The WHO on Tuesday said it was “getting closer” to declaring the H1N1 (swine) flu outbreak to be a pandemic, as the virus continues to spread to people outside of North America, and in populations “as far apart as Britain, Spain, Japan, Chile and Australia,” the AP/Washington Post reports (Jordans, AP/Washington Post, 6/2).

The WHO on Wednesday confirmed that 66 countries have officially reported 19,273 cases of H1N1, including 117 deaths. A full list of country cases and deaths is available here (WHO Influenza A(H1N1) – update 43, 6/3).

“We still are waiting for evidence of really widespread community activity in these countries, and so it’s fair to say that they are in transition and are not quite there yet, which is why we are not in phase 6 yet,” WHO’s Assistant Director General Keiji Fukuda said (AP/Washington Post, 6/2).

“Phase 6 is a declaration that many member countries have long feared could mean economic disaster,” CNN writes (Sloane, CNN, 6/2) because, as Bloomberg describes, it “may spur some countries to restrict travel, ban public events and adopt other measures that aren’t needed for mild flu, worsening the deepest economic slump since the Great Depression.”

Michael Leavitt, former HHS secretary, said, “The formalization of an influenza pandemic does have cascading consequences…The decision ought not to be taken lightly” (Gale, Bloomberg, 6/2).

Such concerns have forced the WHO to reevaluate the pandemic alert scale – a tool that takes into consideration the geographic spread of a new virus, but not its severity (Kaiser Daily Global Health Policy Report, 5/26). Sources “familiar with the agency’s plans” said WHO Director-General Margaret Chan and her colleagues spent seven hours “consulting experts on how to explain that swine flu is global, but not severe. … [S]ometime in the next 10 days, [the WHO] will declare the first flu pandemic in 41 years, said the people, who spoke on condition of anonymity because the WHO’s deliberations are private. WHO is using the time before the announcement to help member states prepare,” according to Bloomberg (Bloomberg, 6/2).

If the WHO “declares [swine flu] a Level 6 pandemic, Dr. Fukuda said, it may add a caveat indicating that the virus is not very lethal,” the New York Times writes. “Still, measuring severity can be tricky because the same flu virus may theoretically kill far more people in a poor country with widespread malnutrition and AIDS than it does in a wealthy, well-fed nation” (McNeil, New York Times, 6/3).

World Bank Approves $500M For Low-, Middle-Income Countries To Prevent, Control Outbreaks

The World Bank on Tuesday approved $500 million to “expand an existing fund to help developing countries prevent and control outbreaks of influenza, including the new H1N1 virus,” Reuters reports (Wroughton, Reuters, 6/2). The money expands upon the World Bank’s preexisting $500 million credit line created in 2006 to help countries to deal with the H5N1 (bird) flu. “Low- and middle-income countries can access the financing to pay for drugs, medical equipment, hospital care, human and livestock health surveillance, and offset the economic and social costs associated with pandemic flu, the bank said in a release,” according to Dow Jones Newswires/Wall Street Journal (Barkley,  Dow Jones Newswires/Wall Street Journal, 6/2).

“This is a particularly bad time for a pandemic to occur given that developing countries are more vulnerable now because of the compounded effects of the food, fuel and financial crises,” said Jeff Gutman, the World Bank’s vice president for operations, adding, “The worst-case scenarios for pandemic flu point to a significant economic impact, with poor people in developing countries likely to be hit hardest” (Xinhua, 6/2).

Obama Requests Additional $2B From Congress To Deal With H1N1

President Obama on Tuesday requested from Congress “an additional $2 billion to address the H1N1 flu strain circulating around the United States,” Reuters reports. The funds would be in addition to Obama’s previous request of Congress for $1.5 billion request for the purchase of antivirals, vaccine development and other preparedness equipment. In a letter to House of Representatives Speaker Nancy Pelosi (D-Calif.), Obama described his request for additional funds as being “out of an abundance of caution,” adding there “remains much uncertainty about the outbreak and its potential to return during the upcoming flu season in the United States” (Allen, Reuters, 6/2).

U.S. Feds Award $90M Contract to MedImmune For H1N1 Vaccine Development

U.S. health officials on Monday awarded a $90 million contract to the pharmaceutical company MedImmune – makers of seasonal FluMist vaccine – to develop a vaccine that offers protection against the H1N1 (swine flu) virus, the Washington Post reports. The article explores the differences between an H1N1 vaccine developed by MedImmune to the more traditional flu vaccines made by Novartis, Sanofi Pasteur and GlaxoSmithKline – all recently awarded H1N1 vaccine contracts, including that MedImmune’s H1N1 vaccine would be administered nasally and could produce a stronger immune response to the virus (Rosenwald, Washington Post, 6/2).