From Flu Wiki 2

Forum: The WHO Again

International Health Regulations 2005 WHO chain of command

17 May 2006

Monotreme – at 23:41

The WHO, again.

I started this thread to provide a place to discsuss the WHO, to discuss our discussion of the WHO, and so on.

I do this in an attempt to keep other threads on topic.

I also have a more nuanced understanding of how the WHO works than I did before.

Let me state, as I have many times, there are scientists at the WHO who I admire very much. They have done tremendous good and risk their lives without hesitation.

However, there are problems at the WHO. Lot’s of them. Let’s start with the Director-General. I have read many of his speeches. I have come to the conclusion that he is a political hack. This is my opinion. If someone has a different opinion, I’d love to hear it.

The epidemiological record keeping for the avian influenza is a disgrace. I write this having read every single one of the situation updates. Given the resources at their disposal, they do a horrible job in charting the available information.

Risk communication. This has improved somewhat, lately, but has been quite terrible, in general. Conflicting messages, such as, “China is totally transparent” from one WHO spokesperson, to “China is witholding essential sequences” from another spokesperson, within days of each other. Cluster information has been ignored until recently. Bird-to-human transmission is asserted in almost every case with little or no evidence. Alternative explanations were not presented. Again, this has improved somewhat, lately.

Witholding data. Key sequence data is being suppressed. We have not been told why. We know the WHO maintains a secret database. It may be that the WHO has been told by countries with H5N1 infections that they are not to release the data more generally. If this is the case, then say so. The Director-General could simply say that it is WHO policy to release all H5N1 sequence data to GenBank unless the country from which the data comes prohibits it. This would make it very clear where the problem lies. And we could start boycotting the offending nations.

Promising too much. We have heard many times about how the WHO is hamstrung by the international treaties. Maybe that’s so. A recent newstory suggested that the WHO was unable to comment on the cluster in Indonesia until the Indonesian government gave them permission. OK, I accept that.

Then why the hell do they have a phase system? The WHO gives the impression of being THE authority on threat level. Yet, when faced with a clear and present danger (a large cluster in Indonesia), they were silent. Time for the Director-General to publicly admit he’s impotent. Scrap the phase system, and let everyone in the world know that they are on their own and the WHO will give no warning if the country where the pandemic starts doesn’t want them to.

anon_22 – at 23:54

(this post is copied from another thread for coherence of discussion)

Tom,

(This post is not succinctly written as it is 4 am here and I’m too sleepy to edit, so apologies.)

“Therefore, based on our understanding of scientific principles and the scientific method, was their continued use of the 2–7 million mortality estimate deliberately misleading the public or not?”

The problem here is the issue of ‘plausible denial’. Estimates are just that, estimates, guesses about something that has not happened yet. By its very nature it is very hard to pin them down and say “Gotcha!” For example, if the WHO were to say, “nobody died of H5N1 infection in Indonesia this past week” then yes, you can catch them red-handed and they will have to be held accountable for that.

So I would say yes, one could argue that statement is misleading to the public. Was it deliberate? Maybe, maybe not. It will be hard to prove.

But there is a higher level problem of which this is only a consequence.

The WHO is an agency of the UN, controlled via the general assembly by 190+ member states. Individual officials may have some discretion on policy but not much. Even the phrase ‘member state’ is misleading, cos what you have at the UN is only a collection of diplomats representing mostly the interests of that particular government where they came from, the vast majority of which are not democracies, where corruption, cronyism are the order of the day. For these representatives, their posts in New York are nothing more than another opportunity to scramble for the riches that come with the territory. The UN ‘Oil for Food Programme’ for Iraq was the most blatant but far from unique example.

Here let me pause and tell you a story:

Either Feb or March this year, a big conference was organized by the UN and held in Africa to discuss Avian Flu. Now here at the fluwikie we have people frequently expressing concern about Africa. Did you know what happened? After 2 full days of discussions about how to allocate the aid money for agricultural compensations, NOT ONE WORD was raised about a HUMAN pandemic. The subject of HUMAN deaths did not end up on the table AT ALL. Why? Cos most of these governments are the same as the businesses that control agriculture, and all they want is the money.

