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Rev. bras. epidemiol. vol.12 n.2 São Paulo Jun. 2009
Since 2005, RBE has been addressing the threat of an influenza pandemic. Initially, one of our contributors (M.R.Donalísio), in analyzing a seminar about it, pointed out that:
"Most human diseases originate from animal reservoirs. The existence of multiple reservoirs of the influenza virus in nature favors recombination of viruses that circulate in humans and animals or mutations of the viral genome, increasing the possibility for the emergence of new subtypes that the human population will be susceptible to". (December 2005)
In later issues, we continued assigning to the same researcher the responsibility of conducting a debate. We chose themes and debaters that addressed many issues raised by that threat. We considered then:
"The threat to global health is increasingly more present, with the description of flu in migrating birds and its dissemination in confined domestic birds affecting the people in Asia and, more recently, in Europe and Africa. We are publishing in this issue a special section coordinated by Maria Rita Donalísio, with several opinions of Brazilian experts on essential issues of this endemo-epidemic process. We are presenting: (1) The prospects of viral surveillance in Brazil, by Terezinha Maria Paiva, Airborne Virus Laboratory, Adolfo Lutz Institute, São Paulo; (2) Possible mutations of H5N1 virus and its adaptation to inter-human transmission, by Rita Catarina Medeiros Souza, from the Tropical Medicine Center, Federal University of Pará and Airborne Virus Laboratory, Evandro Chagas Institute; (3) Clinical aspects of the Avian influenza, Luiz Jacintho da Silva, from the Medical Clinic Department, College of Medical Sciences, Unicamp; (4) Efficacy of antiviral therapies in human cases, Dirceu Bartolomeu Greco, from the Medical Clinic Department, College of Medicine, Federal University of Minas Gerais; (5) Prospects for the production of the vaccine in Brazil, Isaias Raw, from Butantan Institute, São Paulo." (March 2006)
Next, taking advantage of the successive reports of the WHO, we gradually realized that the evolution of the pandemic already showed to be a less fearful threat than announced:
"Avian flu: epidemiology of cases of human infection by H5N1 virus" (June 2006)
"Ten things you should know about the flu pandemic" (September 2006)
"Update published by the World Health Organization (WHO) about the 261 laboratory confirmed cases (including 157 deaths) of Avian flu, distributed per country of occurrence" (December 2006)
Then, the pandemic became "unpopular", until it led us to hold back new and almost superfluous comments:
"The debate about the avian flu cooled down. We are presenting only the table of laboratory confirmed cases and deaths published by the WHO. With the possible opening of the influenza vaccine plant at Butantan Institute, in São Paulo, we will go back to the theme. (March 2007)
"In this issue, we are only updating the table of cases and human deaths from avian flu in the world, as published by the WHO." (June 2007)
Two years later, we are going back to that theme in this RBE issue in a different scenario, in which the changes occurred made it a "popular pandemic". We are going to undertake a new incursion into the theme, calling the same contributors as before, incorporating new ones that may provide a different approach of the way through which the new threat expresses itself. We should analyze: its probable origin (swine), the complex recombination of the virus A(H1N1), the geographical localization of its origin (Mexico) and, above all, the modern information technology that makes it possible to monitor the distribution of new cases in real time. The latter is the main difference and makes the current endemo-epidemic process the most popular of all times. All current means of news dissemination are being used, rather than just the usual reporting that used to circulate through the health information system.
Since the beginning, some novelties deserved to be highlighted. First, the difficult relationship of managers with the media gained a dimension different than usual. It is necessary to explore this new relationship, in which apparently there is greater respect for the interpretation of scientists and those in charge of public health. It goes against even the pessimism that thrives in some academic environments, where evidence-based policies are denied. Some skeptics prefer to consider that, at the most, policies can be "influenced" by these evidences or, the even more radical, that it can just be "informed" by them.
Another point to be considered leads us to the usual alternative explanations, including the ever present ideas about genetically modified organisms, that might have been released or especially produced by laboratories with ideas of bacterial war, or even due to market interests of vaccine manufacturers. These ideas have been systematically denied by the scientific world summoned by the global health authority.
Even more controversial has been the attitude of international vaccine manufacturers and their radicalism in fighting the position led by Brazil in the World Health Assembly and considering the results of scientific efforts "for the public good of humanity", mitigating the TRIPS agreement that rules on access to intellectual property.
Above all, we should emphasize the relevant and sober role played in this event by scientific journals. The New England Journal of Medicine stood out abroad because it has created a special section with free access providing a "health map" updated with information coming from different possible sources of information. RBE is joining them, willing to follow up the "popular pandemic" with the same moderation and competence. This is what we promise for the coming issues, when we will have a more accurate layout of its picture.
José da Rocha Carvalheiro