult on this decision. You said it's time for all countries to activate their pandemic preparedness. What exactly should they be doing and what can individual people be doing who many of whom would not have experienced a pandemic in their lifetime?
CHAN: Thank you for that very important question. I will touch upon the general principles and ask Dr. Fukuda to give you the details on what an individual society or country can do in response to this raising of phase four to five. Indeed, the pandemic preparedness plan and also the work that has gone into it started several years ago. You may recall the first H5N1 the first incident that threatened the world in 1997 and then again in the early 2000s, 2003, 2004 and 2005, during those years. H5N1 kept coming back to cause sporadic human cases. And in view of that threat to the world W.H.O. with the support of our partners, we have provided support to all countries to help them to develop a pandemic preparedness plan.
Though much work has gone into it and in fact the fact of the matter is, we are able to, you know -- how should I call it, do all the surveillance and get reports from these countries, early reports from these countries is because they exercise and activated their pandemic preparedness plan and enabled us to pick up cases rather early, instead of allowing it to gain a foothold in many countries. So to that extent, I think, you know, countries are prepared, but it is better for me to tell you, not every country has the same level of preparedness and sophistication and that is a fact. And that's why our attention should be paid to developing countries that may require more help. Dr. Fukuda.
FUKUDA: Sure, Director General. I think that, in terms of some of the specific things which countries and individuals can do, if we start with countries, one of the most basic things is that countries have been preparing for pandemic influenza for the past few years.
So, they ought to look at their plans, make sure that the plans are up to date, and then look at the kinds of capacities that they need to carry out those plans, and help fill any gaps that are there, so, for example, looking at laboratory capacities, looking at the ability to conduct surveillance.
Now, a second thing is that countries really can increase their surveillance and their watchfulness for this disease. If they don't have it, are they getting cases? If do they have it, are disease patterns going up? Are they going down? Are patterns severe or are they mild? They can monitor these sorts of things.
A third basic thing for countries is that -- to look at their communications. Probably the single most important thing is that the populations are informed, they have accurate information, they know what's going on, and they build trust in their governments as a good source of information.
And then they can also go to other sources of information, but to -- to look at what their governments are saying. Then, I think governments have a variety of choices. There are a number of potential disease control actions called social distancing maneuvers. These may include closing schools. They may be looking at whether people ought to delay holding meetings, these kinds of actions.
And here, I think it depends really on what the country assesses its situation to be. And it depends in part on whether the disease appears to be severe or -- or mild. These things will impact how governments make those decisions.
At the institutional level, for example, in hospitals, one of the things to be careful for are things such as infection control measures and make sure that you know what to do to avoid spreading infection within institutions.
Then, at the individual level, families and individuals in communities, one of the first things to do is make sure you know where there is good information, so you can always turn to different sources to find out answers to questions that you don't know, to get information about what might be going on.
There are certain steps to take. If you are sick, if you have something which may well be swine flu, or any illness, it may be prudent to stay home until you're feeling better. This is a way of sort of voluntarily preventing yourself from transmitting infection perhaps to others. And it's also a way of getting rest and getting treatment.
There are other steps that you can take, such as washing your hands, and practicing what is called good respiratory hygiene. Don't cough in people's faces. Cover your mouth. Use kleenexes or your shirt sleeves to cough in, and a variety of steps like that.
So, I think, if you go to some of the Web site of WHO, some of the other organizations. You will see these kinds of recommended actions. And they can be very helpful.
UNIDENTIFIED MALE: (OFF-MIKE) or Bloomberg over there, Bloomberg News Agency, then...
QUESTION: Are there any signs that the symptoms are becoming more severe or that the virus itself is growing in strength?
FUKUDA: At this point all the viruses which have been identified from the cases -- that is, there are cases of disease from a number of different countries from which viruses are available -- all look to be remarkably similar. But we're in a very short time frame right now, and, so, we do not see much change among the different viruses. In terms of the disease, right now, again, it's a very short time period, and we're -- we're really getting a handle on what some of the symptoms may be.
There's a science meeting today convened by WHO with a few hundred people around the world. And in that conference, we learned some of the symptoms that we're seeing in the mild cases are really very similar to regular seasonal influenza, headache, fever, cough, those kinds of symptoms.
In the more severe cases being reported by Mexico, we see complications such as pneumonia. And, again, in the most severe cases, we see that there are fatalities. But, right now, we're getting a handle on that.
So, right now, as the picture evolves, we don't have any suggestion of any unusual changes in the course of illness, but we will monitor this.
