Does WHO need to declare flu a full pandemic?

By Laura MacInnis - Analysis

GENEVA (Reuters) - With most people breathing easier about H1N1 flu, the World Health Organisation finds itself in a bind about how to respond to the continuing spread of the virus whose effects have proved mainly mild.

The United Nations agency's guidelines state that as soon as the virus starts spreading freely in two regions of the world, its six-point pandemic alert should be raised to the top notch.

With infection numbers rising in Europe, public health experts are struggling to decide whether it is worth sounding the full alarm over H1N1, which is treatable with existing drugs and appears less severe than seasonal flu in most cases.

"It is a judgement call," one WHO official said when asked about whether the global alert needs to hit its top rung.

WHO Director-General Margaret Chan raised it to level 5 -- signalling a pandemic was "imminent" -- last week after the flu strain that killed young adults in Mexico emerged in the United States and Canada and spread from schools to communities there.

Under the rules, just one country outside the Americas needs to have a community-level outbreak of the new strain to trigger a Phase 6 designation indicating a global pandemic is under way.

Chan has sought to prepare the public for the declaration of a full pandemic of H1N1, which is widely known as "swine flu" and also contains pieces of human and bird viruses.

"Level 6 does not mean, in any way, that we are facing the end of the world," she told the Spanish daily El Pais this week. She stressed that the alert ladder indicates how likely the virus is to spread around the world, not how dangerous it is.