There seems a consensus here, and in other like forums, that the WHO is deliberately witholding important data, misrepresenting results and hiding h2h transmission. I may be naive but I have to ask why do people think they would do this ? I mean, I like a conspiracy theory as much as the next guy but what has WHO to gain by allowing countries, businesses and individuals to remain unprepared for a full pandemic ?
I believe that the theory goes something like this: if the WHO raises the pandemic threat level many plans come into play (borders closing, etc) which would have a huge economic impact. There may be powerful people out there who don’t want that to happen in the absence of what they might consider to be ABSOLUTE PROOF of a pandemic threat. Unfortunately, waiting for that sort of proof (like major outbreaks of H-H transmission) will only mean that it’s too late anyway.
another theory is, that the news of bird flu might cause fear of quarantaine, people trying to flee before it’s too late and thus making containment harder.
Okay ,fair observations. But as a follow up can I ask does anyone in this community believe that such measures as border closings, quarantines etc are warranted at the existing level of threat. If not, could it be argued that the WHO strategy is actually appropriate - whilst accepting that it is extremely irritating to have our intelligence insulted by their daily obfuscations.
If the system they have set up (pandemic alert phases) is flawed, why not change the system rather than obfuscate? Perhaps that is a naive view, but it makes more sense to me that the system be updated to recognize the “real world” situation than for them to basically ignore it.
Entirely a tangential comment: my favorite bumper sticker --- “Eschew obfuscation.” Maybe we should send a few to WHO.
I guess if you wandered the corridors of WHO saying eschew, eschsw, they’d instantly put you in isolation and dose you with Tamiflu……….. More seriously perhaps WHO would say that they are recognising the “real world” but trying to best manage the world’s response.
Containing a Global Pandemic? 28.01.2006 World Economic Forum Annual Meeting 2006
David Nabarro speaks:
“Only as governments have started to do simulations on what happens in each stage of a pandemic have countries realized that they are nowhere near prepared for the damage this might cause, he said.”
Furthermore,
“Nabarro said there will be a very clear statement from the World Health Organization when a pandemic does start and he cautioned people to wait until the official notification occurs. He warned against false alarms which could cause panic.”
So….
Nabarro trusts WHO’s executive / technical judgement to change Pandemic Alert Phases.
The keystone of the next Phase Alert change is evidence of h2h transmission. That said, it’s not clear what evidence of h2h would / should mark that change. It’s as if everybody seems to know what weak h2h might be, but nobody can say in advance how it might be detected.
It’s not known (and probably not knowable beforehand) what events and increments of time might transpire between some moderate Phase 4 h2h development (above) and the “strong signal” of sustained h2h transmission expected at the onset of Phase 6 pandemic conditions. Still, WHO seems to believe that uncertain interval should allow ample time for preparation.
By its own recent admission, WHO is presently incapable of exercising global executive authority in case of pandemic influenza.
The world is “nowhere near prepared” in case of pandemic influenza.
Governments and other agencies are taking action mostly out of public view to be ready in some sense for pandemic conditions. Absent offical WHO declaration of a Phase 4 Alert, preparations have been made - are being made - to be implimented later by Emergency Authority.
The challenge of preparing for the threat of a pandemic is that people cannot imagine what it could do to their administrations, businesses, homes and health systems, said David Nabarro, UN System Senior Coordinator for Avian and Human Influenza, United Nations, New York. Only as governments have started to do simulations on what happens in each stage of a pandemic have countries realized that they are nowhere near prepared for the damage this might cause, he said. Businesses are perhaps more advanced, he added, because large companies have had to think through what disruption might do. Nabarro said there will be a very clear statement from the World Health Organization when a pandemic does start and he cautioned people to wait until the official notification occurs. He warned against false alarms which could cause panic. At a meeting last week in Beijing, the emphasis was on improving animal health services, he said, because world veterinarian services currently are inadequate and almost 75% of new infections of humans in the next decade are expected to come from animals. Without good veterinarian services, diseases cannot be detected. Massive public information campaigns about the threat from animals are also important. “Children should not be dying because they have been playing with sick chickens; they should know that a sick chicken is a biological hand grenade, a very dangerous creature.”
they don’t bother about our intelligence, they are there for the unsane;-)
BTW. I had already suggested that they should have more than 6 phases, but people only ridiculed. They could go to phase 3.8 now …
just so we’re clear, I am asking do people believe that WHO is deliberately suppressing factual information or hiding current levels of WHO transmission - if so what is their thinking for doing this ?