UNIDENTIFIED MALE: (OFF-MIKE)
QUESTION: (OFF-MIKE) I was wondering if you could elaborate a little bit. During the H5N1, we got a lot of details on the virus and the epidemiology, which, in this crisis, we have not seen the detail coming from WHO. Is the WHO going start sharing the expert information from your emergency committee with the public by posting, at least the findings, if not the names of the experts?
FUKUDA: Yes. We will make -- we will make the information from -- available to us, available to the public, and -- and the discussion, summary findings of the discussions of meetings, such as the science call which was held today, available to the public.
I do want to remind everybody, I think we're about six days into when the emergency room at WHO was stood up. And we are still very early into this. And -- and, during this time, I think an incredible amount of information, guidelines, have been provided. And so -- but we will continue to do this.
UNIDENTIFIED MALE: From over there, Mr. Beckoff (ph) from German television over in the corner.
QUESTION: Thank you.
I have one -- more questions concerning the behavior of the normal people. Is there any difference between phase four and five? Should people do anything, yes, in a more careful way, or whatever?
CHAN: I don't believe so.
And all the measures, insofar as personal protection as described by Dr. Keiji Fukuda, I think, you know, even in phase three, phase four, phase six, you should continue. I mean, you know, don't let me -- let me reinforce the point made by our media friend from BBC. You need just to be careful, to attend to personal etiquette, and not to unduly be affected by this.
Continue with your important work, to report information to the public. But I did say, you know, internally, now we are in Geneva. I just say that, perhaps, instead of having the traditional three hugs to say hello and welcome and hello to your friends, maybe you -- you -- you don't do that. Don't hold each other and hug their face three times.
That's just an example, to say, continue with your -- your -- your business, but, you know, try to pay special attention to just personal hygiene.
UNIDENTIFIED MALE: Thank you very much.
If you could identify yourself, please, here, right here?
QUESTION: (INAUDIBLE) with the German Press Agency.
If I can just move back to the financial issue, which you raised earlier, you said that you were in contact with the World Bank and some other organizations. I know it's early days, but do you have an estimate of how much money is needed to deal with this, both in terms of prevention, as well as actual treating of the disease, and what exactly are you expecting from the pharmaceutical -- pharmaceutical companies? You said certain actions, if you can elaborate on that, please.
CHAN: The strict answer is, you know, I cannot give you an answer today as to what would be the financial amount required, because very much of this depends on how the disease evolve, whether it is going to cause severe illness or whether it's continue, as it has demonstrated in the many countries reporting cases.
Many of these cases are mild. And -- and some of the good things are coming out from USA, as many of these patients recover on their own, without medicine. But that is not to say we should be complacent. And we need to get, you know, more time to continue to observe the behavior of the virus.
Now, if it is going to stop, you know, now, and do not go beyond a big number of countries, the financial implication is also different.
But, having said that, having said that, we learned from previous pandemics, pandemic virus is precarious, unpredictable, and will take us by surprise. So, insofar as preparedness is concerned and vigilance is concerned, that will continue.
And, as we move along, we're going to map out how much is required. And I would like to thank the World Bank, also. I was on the phone with the president of World Bank, Mr. Bob Zoellick. And he has, very proactively, with his team, identified possible financial support, you know, to countries or to agencies that need to support countries.
And, so, those are the things we are doing in a proactive manner. We may not need the money, or we may need more. We -- we don't know. So, that -- that is how we discuss, you know, about the financial situation.
But what -- what is my expectation of the drug company or, for that matter, in future, if we need to move into making the pandemic vaccine, is -- well, I understand, and the world understands, private sector is private sector. I mean, it is quite right for private sector to make profit. But under these very special circumstances, I'm sure many companies that I have talked to so far are prepared to support WHO, to deal with this crisis in a manner that is in keeping with their corporate social responsibilities.
So, I cannot give you an outline, because different companies have different considerations. But, broadly speaking, not a single company said to me, we are not paying attention to the need of the poor.
UNIDENTIFIED MALE: Thank you very much.
The gentleman with the white computer back there. And identify yourself, please.
QUESTION: I'm (INAUDIBLE) from (INAUDIBLE) San Paulo, Brazil.
Dr. Chan, there were -- there are some reports coming from North America and Latin America that there were -- there were some alerts two weeks before the WHO announced last week, sparking some questions whether more could have been done to prevent the spread of this infection.
So, I would like to hear your reaction to this.
And another question is that, when Dr. Fukuda announced the level four alert, he said that containment was not feasible anymore. So, is there any measure that could be done now to contain this virus?