It broke my heart to read that. Truly. The extent of human greed, what human beings will do to each other, is sometimes beyond comprehension.

These people and their cronies are the same ones who get to sit in on judgment on the actions of the WHO. Directly. Not you or I.

Now I’m not saying all governments are like that. But if you study this even in moderate detail, you will discover that they are far far more common than anybody would care to talk about.

How does that justify the actions of the WHO, you might ask? On one level, it doesn’t. But on another level, let me ask you a pragmatic question. If you, Tom, are employed in the WHO, how much leeway do you think you have to tell the ‘truth’? Against such powerful interests?

Now I come back full circle to the notion of conspiracy. Yes, there is a conspiracy, but it is not conspiracy at the level of the WHO. It is not even a conspiracy at the level of the UN. But a general conspiracy that we all help to prop up, a conspiracy that pretends that countries and governments are inherently, as you Americans would say, “of the people, for the people, by the people”.

The sad truth is that as global citizens we have not succeeded in some very basic battles against the evils of human greed. We turn a blind eye when catastrophes happen elsewhere, because it is not happening to us. We are complacent when people kill and maim and enslave each other, because it is happening in countries we cannot identify on a map whose names we cannot pronounce.

And yet I don’t blame ‘us’, not at all. Why? Because there exists a limit to human capabilities. Because as biological beings we are constrained as much as any other species. With all the good will in the world, we as a species have made mighty progress in certain things, but have failed miserably in others.

So the issue is not whether the WHO is living up to our expectations. It is not. The issue is whether we have any right, absent of personal obligations to improve the planet, to ask for more.

(I did not intend to take this discussion to this level. And yet I’m glad it did.)

anon_22 – at 23:56

How many of you Americans like John Bolton and think he represents integrity and accountability?

I can probably guess your answers.

And yet America is the No1 democracy in the world. Supposedly with the highest standards. If you guys cannot produce a better specimen than John Bolton to grapple at these issues at the UN, what gives you the right to expect more from others?


So by all means point out the failings of the WHO. But don’t get all moralistic about it. They are no better and no worse than any one of us.

18 May 2006

Okieman – at 00:23

If I may, what is the greatest danger of a pandemic that has the capability to kill greater than 100 million people? Is it the terrible loss of life, or is it the destruction of civilization as we know it, and the untold additional hundreds of millions that would die as “secondary” casualties? This disease’s capability to destroy civilization as we know it in my opinion is the greatest threat.

So, while we are all here on FluWiki wishing and wanting to know everything as it is happening so we may protect our families, there are others that are trying to save civilization and the billions of lives it sustains. Yes, there are greedy people that can not see beyond growing their own bank accounts, and scientist who are seeking glory, and beauracrasies bound up by their own red tape and formalities, but I have to believe that at the highest levels of government, UN or soverign nations, there are people that recognize that it is not the disease that is the greatest danger, but the capability of human kind to tear itself apart when faced with such a disease.

I want to protect my family. But, other than that, why should I or anyone else not directly involved in the development of vaccines or anti-virals need to know everything there is to this virus. Don’t get me wrong, from strictly a personal standpoint I would like EVERYTHING out there and on the table for me and everyone to look at and pick apart and analyze. But if we did have that, and we or others like us determined that it was something that was definetly going to happen next month when it reached country X and met up with the right sequence, then would all the underpinnings and nuts and bolts that hold society together, stay together?

When the issue is looked at in a disinterested manner, keeping civilization and society functioning has to be the primary goal of the powers that be, while at the same time preparing for what is coming. Our governments by and large have not been silent about preparing for a pandemic, it is just that humankind has simply decided to ignore the warnings. We think it can’t happen to us, and we have gone on about our business.

This is why I prepare, gather and try to solve, read and write. But ultimately I do not expect anyone to give me much of a “heads up” about what is coming at me. They just can’t afford to do so. Not if they expect society to hold together.

We are told that “hope is not a plan”. But I think that while the powers that be make plans, they are at the same time hoping against hope to dodge the bullet.

Monotreme – at 00:24

anon_22, Tom DVM is a Canadian. And there probably are people here who admire John Bolton very much. Which is why non-flu politics is verboten here, I thought.