Stop being arm chair quarterbacks!
It is not being passed H2H now!
Stop your FEARMONGERING!
get off this website and live your lives.
irisheyes,
Actually there is no consensus. I for one do not think there is any deliberate cover-up, not in the sense that some people got together behind closed doors and organized it. But there are serious institutional limitations in the command and management structure of international organizations. You won’t be able to find the efficiency or sometimes even the same standard of excellence that you would expect from modern national level bodies in such a large lumbering machinery.
Plus the WHO is a UN entity, whose mandate is based on consensus between the governments of 190+ member countries. As the majority of these governments are not democracies, the person who sits in the voting chair often does not represent anything other than that government’s interest, not necessarily their countries’ interest. Often its a case of horsetrading and compromise.
It’s not perfect; it is only what is available.
My thinking is that we don’t have to like the WHO. It is certainly good to offer criticism where criticism is due. It is necessary to interprete its utterances and reports within these contexts. And then get on with your life.
My short cynical take on the WHO is this : I trust the WHO to be the lowest common denominator. I trust that it will say SOMETHING when TSHTF. Anything you get beyond that is bonus.
Anon-22, very clear - thanks for taking the time to explain
Has WHO published the protocols of their
“investigations of several clusters of childhood cases
in families from the Dogubayazit district”
“Field investigations, including interviews with family members.”
“Monitoring of patient contacts and of staff at hospitals”
“Three teleconferences on a virtual network of clinicians”
which they claim having done ?
Doc watgone – at 05:29 “Stop being arm chair quarterbacks! It is not being passed H2H now! Stop your FEARMONGERING! get off this website and live your lives.”
Damn, Doc. wish I could stay home from work and post all day but my boss would freak out worse than you. You seem to have faith in the team (sticking with your sports metaphor WHO, governments etc) Have you followed their adice to prepare for the “inevitable” (their word not mine) pandemic? I assume so since you have such faith in their quarterbacking ability. Don’t let it bother you that folks here like to discuss things. It’s the essence of a free society. Now China, that’s a different story. Your advice would fit in well there. :)
…..i’ve been on holiday in Thailand for two months now and it seems that the frequency of poultry infections has either declined drastically since I was last here or is not being reported as much. Have any of you guys heard any news regarding Thailand in the last few months….?…..it appears to be very quiet over here at the moment and what with the Thais fascination for cock fighting I find it quite difficult to believe that there have been very few outbreaks recently. The same goes for Vietnam I guess. Haven’t heard anything from there for quite a while. A friend has just come back from Hanoi and has told me that restaurants were not serving chicken (granted, this was before the Lunar New Years celebration there)….do you think it’s possible that the Vietnamese are taking this far more seriously than either Thailand or Indonesia…….?
I’m with anon_22 in all respects. There’s no consensus WHO is hiding anything (there can’t be if anon_22 and I agree). There is suspicion because Indonesia and Turkey clusters suggested the possibility of stage 4 (which has been loosely defined), yet we’re officially at stage 3. (And there’s always China, which no one feels we have a handle on).
Some of the posters are more suspicious than others. Some don’t (IMHO) recognize how long things take, like lab samples for confirmation, or field confirmation of exposure for epidemiological purposes, so we get frustrated when there’s no news (is no news good news or no news or surpressed news?). And WHO and others have not been terrific about making public all available data on seroprevalence and sequencing (though what’s WHO’s responsibility and what’s national responsibility is also blurry).
But many posters simply have a natural suspicion of government in general. One thing that WHO has been doing is more frequent and more detailed updates, and that’s a good thing which I hope will accelerate and continue. That should help, at least, with the no news conundrum.