CHAN: Thank you for your -- for that information.
Yes, you know, I understand what you're saying. But, in discussing with the government of Mexico, when we looked at the data, yes, some two weeks ago, they began to see, you know, something, you know, which looks like an influenza outbreak. And don't forget, you know, the country is coming out of the tail end of its influenza season.
So, it is really acceptable for the countries to look at, you know, an outbreak of very mild nature. But, then, as things happen, things become to -- to turn into a different dimension. And that's why they call in and report to WHO.
I do not -- I do not detect any evidence that the government is not willing to share information.
Keiji, on the quick containment question.
FUKUDA: Actually, let me -- let me defer to Mike Ryan, who's head of our operations, on this question.
Mike, rapid containment.
MIKE RYAN, GLOBAL OUTBREAK ALERT AND RESPONSE NETWORK COORDINATOR, WORLD HEALTH ORGANIZATION: Yes.
And, just to clarify, I would like, personally, to thank the authorities in -- particularly in Mexico and the other countries, because the responsiveness of countries and openness in providing data to us has been amazing.
And our verification requests have been met with the provision of detailed responses and detailed data, many times within hours. So, I can certainly say that the world has changed, in terms of the way we work.
In -- in -- in terms of containment, history will tell for how long this virus may have been circulating. Nobody at this point can make any accurate prediction or estimate as to the origins of a virus at this point.
And I think it's, at this point, unhelpful speculation. A lot has to be done to establish original sources. The more we understand about the virus, the better we will be able to deal with it.
The purpose of understanding is knowledge, and the purpose of knowledge is action. And we need to focus on what we can do to understand this virus. Unfortunately, at this point, and the -- the D.G. had made the decision, with the advice of the advisory -- the expert committee, that containment, in the context of population-based containment and stopping the spread of the virus, was not possible.
That does not mean that individuals can not protect themselves from being infected. And I think we need to make that distinction. And governments can do much, both to reduce the speed at which an infection may spread in the community, giving themselves vital hours and days to prepare people, and individuals can protect themselves with the precautions and the behaviors that both the director general and Dr. Fukuda outlined.
I think we're moving -- we have moved, as Dr. Fukuda has said previously, into the era of mitigation. And mitigation will depend on having the tools to do that.
BLITZER: All right, so there it is from the World Health Organization in Geneva, Switzerland, the dramatic announcement -- and we have been listening now for most of this hour to Dr. Margaret Chan, the director general of the World Health Organization. She made the announcement that they were going from a level four to a level five in terms of a pandemic concern. She says that the world right now should immediately activate their pandemic- preparedness plans.
Level five suggests, according to the World Health Organization, that a pandemic is imminent -- is imminent -- around the world.
We're watching, and we're trying to understand better what's going on.
Dr. Sanjay Gupta, our chief medical correspondent, has been listening to this news conference from Dr. Chan and others from the World Health Organization.
Sanjay, it sounds so alarming, what they're telling, not only us in the United States, but people all over the world about the potential of a pandemic.
GUPTA: That's correct. And we have never heard something like this, quite like this before, because this particular grading system to which they were referring has only been around for five years.
After the concerns about avian flu, they developed this grading system and urged countries to all develop pandemic-preparedness plans, should the need arise. And, basically, what they're saying today is, the need is -- has arisen.
Specifically, they're asking all countries to heighten their surveillance, develop early detection and treatment plans, and to start practicing very, very diligent infection control.
But, more than that, Wolf, to your point, this is sort of a signal to the pharmaceutical industry, to the business industry, that the -- there's an increased urgency here like they haven't seen in some time, and they have got to increase the pace of doing things to help control this pandemic.
Now, they look at these in several different ways, from an epidemiological standpoint, from a clinical standpoint, from a biological standpoint. And, based on all those criteria, and based specifically on the fact that there is evidence of human-to-human transition -- transmission in at least two countries within one region, those two countries being the United States and Mexico, this takes us to a grade five -- so, so, pretty -- pretty remarkable, as you said, Wolf.
BLITZER: And she says these words, which I'm sure she weighed them very, very carefully, Sanjay -- and I will read precisely from the quote.
She says: "It really is all of humanity that is under threat during a pandemic. We do not have all the answers right now, but we will get them."
"All of humanity," Sanjay, I can't underscore how -- how ominous that sounds to the average viewer out there listening, trying to understand what's going on. And -- and she makes the point, as you point out, that there are two countries, Mexico and United States, where it has been shown that this new virus, a combination of swine and bird and human ingredients, has been able to spread from human to human relatively easily, I take it.
