“We are far from out of the woods” seems to be the mantra among the public health officials who have to speak to the public. But for right now, it seems clear that this round of H1N1 is not nearly as serious as many initially feared. In this light, I wanted to provoke all those of you following this more closely to brainstorm a bit about what exactly the “lessons learned” might be from this event for different experts and policymakers, and what, for us, are the emerging sites of reproblematization, where existing undersatndings and practice are called into question.

One possibility is that there will be a certain amount of derision about the level of alarm that was raised. But my sense is that this will mostly be limited to late night comedy and right wing talk.

Another possibility is that there will be intensive discussions about the issues that Carlo has been raising, concerning the relationship between the current “phase” definitions and levels of political and medical mobilization and response. As Carlo wrote:

One of the interesting questions is the following: If this virus (which we are not allowed to name anymore …) continues to circulate among humans, will the WHO announce phase 6, i.e. a full-scale pandemic? With a virus that seems to cause not much mortality, this will be a difficult question. I really doubt that they will announce phase 6, even if all the criteria of phase 6 are essentially met. The pandemic alert scheme might soon need extensive revision …

A third area of reflection might have to do with interpreting the performance of health authorities in Mexico and drawing conclusions for global health surveillance. It seems to me that the initial sense is that once the Government got into its disciplinary lockdown mode, it did pretty well. But it is also obvious that everyone would have liked for there to be more laboratory capacity right at the beginning, such that the case and death counts would not have been exaggerated at the beginning. Everyone knows that basic public health surveillance globally is crucial to a global health preparedness system, but investment in basic lab capacity is a different issue.

A fourth area has to do with the question of how seriously to take H1N1 moving forward, what measures to take in preparation for a more serious outbreak, and what measures to take to prevent such an outbreak. In the former case, one key question is obviously going to be vaccine development. My understanding is that there is no decision about whether to proceed, but I don’t understand what the issues are. In the latter case there may be a whole series of questions, such as farm biosecurity. I have heard that one of the major concerns is large-scale transmission to pigs (again) which would create conditions for recombination into more virulent forms.

Thoughts on these or others?