I don’t think the WHO is committing overt fraud, ie, making stuff up out of whole clothe. Nor do I think the people doing the investigations are bad people. The problem, I think, is that the leadership, particularly the Director-General and the flu pandemic czar, are incompetent. They got their jobs through political connections, rather than merit. So, their first impulse is to satisfy their political masters, not safeguard the health of the world. They’ve backed themselves into a corner by linking phase 4 to travel warnings (don’t go to agree with outbreaks if not necessary). Rather than admit this was a terrible mistake and acknowledge that we are at phase 4 but that border closings would be premature, they manipulate the data and omit facts like disease onset dates and the relationships between infected individuals. A classic sociopath move. The consequence is that the nation-states do not ramp up their preparedness. Their plans are yoked to the WHO phase system. So, regardless of verbal warnings to increase preparedness, no nation will significantly increase preparations until the WHO raises its alert level. The end result is that millions of people will die unnecessarily because of the careerist machinations of a few people.
anon_22: I don’t agree that we can’t expect any more from an international institution. I consider myself an internationalist and very much want the WHO to work. The solution, IMO, is an external review committee of the best scientists, perhaps chosen by their national academies who would review WHO operations and make their findings public. In the meantime, the best way to help the honest, competetent scientists at the WHO, is to shine a bright light on the problems with the leadership.
Read this url if you think WHO is trustworthy. http://www.recombinomics.com/News/01220601/H5N1_Kocyigit_Ozcan_Timeline.html Three related families and a time line that indicates a large cluster with H2H transmission. WHO has intentionally not reported this data. We are at stage 4 in the mideast. (Sorry about the length of the URL.) There is a need for differential reporting such as Lab id, clinical presentation, those on virus meds or some such.
We have debated this at length and are familar with the worrisome clusters. We are also very familiar with Dr. Niman and his work on this topic.
Dr. Niman’s strongly held views don’t make him right or wrong. The clusters are worrisome but not proof, any more than the Indonesia zoo exposures were proof. In each case the new cases stopped, but many questions remain.
we await proper field investigation before drawing conclusions which may or may not be supported by data.
The question seems to be the trustworthiness of WHO. Nieman’s opinions to the side, he has done his homework. If you plot the data as shown there is a very strong suspicion of h2h transmission in this instance. WHO did not report it and WHO’s integrity comes into question when it apparently is not forthcoming about the situation. It would seem that WHO is setting unnecessarily strict guidelines for what is and is not reported. This situation leads to a loss of credibility (as indicated by some in this thread). My wife says that when everyone is calling you a jackass perhaps you should turn to see if you have a tail. Who’s unstated polices are suspect and this is not a good situation.
JoeW, that’s a plausible explanation. An equally or more plausible explanation is that proper investigation takes time, and those doing the investigation don’t yet know and therefore are waiting for field data, interviews, serology, etc. before drawing a conclusion. WHO has repeatedly said that’s what they’re doing (‘investigations take time’) though they aren’t transparent about details. Their latest statement on Turkey specifically addresses the testing conundrum, for example, which we are also very familiar with.
Given what we know, there will be people who take it the way you do, and people who take it the way I do. That goes to the heart of the original comment, and shows there is no onsensus about WHO’s standing on these threads.
Dem, you would also doubt that e.g. the universe expands due to lack of data and suggest we should wait another 10 billion years. There is suspicion→evidence→proof and everyone has other definitions, but clearly this is a continuous process. There can be small evidence and big evidence and if you always subsume both under “lack of data” your assertions will lack of content. I wished you would dare to speculate a bit, occasionally.
DemFromCT: No scarasm intended — who is the “we” in your post? Do you represent a group or is it simply the royal we?
1. We are possibly on the threshold of a major world changing event. 2. Nearly all countries have said that transparency and rapid reporting are essential. 3. It could be expected that a rapid deployment of qualified personnel is important. 4. The Turkish problem began over Christmas 05 5. First death is Jan 1 (or so) 6. Other admissions in this large related cluster begin with suspected h2h on Jan 1 (or before) 7. Given the large size of the cluster it could be expected that something would be presented by WHO. 8. It takes 2 days to deploy a team (assisted by locals) 9. It should not take more than a few days to survey everyone involved for clinical symptoms, routes of transmission, contacts etc. 10. Rapid presentation of information is necessary because other countries will need the results. 11. The public needs the results for preparedness without starting a panic. 12. One month with no news at all from WHO is far too long to determine if we are on the edge of stage 4 or in the middle of stage 4 (see also Iraq and the lack of transparency there). 13. It would be helpful for everyone to know what is under investigation as one gage of the potential pandemic.