I am an American and I expect more, much more, from my leaders than from the UN or the WHO. This is why I am so critical of the CDC. I would be a hypocrite if I criticised the witholding of sequences by other countries if I did not criticise the CDC for the same behaviour.

I criticise the WHO, not because I don’t understand their constraints, but because they put themselves on a pedestal. I don’t expect the Director-General to change his behaviour because I say he should. My criticism is a public service announcement. The public should know that relying on the WHO for threat assessment is dangerous for their health.

Monotreme – at 00:32

Okieman, many deaths could have been avoided if all scientists had access to all the flu sequences.

More info here and here.

There are people who are trying to contribute to a vaccine for H5N1 who are being blocked in their efforts because sequence is being withheld.

Okieman – at 00:43

Monotreme,

I am all for the sequences being released. From a personal standpoint, I am alarmed that they are not, and my respect for the CDC has been dropping as time has gone by. My post up above is simply my thoughts on why they have not done so. I think they are more afraid of the disease destroying society (and the resulting chaos), than the deaths caused by the disease itself. Why else would they keep hanging on to the data and slowly ratcheting up the retoric about preparing for a pandemic?

BroncoBillat 01:13

anon_22 – at 23:56 --- Simple question: Do you have someone better in mind?

Masked Woman – at 03:20

From the other thread, by anon_22

“The virology of influenza is one of the biggest puzzles of science, and despite intense study, particularly in the past few years, many prominent flu scientists are now saying that they know a lot less than they thought. What makes us think that just pulling ideas out of thin air here on the wikie gives us enough reasons to conclude that cover up’s and stuff has happened?”

So if they admit that they know a lot less than what they thought, then why does WHO insist on doing it all their way? Why don’t they combine their research with the research with other scientists who have differing data, like Dr. Niman? Why are they so absolutely sure that they have all the data right? Why is it the WHO way or the highway? Why can’t they give the info out and ask everyone to contribute their expertise, however far fetched that may be? It’s like Dr. Niman said, they do it for panic control and we can’t panic until they say we can. Until they say so, then it’s just some far out there scientist (because he is not one of THEIR scientists) making a lot of speculation. Certainly not a conspiracy theory, but one of power control. Unfortunately, it is power that is the name of the game.

lugon – at 03:54

Mr (or is it Mrs) Bolton is probably a person involved in politics. I’m not even asking!

Here I’m talking from the point of view of an ignorant outsider.

I think we have to act with what we have.

This thread is about WHO and us:

And, after looking at all that, what is in our direct or indirect hands to do?

goes back to seat

lugon – at 03:58

(Oops, it’s “John” Bolton. Obviously a he. Just to show that we want to move on. Sorry.)

Ruth – at 07:55

The WHO updated their website today, but it did not update the birdflu stats. I wonder why.

janetn – at 08:29

So what it all comes down to is that the world wants to play politics, the motive greed. So the powerful will sacrifice the lives of millions to line their own pockets. We cant change any of it. Disban the UN its usless - why waste the money and talents of those honorable scientist working there

Mstrbubbie – at 08:39

Lugon are president is leaving office in about a year or so.You would have my vote if you ran for his office.The Un knows how bad this is going to get.Oh beleive me they know.There is going to be a major power vacum in alot of these countries.1st world countries 2nd,world countries and 3rd, world countries.They are witholding the information.so the general public doesn’t freak out.I am affraid when this thing is all over.the world as we know it.Is not going to be ther anymore.They are very very scared.and are trying to save there own asses and survive this thing while trying to look like they are doing there jobs.Because when this is all over.Somebody will pay for the millions of people who had to die for little or no reason.They (the powers that be) that is.Man it is way to early for this stuff.I haven’t even had my coffee yet……I hope I made some sence

crfullmoon – at 08:55

Monotreme, I guess the WHO sort of did tell the world “are on their own and the WHO will give no warning if the country where the pandemic starts doesn’t want them to”; in that pdf Rapid Response update notice, Jan. 2006, but, looking at the stopped at “Nov. 2005″ alert (what; a month after they announced the system?) should have given our local authorities a big clue about ignoring the “phase alert” and getting more proactive for their regions and for what needs to be done in areas lacking health infrastructures.

