What's next if WHO declares flu pandemic?

LONDON - The World Health Organization has been warning for weeks that swine flu is on the verge of flaring into the first flu pandemic in four decades.
Countries are on the lookout for cases, governments are buying anti-virals, and China has quarantined entire hotels full of people connected to cases.
But if WHO raises its alert to phase 6, the highest level, what exactly will that mean?
Because the word 'pandemic' often conjures up images of the 1918 Spanish flu, which killed up to 50million people worldwide, some people worry a phase 6 would automatically herald a catastrophic death toll.
For the moment, experts say, there could be greater danger in mass panic than in swine flu virulence.
WHO's pandemic phases only judge how fast a virus spreads -so moving from phase 5 to 6 doesn't mean the virus is more dangerous, only that it will be spreading widely in another region beyond North America.
So far, swine flu appears as mild as regular flu, meaning even if it does go global, there probably won't be millions of deaths. But health officials also warn that could change if the virus mutates into a more deadly form.
Since 1918, there have been two other pandemics. In 1957, the Asian flu killed about 2 million people worldwide. And in 1968, the Hong Kong flu killed about 1 million.
Some countries worried about global panic attacks over phase 6 are pressuring WHO behind the scenes to hold off on declaring a pandemic. Other countries may also be dragging their feet on testing, fearful that they will be the trigger for hitting the phase 6 threshold.
One reason is that a pandemic announcement would likely have severe economic consequences: it could trigger expensive trade and travel restrictions like border closures and quarantines, as countries not yet affected by the virus struggle to keep it out.
Under public pressure, extraordinary measures such as large-scale pig culls slaughters like the one undertaken by Egypt could be taken, whether or not they are scientifically justified.
At a recent meeting in Bangkok, 10 Asian nations asked WHO to revise its pandemic phases to consider a flu virus' severity before announcing a global outbreak.
"Countries that have been reluctant to do anything... will be up against the wall," said John Oxford, a professor of virology at St. Bart's and Royal London Hospital. "Their citizens will be asking, why haven't we got Tamiflu? Why haven't we got vaccines?"
Despite calls for transparent reporting, there are suspicions some European countries might not be moving fast enough to identify cases, slowing WHO's decision to declare a pandemic. As of Friday, WHO confirmed that worldwide, 34countries reported more than 7,500 cases.
For WHO, one of the most difficult decisions upon reaching phase 6 would be whether to start making swine flu vaccine.
With incomplete information about how deadly the virus is, WHO must gamble on whether the world needs regular flu vaccine or swine flu vaccine more, since large quantities of both cannot be made at the same time because of limits on global vaccine production capacity.
Regular flu kills up to 500,000 people a year. So far, officials aren't sure if swine flu's ultimate toll would top that or if the virus will fizzle out. Deciding which vaccine is needed more means guessing which virus will do more damage. And if the swine flu mutates into a more deadly version, it's uncertain whether any vaccine now will still work later.
That is a dilemma WHO grappled with this week in a meeting it convened with vaccine manufacturers and other experts in Geneva.
For developed countries that dusted off their pandemic plans when the swine flu crisis began - and have already stepped up their response systems - a pandemic announcement could be anticlimactic.
"There will be some initial concern, but I don't think a lot will change in phase 6," said Michael Osterholm, a flu expert at the University of Minnesota who has advised the U.S. on pandemic preparations.
With more cases detected in more countries every day, many experts think the declaration of a pandemic is inevitable.
"At this point, you have to expect that what happened in the US and Mexico will happen around the world," Osterholm said. "The virus is continuing to spread. I can't see how we won't get to a pandemic at this rate." - AP