There is a difference between scientific significance and clinical significance. Clinicians (of whatever persuasion) need to act much sooner on less firm ground. So who is running the show and what constitutes “proof” to one is not significant to another. Politicians use whatever serves their purpose.
I hope that we will not have to confirm large clusters in several countries by lab work, reviewed by peers across several labs before we declare a shift in stage.
We are in potentially serious trouble here and transparency is the order of the day. WHO needs to give serious consideration to what it presents and when the information is presented. There are far too many “interested parties” with vested interests influencing the decision making here. There is a need for responsiveness to the public that assumes the public can handle it – we usually do.
As a “well educated” scientist with many years in the sciences, I do not trust WHO’s work at this point. I doubt that I am too atypical.
Playing devil’s advocate, last year when things were happening in China people on this site were insisting that WHO should move to level 4. When Turkey happened people were saying ‘it’s happening, we are in the pandemic phase’. Both times they appear to have been wrong.
Monotreme, thank you for raising the point about the effect of not declaring stage 4. This is a good illustration of what I meant by governance by lowest common denominator.
If you look at the pandemic staging definitions of stages 3 thru 6; whereas 3 and 6 are relatively easy to recognize, the transitions from 3 to 4 to 5 to 6 are defined so loosely that you can drive a tank through them. I don’t know how they arrived at these definitions, I would imagine it would be the normal tradeoffs between science, economics, politics, and simple bloody-mindedness between too many parties with vested interests. (BTW it would have been interesting to be a fly on the wall when they hammmered out the definitions.)
The result, of course, is a system that, like the League of Nations before the UN, will turn out to be a lot weaker than promised by its lofty principles. But since individual countries for better or worse have subscribed to such principles and willingly joined the club, there is at least some perceived need to pretend it’s all going to work and we all need to co-operate with the ‘international community’ (remember that one?).
Now with this pandemic threat being unprecedented, policymakers have had to make things up on the fly. Stockpile tamiflu? Let’s do it. More vaccines? Sure, only we need lots of carrots to feed the beast called Big Pharma or they won’t play ball. More transparency (someone else’s of course, not ours, like China)? Of course we will call for that. (BTW ‘calling for’ something is a great all-purpose get-out-of-jail-free card. Don’t leave home without it.)
Close borders? Well, we don’t know about that one, probably not going to work. Oh you guys are freaking out? OK maybe we will do it but we won’t be held responsible for getting the timing wrong cos its shit either way, so let’s follow the WHO’s guidelines. (see what I mean by lowest common denominator?)
Now it’s the WHO’s (or the Director General or what-have-you) turn to freak out. OMG I thought these were just words on paper, to be filed in the giant vault in New York. We churn them out by gazillions every day (kept the good-ole mother country’s papermills running, bless them) and we never thought anyone was going to take that seriously. Quick let’s go look up resolutions no 456.12, 860.XX, 609.38, we need to know what exactly our mandate is. OK, Mr Secretary Geek from Mumbojumbo Republic, you have been studying these resolutions everyday for 32 years and you still don’t get it? Well then shhh don’t tell chances are no one else can either.
In come the scientists (in shining armor, bless their sweet souls) and say H2H. DG (Director General) cowers behind his desk. Mr Secretary Oh-So-Clever Geek pulls him out and whispers in his ear, not to worry, just do the ‘No Evidence’ show. That buys you at least a couple of months, couple of years if you are lucky, yes you might be able to hold it off till your Nobel ceremony.
So off we go again on this pass the god-damn hot spud game. Round and round in no man’s land. Of course we at the WHO are soooo new at this; those folks over at IAEA have had a lot more practice, they can keep the darn thing going right through the nuclear winter, keeps one warm, you know.
Conspiracy? Who, me? Cover-up? You kidding me? Too much work. Parties at Kofi’s apartment are more fun.
See you later.
LOL. And there you have it. JoeW, I don’t speak for the board, but there’s a group on the board who perhaps agrees with me and a big group wo don’t. That’s my definition of lack of consensus.
