Wednesday, June 10

H1N1/swine flu: Lost in WHO's wonderland

For readers who saw yesterday's post in the early afternoon: around 3:30 PM ET I added two photographs supplied by RBO. And I added text to accompany the photos although that was hardly necessary. Taken together the photos speak volumes about the vast difference between the U.S. and China's approach to fighting swine flu. China got an efficient flu fighting corps. America got Elmo.

Before I turn to WHO, a few notes:

From reader CGardner: "As promised, I researched where the additional monies for H1N1 that Obama promised was sitting. It's in the Supplemental Budget Bill (primarily for funding the Iraq and Afghani wars) and appears to have grown at least to $3.5 billion. As you see in this article, what these dollars will fund remains very, very vague."

Pandemic Information News blog has been carrying news reports about swine flu that the mainstream media in the USA have missed. Two June 9 reports from PIN:

  • In Canada the outbreak is hitting hard at the aboriginal population; there are reports of a disproportionate number of serious cases occurring among Inuit communities. This pattern has been noted in earlier pandemics and it's raising concerns that swine flu will hit hardest at 'vulnerable' populations in Africa and South America.

  • Yesterday ScienceInsider reported that six sub-Saharan countries have suspected swine flu cases.

  • In Egypt the emergence of swine flu has prompted at least one doctor there to demand the "abolition" of the Hajj, which this year will take place in late November. The pilgrimage to Mecca, attended by Muslims from all over the world, is also the world's largest annual pilgrimage.

  • The report posted by PIN is a bad machine translation from the Arabic but I think the gist is that there's concern that by bringing together large numbers of people from so many nations, and in such crowded conditions, this will increase dispersal of swine flu around the world.

    For those wondering why it's taking WHO so long to raise the pandemic threat level to its highest, this May 3 Associated Press report titled Politics play big role in World Health Organization's decisions will answer the question and many others.

    To boil it down the organization has no teeth and that's the way governments want it. But WHO has a voice and they're expected to use it in times of crisis. My worry is that Margaret Chan, the current director-general, is a little too consensual in her approach and too focused on the negative economic and diplomatic effects of officially declaring a swine flu pandemic.

    Granted, governments do tend to get hopping mad when WHO issues advisories that if followed cause loss of trade and tourist income, which helps explain why WHO has been walking on eggshells since the swine flu outbreak.

    Early on Mexico's government hurled the "discrimination" charge at governments that suspended flights to Mexico. And until Mexico's government realized that China was quarantining every inbound airline passenger who had a suspected case of swine flu, they huffed that China was being discriminatory toward Mexicans for quarantining a group of them.

    However, the AP report dredges up some history that should be applied to the present situation:
    "WHO is in an incredibly difficult position," said Richard Horton, editor of the Lancet medical journal. "On the one hand, its entire modus operandi is that it responds to government requests. But in this situation, what governments might want may not align with what WHO thinks is best."

    Horton cited the 2003 SARS outbreak as a prime example. When the illness began spreading in Toronto, WHO issued a recommendation advising against non-essential travel to Canada's largest city. Similar recommendations were made for cities including Hong Kong, Beijing and Taipei.

    The recommendations sharply cut travel to affected economies, dealing them a big economic blow - but the aggressive WHO action was credited with being key to containing the illness.

    The advisory incensed Canada, and Toronto's then-mayor publicly lambasted the agency, declaring it had no right to issue such guidelines. A delegation of Canadian diplomats and journalists flew to Geneva and camped out at WHO's Geneva headquarters, forcing the agency to reconsider - and eventually lift - the advisory.

    "I suspect the reason WHO has been very reluctant to make any comments about travel (during the swine flu outbreak) is because of that experience with Canada during SARS," said Horton.
    I think Horton's suspicion is correct. But if WHO officials see their position as "incredibly difficult" they need to keep in mind that WHO is not a trade or tourism association -- or government.

    The best WHO can do is carry out their mission statement and if governments howl, that's not WHO's problem. They just need to do their job and stop wiffling and waffling about matters that shouldn't concern them.

    Why is that concept hard for so many moderns to grasp, I wonder? I've noticed that many people in modern societies have a tendency to split their mental focus between making a declaration and trying to predict and control responses to the declaration.

    That's an easy way to drive oneself and others to distraction and create needless problems.

    Look at this statement by Dr Keiji Fukuda, an assistant director general at WHO:

    "One of the critical issues is that we do not want people to over-panic if they hear that we are in a pandemic situation."

    Fukuda is an epidemiologist. How did he get elected Panic Minder to the world?

    And yet he and Margaret Chan have wrung their hands for weeks over imagined outcomes of their decision to raise the pandemic threat level.

    Indeed, all I've heard during the past month from Fukuda and Chan are explanations regarding why they want to be cautious about raising the pandemic alert level to 6. What, then, are the reasons for having a pandemic index?

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