And, as a result, that's why they're so alarmed, because there -- there is no vaccine for this swine flu -- this -- this swine flu that's just developed; is that right?
GUPTA: That is correct. And she addressed that issue as well, Wolf.
In context of her remarks about all of humanity, she said, this is a time for global solidarity. She made that point a couple of times. And she also made a point at sort of the business and pharmaceutical level, as well, saying, look, I understand that the private sector is predicated on profits, but, if there's a time, if there's a special circumstance for that to be different, that time is now. There's -- there is -- this is an era of social responsibility.
And that's a message, I think, she was targeting straight at the pharmaceutical and business communities.
Wolf, let me -- let me give one sort of piece of assurance -- reassurance here. And that is that, when you're talking about this sort of pandemic, that there's sort of two things you're sort of talking about.
One is the scope of these infections. And the other is the severity of these infections. What we were talking about, from a pandemic standpoint and all the comments that she made and we're making now, really refers more to the scope, how -- how widespread these infections could be.
But what's unclear now -- and I think this is very important -- is just how severe these infections could be. As we know, in the United States, for the most part, so far -- though it is early -- these have been -- this has been mild illness.
Now, we have seen more -- more significant disease where I am here in Mexico. And what appears to be happening, at least according to Dr. Chan, is that, in more affluent countries, it does appear to be more mild illness, whereas developing countries tend to have more severe illness.
It is unclear exactly why, although you can guess as to some of the reasons, but, again, this pandemic referring much more to scope than it is to severity -- Wolf.
BLITZER: I'm assuming she's referring to the level of medical treatment in the more developed countries would better than in the developing countries, where you don't have, necessarily, the doctors, the hospitals, the public health officials that you have, shall we say, in the United States.
GUPTA: That's right.
And I think that was part of that appeal, again, to the pharmaceutical injury that, you know, this is a time for social responsibility. Part of that is to try and get medicines, in the form of antivirals and vaccines, like you were talking about, and, as needed, to countries that maybe otherwise couldn't afford them.
So, you're absolutely right that this is -- this is a good example of a couple of the appeals that she was making here -- Wolf.
BLITZER: It's late at night in Geneva, Switzerland, right now, approaching, what, about 11:00 p.m. For them to call a news conference at this late hour, and to make this announcement that they're raising this pandemic alert level, from a four to a five, meaning a pandemic is imminent, it underscores how quickly this is developing.
They didn't even want to wait until normal business hours tomorrow for Dr. Chan and Dr. Keiji Fukuda, the acting assistant director general, to come out and brief the press, indeed, brief the world.
What does that say to you?
GUPTA: Well, this is done on a data-driven basis.
So, when the data comes in that basically shows specific criteria being met, in this case, evidence of human-to-human transmission in the United States, I -- I'm pretty sure that they had already documented human-to-human transmission here in Mexico, where I am.
Once they documented it also in the United States, that meant there were two countries in one region of the world, and the criteria was met.
Again, this is a new sort of pandemic preparedness. We didn't have this sort of scale -- scale or grading system even more than five years ago.
Something else that's worth pointing out -- and she alluded to at the very beginning of her remarks -- is that, as much as we sort of talk about past pandemics, this is unquestionably a different time.
We have ICU care that's better than ever before, hospital care that's better than ever before, antivirals that simply weren't available in some of the other pandemics, and overall ability to detect these cases very early on. The surveillance systems are better than ever before, not across the world.
And, in developing countries, it's going to be different than more affluent countries. But it was a little bit more of an optimistic picture that, look, you can look at the previous pandemic numbers, and they will scare you, but we are better equipped at handling this. And I think that this -- this grading system and all that it means is an example of that. BLITZER: And, as you point out, Sanjay, this is the first time since this grading system, one through six, that there is now an imminent notion of a pandemic, level five right now.
But give us some context. When was the last time the world had a pandemic?
GUPTA: Well, you know, we -- haven't -- as far as the grading system goes, given that it was around only in the last five years, avian flu was something that fell within this time period. And, at that time, that was a grade three.
Now we're talking about a grade five. So, that's a little bit of context. I tried to sort of reevaluate what SARS would have been, something people remember from about five or six years -- I guess six years ago, seven years ago. And that would have fallen more into a grade four sort of category.
Clearly, we have had larger epidemics. Back in the 1918, one of the largest, the Spanish flu, that worldwide pandemic at that world, there wasn't a grading system, but, clearly, that was a grade six, one of the earlier pandemics that we documented.
