Is it a pandemic or is it not a pandemic? Since the world has never had a chance to make a call like this at the outset of a pandemic, nobody is quite sure how to handle it. The usual definition -- an epidemic (an increase in cases beyond what is expected) of global dimension -- has a lot of wiggle room and WHO and everyone else is busy wiggling. One reason is not whether this meets the definition or not but what the consequences might be of calling this "a pandemic":
Britain, Japan, China and other nations urged the World Health Organization on Monday to change the way it decides to declare a pandemic -- saying the agency must consider how deadly the virus is, not just how fast it is spreading.
The debate arose as WHO began its annual meeting, a five-day event attended by hundreds of health experts from the agency's 193 member nations. Swine flu is expected to dominate this year's conference _ and WHO must consider whether it should raise its alert level or tell manufacturers to begin making a specific swine flu vaccine.
WHO's current system focuses on how widespread the disease has become without regard to its severity. Some member nations are anxious to avoid having the agency declare a swine flu pandemic, because the ramifications of that scientific decision could be very costly and politically charged. (Frank Jordans, Washington Post)
The reticence is not mainly at the WHO level but at the level of its member states. There is also suspicion this reluctance is affecting how thoroughly or honestly some countries are reporting cases of infection with the novel swine flu virus within their borders. The idea that severity should be an additional criterion is (sensibly) being resisted by WHO:
"Severity and the broader impact on society is something that we really can't set globally, because of the unique conditions in every community," WHO spokesman Dick Thompson told the AP. "Severity is going to be different in different countries. And within a country, it will be different in different populations." (WaPo)
The argument boils down to this. We shouldn't call a pandemic a pandemic, because people might misunderstand that this means it's a pandemic. And then they would do things like panic, like UK officials are doing now when the prospect is broached we are having a pandemic. And since even the considerable wiggle room of the current definition of a pandemic is insufficient to avoid calling this one a pandemic, please provide us with some more wiggle room by adding severity to the mix, so we can then argue about whether the pandemic is severe enough to be a pandemic.
Two of the US's premier risk communicators have wryly taken note (via a commenter at The Flu Wiki):
In response, here is another modest proposal from Jody Lanard and Peter Sandman:
If WHO decides not to call a widespread "mild" swine-origin Influenza A/H1N1 pandemic a pandemic, then we believe they are obliged to announce that the H2N2 event of 1957 and the H3N2 event of 1968 were also not pandemics.
They should then announce that the last influenza pandemic occurred in 1918, and there have been no flu pandemics since that time.
WHO should also review the list of pre-1918 "pandemics" and decide which of those events were also not really pandemics, so we can re-calculate how many times per century, on average, a pandemic can be expected.
That way, we can be doubly relieved: Not only that swine flu H1N1 isn't a pandemic, but also that pandemics are very much rarer than previously thought.
Now if someone will please tell the virus, we're all set.