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Now is the time to rethink new flu tack

This month marks one year since the first confirmed case of the new strain of influenza in Mexico.

The World Health Organization held a three-day meeting this week, the first conference to reexamine past measures taken to deal with this new type of flu.

Though Japanese health authorities also have begun rethinking their approach to the illness, the government will have little choice but to review its countermeasures in preparation for a second wave of infections and an outbreak of the highly contagious bird flu, which is believed to be the real threat to humans.

WHO officials are keeping a close eye on how Japan has dealt with the latest outbreak of the new flu in an attempt to understand why Japan was the only country where infections remained remarkably low.

The estimated death toll from the new flu reached 17,000 worldwide--12,000 in the United States and a mere 198 in Japan, only 1.7 percent as many.

While the U.S. media was busy ridiculing Japan's extreme reactions as those of a "paranoid nation," the WHO called the small number of new-flu deaths one of the three mysteries of Japan. The other two "mysteries" are regarding how the country managed to contain the epidemic at such an early stage and why there were fewer pregnant women among the victims than seen in other countries.

Domestic health experts believe closing schools in the early stages of the epidemic helped stop the virus from spreading outside the Kansai region.

Part of the reason was that the new strain of flu was not as contagious, though infections were largely kept low through the nation's significant supply of flu medicine, which had been stockpiled in preparation for a bout with human bird-flu infections. Japan was the world's largest consumer of Tamiflu flu medicine.

Unlike the United States, Japan has national public health insurance, which covers everybody, in principle. This was a big factor in providing treatment to people who were infected.

However, the latest outbreak also shed light on the fragile structure of Japan's measures to fight infectious diseases. Most problematic was the confusion over vaccinations.

The government repeatedly changed its mind over how many shots each person should receive. It also was inconsistent on importing vaccines to offset an expected shortage and who would receive them first.

Though it was a matter of urgency, the Health, Labor and Welfare Ministry took a long time to make the decision. As a result, the country ended up with 106.5 million surplus shots.

It was partly because the ministry had been unwilling to promote vaccination due to side effects associated with past vaccines, such as MMR (measles, mumps and rubella).

Adding to that was the fact that within the ministry, several departments were independently handling vaccination policy, resulting in uncertainty over which had the final say.

Health, Labor and Welfare Minister Akira Nagatsuma saw the situation as problematic and decided to review measures against infectious diseases.

"How we fight infectious diseases is a matter of national security," he said.

First, the minister aims to revise the Preventative Vaccination Law in the current Diet session so the government will be able to deal more responsibly with low-pathogenicity infectious diseases such as the most recent outbreak of the new flu.

The ministry also will reexamine how to quell suffering from vaccination side effects and how best to spread the cost burden.

A point of regret, however, was that the government was forced to urgently import vaccines.

Nagatsuma told the Diet that the government would establish within five years a cell culture method that could produce a large quantity of vaccines.

The government also plans to rectify the lack of a government entity acting as "control tower" for vaccines. It plans to establish an entity like that in the United States, in which experts and public representatives make quick decisions about vaccines.

The envisaged entity will review by June the systems of quarantine, public relations and medical care.

As the new strain of flu is still rampant in some areas of Africa and South America, the WHO has not yet declared the new flu to have passed its peak.

In reality, however, the situation surrounding new flu appears to have calmed down.

Yet medical researchers warn that we must be wary of a new wave of the virus.

Research has confirmed that a mutation of just one of the amino acids in the new flu virus could make it more infectious. Because of this, the next outbreak could occur in a different form.

An outbreak of the highly pathogenic bird flu--which has killed 60 percent of infected humans so far and randomly struck in Asia and some other regions--cannot be ruled out.

Nobuhiko Okabe, chief of the Infectious Disease Surveillance Center at the National Institute of Infectious Diseases, suggests this period of relative calm should be used to prepare for future contingencies.

"Now that the epidemic has entered a silent stage, this is a chance to quickly rethink our tactics," he said.

(Hiramoto is a correspondent based in Geneva.)

(Apr. 17, 2010)
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