Talented and honorable scientists, who can see what may happen to the world the way officials want to do it so far,

Join us! Join us! Come over to the Wiki side!

(I’m joking, and, not joking)

While there is still time. Might be very hard to find a safe computer to get in on, but… please find some health or reputable media organization, somewhere, that would get the information out that is needed to help understand the H5N1 virus.

The public can be educated how to take better precautions about current H5N1 as well as get them preparing infrastructures and households against pandemic influenza, but, the longer they aren’t, the more difficult and unlikely that time-consuming process becomes.

Failing to prepare the public is nothing but preparing to fail the public.

Roman – at 09:28

Okieman, The majority of the public is not prepared because of the kindness of the CDC, WHO, etc. That’s right. They have been so kind not scaring us. Thank you, WHO. When hungry, desperate people break into my house for food and water, I will think of your affection. It was so kind of you to save “civilization.” As some of us preppers get beaten for the goods we stored and left to die, I will thank you, again. What a brillant choice! Simply don’t tell the public what is really happening. Let the pandemic slowly engulf them. By the time they are aware of the danger, they will be to busy caring for the sick or themselves to question authority. Most of them will be without food and water. That’s OK. They will find a way. The public will work this out amongst themselves. I do understand why you, WHO, CDC representatives have done elaborate preparations. It’s my understanding that the WHO has a bunker and plenty of food and water for it’s representatives. I wish I could afford a bunker. Oh well, I must remember this is about saving our infrastructure. Even though it’s a great, big, pile of crap. God Bless you, WHO. That’s how I’m feeling right now.

Okieman – at 10:04

Roman,

If it was up to me, everything would be on the table for all to see. Let each person judge for themselves and take appropriate action. But it is not up to me. I have tried to put myself in their shoes and see it from their perspective, and what I have written is the only thing that I can see as to why things have been kept so close to the cuff. Maybe they are right, maybe they are wrong. I’m just a country boy in Oklahoma that wants to protect his family and friends. I am not in the thick of things and in the know enough to judge properly. If they are wrong, then history and the world will judge them harshly.

We as a country and as a world are not prepared because in our pride we do not think this terrible thing can happen to us. I tend to agree with Melanie that it is not the government that is failing us, it is the media (and our own selves due to pride of life). The government has been and is warning us. Humankind sits on its backside and believes that “it can’t happen to me”. In our pride we believe that it is “ourselves” that sustains our life (hense my statement about pride of life). It is not ourselves. I am getting into theology, so I will stop there. Those that read the Bible will understand what I have said.

Back to the topic. It very well may be that actions have been and are being taken to provide for as many people as possible. I do not like being treated like a mushroom (left in the dark and fed…) but I have to have some faith that what is being done or not being done has some reasoning behind it besides selfishness. Otherwise I might as well decide my government and all government is useless or worse. I am an amateur history buff and not ignorant of the mistakes and failing of governments of the past. Nor am I ignorant of the fact that whole societies and civilizations have disappeared almost over night. Was it due to disease? I think the powers that be are playing a delicate game of “Prepare and Prevent”. Prepare for the pandemic by research/development and planning. Prevent panic and the destruction of a delicately balanced world economy. Whether we like it or not, money equals lives. Destroy the economy, you destroy lives. I percieve that they are trying to strike a balance. I can only hope that they are right.

Roman – at 10:48

“We as a country and as a world are not prepared because in our pride we do not think this terrible thing can happen to us.”

I disagree. Our leaders have a responsibility to change this. When I was in the Army, I could never use the “ Sorry General, that soldier just wouldn’t do the job, too much pride” excuse. I would lose my job. I believe some mmebers of our “leadership” are trying to save the economy before the people. Of course this is mixed with heaping spoon full of stupidity. Remember, the individuals that hold this information are well prepared. Once the pandemic is over they will emerge from their well-stocked facilities and attempt to lead, again. I want the truth. I want the chance to organize my community. Currently, they are getting mixed messages. This makes my task very, very, hard. If this continues, the individuals that prepped will be left with millions and millions of unprepared people. Many of them will turn their gaze toward folks like us. Our leaders may save “civilization” temporarily. However, we are doomed. Unfortunately, I don’t have a bunker.