I think there are suggestions that Tony Blair take Kofi Annins place. WHen is his term expired as Prime Minister. (outside of a vote of no confidence in your parliment?) Any English participant here know? I think he would be a vast improvement. I beleive Bill Clinton is pressing for this.
Who’s definition of Stage 4: Evidence of increased human-to-human transmission. The problem here is: 1. The definition of “evidence.” 2. The definition of “increased.”
To have a thoughtful discussion we all need transparency with regard to the data. The situation in China, Indonesia, and Turkey are all less than clear. I am lobbying for WHO to take responsibility for presenting all of the data. They can discount or provide caveats as needed but we all need access to the original data. Their estimate of which stage we are in is another estimate to be used by all of us as we see fit.
It looks like Turkey and the Mideast are entering Stage 4. With the lack of data presented and a lack of transparency on the part of WHO, it is best to be conservative and prepare for difficult times. It is expected that this virus is going to move fast and time is important. The virulence problem is up in the air and unfortunately, I wonder how transparent WHO has been on this problem. Lose credibility in one area and it goes out the window in all areas. This is a serious problem for WHO.
I don’t disagree with any of what you said. I might use “it may be” for “it looks like”, but the transparency piece is unassailable. I just cut them more slack regarding speed, as they are cautious and with good reason. SARS cost Canada a bundle, and they’re still not happy about WHO’s restriction on travel. plus, lab test turnaround is not instantaneous.
Anon,
I’m not sure why “they” would be wrong. As far as I know, there are no time parameters for any phase. Since it’s not been possible to study the emergence of any previous pandemics, how could there be?
And besides, isn’t Phase 6 the pandemic phase?
“I’m not sure why “they” would be wrong. As far as I know, there are no time parameters for any phase. Since it’s not been possible to study the emergence of any previous pandemics, how could there be?”
Exactly! People who will not commit themselves will never be WRONG. So it is with systems or definitions.
It doesn’t matter whether there had been emergence of previous pandemics, the definitions still leave too many problems…or opportunities for some.
Grace RN provides a report suggestion caution is on occasion called for and justified.
“GENEVA, Jan 31 (Reuters) - The number of people infected with bird flu in a recent outbreak in Turkey may be only 12 rather than the 21 reported by local authorities, the World Health Organisation (WHO) said on Tuesday.
Tests on samples from Turkish patients, analysed over the past few weeks at a WHO collaborating laboratory in London, confirm only 12 cases of the deadly H5N1 virus, with the other results negative so far.
The information indicating a smaller case load in Turkey would also mean that the four bird flu deaths — now confirmed by laboratories in both Ankara and London — would translate into a 33 percent mortality rate….”
---
Wouldn’t you want data before drawing conclusions about which stage we’re in, case fatality rate, etc. ?
Lily, “I think there are suggestions that Tony Blair take Kofi Annins place. WHen is his term expired as Prime Minister. (outside of a vote of no confidence in your parliment?) Any English participant here know?”
Tony Blair can’t take Kofi Anan’s place. The position is offered to candidates from different continents in turn, and it will be Asia’s turn next.
Good point re SARS and this needs to be taken into consideration. Perhaps what is needed is a clear definition of WHO’s role and function by department/ section. What would help is a clear definition of what data are presented, when, under what conditions. Currently their definitions are so restrictive (based on political considerations?) that they loose credibility.
One section/ department should be clearly independent and its function should be for reporting purposes only. A department/ section with no consideration for policy would go a long way towards improving credibility. I would go further and suggest that it should be staffed by clinicians and scientists for reasons previously outlined.
By the way, I do think that many people read or at least monitor these posts and so suggestions are heard in many places. Refinements are undoubtedly needed but something like the foregoing could work to build a highly credible system
Brain storming does work or so said Joe
JoeW, agreed and thanks!
For a hitchhiker’s guide to the UN, add these to your prep list
“Tower of Babble : How the United Nations Has Fueled Global Chaos” by Dore Gold,
or
“Deliver Us from Evil: Peacekeepers, Warlords and a World of Endless Conflict “ by William Shawcross.
:-)
Raven, Irisheyes, thanks for the giggle re eschew! eschew!
