The World Health Organization acknowledged that the swine flu pandemic is finally over, long after many national authorities started canceling vaccine orders and shutting down telephone hot lines as the disease ebbed from the headlines.
The official death toll, once predicted to be in the millions reached 18,449 last week and WHO Director-General Margaret Chan said she agreed with experts that swine flu has "largely run its course." "This pandemic has turned out to be much more fortunate than what we feared a little over a year ago," Chan said.
While the Hong Kong-born U.N. health chief put this down to good preparation and luck, the virus didn't mutate as some feared the admission that swine flu isn't the threat it was made out to be could be seized on by critics who say the global body hyped the pandemic.
WHO received at least $170 million from member states to deal with the outbreak, some of which was invested in immunization programs long after the A (H1N1) strain was known to provoke only mild illness in most of those infected. Governments spent many times that amount buying vaccines and antiviral medicines that are now being junked.
WHO accused of overstating H1N1
Lawmakers in Europe have repeatedly accused WHO of overstating the danger of swine flu and playing into the hands of the pharmaceutical industry, which has earned millions from the outbreak since it began in April 2009.
Michael Osterholm, a flu expert at the University of Minnesota who has advised the U.S. government on pandemic preparations, said the criticism was unfair and WHO did the best they could.
"People are very skeptical of virtually everything that has to do with the government, the scientific community and when you add pharma into it, there is even more suspicion," he said, describing the outbreak as a "no-win situation" for WHO.
Chan insisted that declaring swine flu a pandemic last June was "the right call" based on the international health rules that existed at the time, which measure only the geographic spread of the disease and not its severity.
She acknowledged that changes may be made to the way WHO defines pandemics. "We need to review the phases, including the severity," Chan told reporters in a telephone briefing Tuesday.
Countries should remain vigilant
She cautioned against complacency, however, saying that even though hospitalisations and deaths have dropped sharply, countries should still keep a watchful eye for unusual patterns of infection and mutations that might render existing vaccines and antiviral drugs ineffective.
"It is likely that the virus will continue to cause serious disease in younger age groups," she said, urging high-risk groups such as pregnant women to continue seeking vaccination.
Unusually, swine flu hits young adults harder than the over-65s, who are believed to have some immunity to the A (H1N1) strain.
Chan also stressed the positives from the pandemic, such as the fact that the international community came to the aid of poorer countries unable to purchase vaccine stocks, and that as many as two in five people in some countries now have immunity to the virus.
Prof. Angus Nicoll, flu program coordinator at the European Center for Disease Prevention and Control, said the decision to declare the pandemic over was consistent with the Stockholm-based body's recent findings.
Health officials preparing for new flu
Health officials around the world should prepare for a new type of seasonal flu to appear in the near future that will combine elements of swine flu, an older A(H3N2) strain and several lesser types of influenza, said Nicoll.
Should that mixture turn out to be more lethal the swine flu, countries now have a better understanding of how to respond, according to Bill Hall, a spokesman for the U.S. Department of Health and Human Services.
"The most important lesson learned from this experience is the critical need for new influenza manufacturing processes," said Hall.
Chan, in her exchange with journalists, also raised the spectre of deadlier flu pandemics in future.
"Lurking in the background we still have H5N1," she said, a reference to the bird flu strain that has infected 503 people over seven years, killing 299.
Associated Press writers Daphne Rousseau in Paris, Kirsten Grieshaber in Berlin and AP medical writer Maria Cheng in London contributed to this report. (Sapa, Frank Jordans, August 2010)
Swine flu timeline