Harvard dean praises Mexican response to swine flu

By James F. Smith, Globe Staff

The winter flu season was winding down in Mexico and the number of cases should have been going down, too. But a high-tech command center in Mexico City, linking a nationwide network of 11,000 disease surveillance units, was picking up unusual signs of an uptick.

That triggered an investigation that isolated a new human virus. Then scientists in Canada quickly carried out complex genetic sequencing, and within a couple of weeks, researchers had unraveled the mystery of a new influenza virus that was spreading among humans, with potentially global consequences.

Dr. Julio Frenk, the former Mexican national health minister who is the new dean of the Harvard School of Public Health, said the 25-year-old Mexican surveillance system had worked just as it was designed to do, contributing to a sense of comparative calm in the Mexican capital though the swine flu has been blamed for 149 deaths in the country.

"People are responding very well," Frenk said in a telephone interview today from the capital. "The fact that the president himself has been leading the response to the emergency has sent a clear signal that this is very serious, and everyone needs to cooperate. The mood is: everyone wants to do his or her part in assuring that we bring this emergency under control."

Frenk said scientists around the world have been on alert for just such an outbreak since 2003, when the SARS virus emerged, followed by the avian flu epidemic two years later. Those events served as a global warning sign, and set in motion a huge push for preparedness in Mexico and elsewhere.

Frenk, who was in Mexico City for the weekend for family reasons, consulted today with government officials in the team that succeeded him when he left office in 2006. Among them is the man in charge of handling the epidemic, under-secretary for health Dr. Mauricio Hernandez-Avila, who also has a doctorate in epidemiology from the Harvard School of Public Health.

Frenk said the normally chaotic Mexico City traffic had disappeared, schools were closed, Masses were called off. But there was no panic as the country's emergency plan was invoked: "I would say that people are calm -- worried and afraid where this could go, but calm."

"In a sense, we have rehearsed this. There have even been exercises," he said. "We've been building stockpiles of antivirals. The response has been good because we've been following plans that were laid out globally."

Frenk, who was a top World Health Organization official before becoming Mexico's health minister, said one reason the cases had been more severe in Mexico than in the United States could be that people in Mexico tend to self-medicate for flu symptoms instead of seeing doctors, and that might have allowed the illness to progress. He said that now, however, the message has gotten through that anyone with flu symptoms needs immediate treatment at a clinic because antiviral drugs work well only if administered early -- within two days of becoming sick.

He said Mexico had built up very substantial supplies of antiviral medication, and the WHO was making more available.

Frenk said he was optimistic that the outbreak would be brought under control, not least because of the integrated network of specialists in Mexico, the United States, Canada and the WHO. He said that when the US Centers for Disease Control and Prevention developed programs to create systems for disease surveillance, Mexicans were the first to take the courses. "There's daily communications with the CDC in the US and Health Canada," he said. "For many years, the cooperation has been very, very intense."

Frenk noted that Mexico is a vast country of 110 million people, and yet the surveillance system was able to spot the outbreak of several hundred cases, locate the victims, and then work with Canadian specialists to identify the genetic makeup of the virus -- and then deploy the nationwide response.

"If you think that all of that happened in a couple of weeks, it is really quite amazing," he said.