Why not level 6? WHO press brief

By Dr Keiji Fukuda, Assistant Director-General ai, Health Security and Environment.
May 26
(Q&A)
Donald McNeil: I wanted to follow up on David Brown's question. He asked, I thought sensibly, why not bite the bullet and raise it to level 6 if it meets level 6. The response was: what is the gain, this could be the panic, this could be the cynicism, but isn't that the other danger is that if WHO changes its rules in the middle of the game, and appears to bend with the political pressure, that you create cynicism as well. If it looks like WHO will bend with the political pressure then it might do it with another public health crisis and there is a loss of confidence in WHO. There are other times when this question has been raised, for instance, when there might have been room for criticism with China doing during its silence in the early days of the SARS crisis, there might be criticism now with Indonesia for withholding viral samples. Isn't it important for WHO to maintain its credibility by sticking
to its rules when it sets them?

Dr Fukuda: I think that there are clearly a number of issues in balance here, but among all of them, probably the single most important one is: “What actions can be taken, should be taken that are going to help people? What actions are going to make people safer, what actions are going to reduce the chances of harm?" When we go back and look at the current situation and also when we look at past situations that have been very difficult – and one of the most famous one was back in 1976 when we had the [unintelligible] swine flu influenza – when we go back to that event, one of the overall big lesson, perhaps the single biggest lesson from that whole episode is: “Take stock, take a look at what the reality is saying and do not put yourself in a hole and just leave yourself there”. You need to take stock of actions over and over again. In this situation here, we have a situation where we have a virus spreading which is significantly different than avian influenza, significantly different than H5N1, we have a situation in which countries are saying “”We want you to take a look at these criteria because if you apply then in the wrong way, they may not help us. In fact, they may cause more difficulties.”

When we look at those issues and when we look at the complexities of severity, and the complexities of defining trigger points for moving up, then it seems like it is a reasonable thing to take stock, take a look at the situation and say “really, what is the best way to proceed here.” It would be possible to simply say, well, because something is written down, we need to just follow those, that is the most important principle. But really if you take the perspective that the bottom line is what is it that we are going to do which is going to be helpful for people, which is going to be helpful for countries, then I think, hopefully, it puts it more in perspective of why we are looking at this so seriously. Why we are considering what is important in moving up.

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