BLITZER: She's speaking, Dr. Chan of the World Health Organization, the director general, speaking of urge -- an increased urgency around the world right now, in terms of, not only raging -- rate -- increasing production of drugs, pharmaceuticals, but also heightened surveillance and early treatment.
For a lot of places around the world, Sanjay, that's easier said than done.
GUPTA: And that question was asked of her directly. How much of these antivirals do we have?
She wouldn't give a direct answer, in part because, I think, we don't know exactly how much antivirals we have for worldwide distribution. I also think that there is a -- that that was another appeal to the pharmaceutical industry to say, look, when we say we're in imminent pandemic stage, you can guess, you can right away start to put together the things that we're going to need, these antivirals being one of them.
The vaccine, Wolf, that you mentioned earlier has not gone into production yet, as far as I know. That is something that may start as well. That's a big decision, by the way, Wolf, of starting vaccines on this H1N1 flu, because, when you start this sort of vaccine production, you do have to take away some of the manufacturing capabilities for your seasonal flue vaccine production.
And that's a tough decision. Keep in mind, Wolf, as much as we talk about these numbers that we're talking about now, the seasonal flu still kills over -- over 35,000 people a year, on average, in the United States alone. So, there's a lot of considerations here. And I think they have probably taken a lot of these things, thought about them, before raising the level to level five. BLITZER: And the reason they're so concerned is because of the uncertainty. As Dr. Chan says, they don't know how severe this -- this swine flu pandemic could be.
Would it be very severe? Would the symptoms be relatively modest, minor? Or would they be deadly? In fact, we have seen deaths in Mexico and now one here in the United States. Those are huge mysteries that -- and there are no easy answers, as she and her deputy, Dr. Fukuda, made clear.
GUPTA: That's -- that's -- you're absolutely right, Wolf.
And I would sort of -- it was remarkable to me. She -- she used a couple of terms. She said, these viruses are very hard to predict. They can take you by total surprise, and there's a lot of uncertainty here.
So, you know, that's something to keep in mind. This is leader of the World Health Organization making these comments, saying, you know, as much as we have all these surveillance techniques and try and track this thing down, we have people rushing to places where this -- this outbreak and now possible pandemic may have originated, there is still a lot of uncertainty here.
And it is very early on, still, in this whole outbreak process. So, we don't know how this is going to behave in the long run.
Let me -- let me tell you, Wolf, from past -- looking at past pandemics -- I have studied a lot of these -- we have talked about these in the past -- given the month and given the time of year that it is, we're about to enter into the summer months.
We know, traditionally, in the summer months, these -- these types of human-to-human transmission and the type of spread tends to diminish, and diminish pretty greatly. Fizzle out is the term that I have heard used by some of the infectious disease experts. So, that is good news.
But let me say, as well, that we know, in the fall and winter, if there is some virus that is still sitting afternoon, it can sort of reactivate or start to spread again. So, this is a message, I think, to -- to have -- while not let our vigilance go down should these numbers start to decrease over the summer, it could come back in the fall and winter.
And, if we're prepared, we're going to have a much better chance at getting through that.
BLITZER: I'm going to have Dr. Gupta stand by. He is Mexico City.
Also standing by is Dr. Anne Schuchat of the Centers for Disease Control and Prevention. She is the interim deputy director for science and public health. We're going to speak with her, get her thoughts on what we just heard from the World Health Organization, that a pandemic now is believed to be imminent as a result of this swine flu.
We will take a quick break, continue the coverage of the breaking news right after this.
BLITZER: To our viewers, you're in THE SITUATION ROOM.
Happening now, breaking news: The World Health Organization warns, a swine flu pandemic is now imminent. It has just raised its alert level from four to five, as the first death here in the United States is confirmed.
Also, we go to ground zero of the outbreak, a small village in Mexico, home of the first confirmed victim, an 5-year-old boy.
And swine flu fears closing some 100 schools across the United States, including New York schools right at the center of a suspected cluster of cases.
I'm Wolf Blitzer. You're in THE SITUATION ROOM.
ANNOUNCER: This is CNN breaking news.
(BEGIN VIDEO CLIP)
CHAN: I have decided to raise the current level of influenza pandemic alert from phase four to phase five.
All countries should immediately now activate their pandemic- preparedness plans. Countries should remain on high alert for unusual outbreaks of influenza-like illness and severe pneumonia.
It really is all of humanity that is under threat.
(END VIDEO CLIP)