Monotreme – at 11:03

Okieman, the motive for hiding the CDC sequences is not fear of causing a panic, it’s a desire to get papers in good journals, which will boost their careers. They hide the sequences of regular every day flu and having been doing so for a long time.

If the WHO or others are hiding human and other mammals because of fear of causing panic, what does that mean? They aren’t hiding the bird sequences. If avoiding panic is the reason, the only interpretation is that they know it is spreading mammal to mammal and a pandemic is immminent.

crfullmoon, those of here at Flu Wiki are fortunate to have people like anon_22 and PathForward who can analyse and explain the nuances of WHO actions. But how many people in the general public have are able to parse WHO announcements so carefully? Most politicians and decsion-makers don’t understand that the WHO is *not* going to warn us that H5N1 is getting better at being transmitted between people.

Either we warn the world, or nobody does.

Ruth – at 11:06

When you sit back and think about what a medium pandemic would do to the U.S. it is unthinkable. I look around my community, and can’t imagine our lives, if a pandemic strikes. I think people refuse to believe this can happen and that’s why they don’t prepare. It’s been all over our papers, stock up, people laugh. The writing is on the wall and it’s very clear. This could happen, it has in the past, you need to take care of your own family, we cannot rescue you. Stock up on food, water and supplies….

anon_22 – at 11:40

Monotreme, it doesn’t matter whether Tom is a canadian. It doesn’t even matter whether the WHO is in the wrong. Let’s say we agree that it IS in the wrong.

My question is SO WHAT?

How much is the world worse off today, right now, cos the WHO covered up (assuming they have, which to a degree I think they have)?

Let’s just take the issue of sequences, which you so bravely have taken on as a cause. Now I have great admiration for your work and I fully support it. But let’s just turn it around for a moment and ask ourselves, what is the REAL damage that the lack of sequence data has done in our ability to save lives now or in the near future? If we get the data now, would it change policy in a major way? How?

Would it change our policy towards poultry outbreaks? More culling? Less culling? Don’t let’s start on how farming should be revolutionized, because the fact is that we already know many better practices that countries can implement BUT THEY DO NOT, not because of no data, but because of no money or no political will.

The bottleneck to farming reform is NOT in the lack of sequence data.

What about human influenza epidemiology? Yes, having access to that kind of data would certainly enhance our knowledge. But by how much? And again how would it translate into actions on the ground? Cos make no mistake about it, knowledge does not save lives unless it can be translated into actions.

Sure, we might be able to discover for example that there are some novel ways of transmission that we didn’t know about. But let’s look at the numbers. To date there’s been 200+ cases. What is the percentage of these patients for whom the WHO or CDC do have sequence data that they are not releasing? And out of that proportion how many would have yielded enough information for us to draw clear conclusions about source of infection? Then out of those that we can decipher source of infection, what is the percentage that is REALLY going to give us the nuggets of gold, of say some novel ways of transmission as I said? A handful? 20? Is that sample going to be big enough for us to draw any REAL conclusions, right now, today?

Yes, if we discover even 1 case of transmission lets say from cats, we could do a lot more research on cats, for example. But do we really believe that come a pandemic cat transmission is going to be the big killer and not h2h via droplets? Or pig transmission, or environmental contamination? Because none of these methods of transmission will come anywhere close to the number of people who will die from straight-forward h2h via the respiratory route.

Since I don’t want to bog down this thread with another pro- and anti-Niman debate, let’s just assume that with that data he is able to give us some predictions about how the virus would act or when we will have a pandemic. But how accurate does that have to be to convince the 99.9% of the population that this is not another Chicken Little? How accurate does that have to be to convince governments to act differently? Especially given Niman’s theories are not accepted by mainstream thinking at the moment?

The bottleneck to epidemiological knowledge that can be translated into actions that will save a lot of lives is not in the lack of sequence data. The bottlenecks are in our dependence on global transport, in overpopulation, in insufficient healthcare services, in local cover-up’s by clueless or corrupt governments, in ignorance and human pigheadedness exhibited for example in patients who will run away from isolation.

Now let’s look at vaccines. On the surface it would seem that the more we know about the virology, the more likely we will be able to come up with the right vaccine.