I too don’t believe WHO is part of any grand, deliberate cover up. I think that for the most part, they’re doing a pretty good job in the face of a massive challenge. But having spent much of my career trying to get “the truth” out of all sorts of officials and all sorts of organizations, I realize that delivering “the truth” is only one of many, many competing — and compelling — pressures on WHO or any other organization.
And what is “the truth” anyway? I’m sure there is as wide a range of views about that at WHO as there is right here at Flu Wiki. If most of us favour a particular view, it doesn’t necessarily mean we’re right either. Whose version was the right one, in my experience, doesn’t often get resolved until the post mortem.
Good points, Name, as always. There’s always room for criticism, and we all want transparency. That’s the consensus position if there is one.
I don’t know about the truth, there are many ways to pursue it. However, while the FBI Uniform Crime Reports (UCR) have their problems (“who” reports “what” based on local definitions) the system for reporting “crimes known to the police” is pretty good. It is apolitical and does provide information for various decisions made by lawmakers and department heads. The UCR distinquishes between arrests and convictions. This is more or less information depending upon one’s definition of the truth. Something similar could be used by WHO to report the data.
I think the WHO’s case reporting system and Pandemic Alert levels were intended to provide that sort of objectivity. But awaiting the results of slow testing in a rapidly unfolding “situation” inevitably has its problems (the parallel would be waiting for a court convinction in crime reporting). That’s why they deviated from policy and started also reporting cases confirmed in the Turkish labs.
Also, the WHO system of alert phases was designed around best guesses about the likely pattern of an unfolding pandemic and we still can’t say if a real pandemic would mirror that pattern or whether we’d skip from Phase 3 directly to Phase 6, causing serious problems for all the govts and people who planned to do all their prep in Phase 4 - 5.
Apparently, the problem is with the alert phases that should perhaps be in a separate section of WHO. There is a need for “case reporting” in a timely fashion of the leading indicators that has not been available.
BTW, I too do not think that there are malevolent or hidden forces at work. I think that there is a need to separate out different issues so that several sets of forces are not influencing the collection and dissemination of information that is needed.
JoeW,
“I think that there is a need to separate out different issues so that several sets of forces are not influencing the collection and dissemination of information that is needed.”
Yes, I think so too.
……”The WHO has indicated that they do not see evidence for sustain human-to-human transmission in Turkey or Iraq. However, previous comments indicate a lack of evidence for easy human-to-human transmission.
Although the changing terminology points toward more efficient human-to-human transmission of H5N1 in the Middle East, the WHO updates of late tend to obscure this important fact.”
http://www.recombinomics.com/News/01310602/H5N1_Iraq_Cluster.html
Isn’t WHO part of the UN? They have had a lot of bad press for mismanaging all kinds of things so if they screw this up by hiding stuff it will probably be the end of them. Any credibility that is left would be shot.
Thordawggy, I agree with you in sentiment but don’t underestimate the world’s inability to sort itself out…
I think we have to realize that WHO, like the UN, is our creature, the creature of our governments. If they fail, it’s not a matter of them letting us down but of us letting ourselves down. Any government or international organization that’s “out there” doing things for us will face many competing demands and they could never hope to satisfy all those conflicting demands, so they inevitably face lots of criticism. Add to that the political games that inevitably get played and you realize that “criticism” of WHO (or the UN or government) is like rain in Vancouver — it comes with the territory.
We can debate whether they are doing everything that we want them to do. Unlikely, but if the answer is yes, we can bet that they’re really pissing off someone else.
Diffusion of responsibility is the best way to avoid accountability. IMO, the Director-General is responsible, personally, for the failure of the WHO to provide complete information regarding onset dates of symptoms and the relationships between the victims. There is no excuse for not providing this information, none. If we demand this information, we may or may not get it. But if let the SOB off the hook we will definitely NOT get it.
The head of any large organization has a difficult job. There are always competing interests and thorny issues to navigate. But some organizations have intelligent leaders with integrity while others have spineless sociopaths. Guess which type I think the WHO has.
Leadership matters.
I think Doc Watgone is really Dr. Marc Seigle in disguise.
I think what Doc Watgone is trying to say is:
“Worry about tomorrow does nothing to improve tommorrow. It only destroys today.”
I see good advice in his few words.
Older thread, closing for speed purposes.
check dates