But as I laid out in my summary on vaccination strategies for H5N1 pandemic, the bottleneck is again not in the lack of sequence data. Not in not being able to get the right antigen. It is in vaccine efficacy, production capacity, safety issues, novel technologies, distribution, triage, infrastructure constraints etc. If and when we can overcome these, then the bottleneck will be whether we got the right sequence. Right now and for the foreseeable future, it is not.

Finally, antivirals. Would having additional sequence data help us make new antivirals? The ones that are undergoing research as far as I know do not depend on minute differences in the nucleotide sequence to work, at least I hope not.

The only place where it might make a difference would be tamiflu resistance. In theory having access to sequence data might help us pick out features that may determine such resistance. But in practice, at the moment, unless H5N1 evolves to a point where most strains are resistant, when you have a patient newly infected with the virus, you would still give the drug anyway, so what difference does it make? Unless and until we have a good alternative drug(s) available, tamiflu remains the major and sole antiviral that clinicians will use. Sure we might make different clinical decisions on dosage, duration, or combination treatments, but we are already doing those things based on clinical judgments.

Come a pandemic, the major bottleneck to antivirals is not sequence data, it will be in supply and distribution.

I would submit therefore that having that kind of data be available sooner is extremely important for many reasons, but none of them will make a substantial difference in saving lives in the timeframe that WHO and CDC etc has been accused of delaying. Some difference here and there, yes, but not substantially.

Not enough for us to spend a substantial part of our energy on it. We as fluwikians would save a lot more lives if, instead of lobbying for sequence data, we lobby for more funding for critical medicines for chronic patients, for a substantial increase in PPE and isolation facilities, for capacity building in surveillance and public health in Africa, for publicity for personal preparedness, etc. The list goes on.

It is gratifying to bash the WHO. You can do that for sport. And somebody should do it, and it might as well be Monotreme. But for the vast majority of us, there are many more things we can, and should, spend most of our energy on RIGHT NOW that if a pandemic arrives in the next few months or years, will save far more lives.

anon_22 – at 11:55

Roman,

“Okieman, The majority of the public is not prepared because of the kindness of the CDC, WHO, etc. That’s right. They have been so kind not scaring us.”

The decision on whether and how much to tell the public does not rest with the WHO or even the CDC. It rests with the leaders of individual countries. If we here at the fluwikie know enough to draw some conclusions about how best to prepare, the leaders certainly do.

Whether they decide to tell is a political problem, not a public health problem.

Grace RN – at 12:27

The President has made the announcementfor the American people-buried within a 232 page web document:

“Local communities will have to address the medical and nonmedical effects of the pandemic with available resources.”

From last paragraph in Chapter 1 of the Executive Summary/ Federal Government Response to a Pandemic, page 9.

http://www.whitehouse.gov/homeland/nspi_implementation.pdf

anon_22 – at 12:41

Grace, in this respect, the US is miles ahead of Europe.

Melanie – at 12:49

Miles, anon? But the US public is still clueless.

anon_22 – at 12:54

Melanie,

That the public is clueless illustrative of the enormity of the tasks. That’s why we all need to work harder, be more focussed, maximize efforts where they will make the most difference.

Roman – at 13:22

“Not enough for us to spend a substantial part of our energy on it. We as fluwikians would save a lot more lives if, instead of lobbying for sequence data, we lobby for more funding for critical medicines for chronic patients, for a substantial increase in PPE and isolation facilities, for capacity building in surveillance and public health in Africa, for publicity for personal preparedness, etc. The list goes on.”

You are missing the point, anon_22. Without current, honest, data. Communicating the need for the above improvments is next to impossible. Why? Because people want proof before they change their perception. If the WHO or CDC is being prevented from providing this basic service, they should start ringing the bell. Really loud. If they don’t, the majority of the world will not be prepared.

“in ignorance and human pigheadedness exhibited for example in patients who will run away from isolation.”

They are running away because they have no idea what is happening. All they know is that people are going in alive and coming out dead. You call this “pigheadedness”, I call it smart. Run, Forrest, run.

anon_22 – at 13:45

Roman,

“You are missing the point, anon_22. Without current, honest, data. Communicating the need for the above improvments is next to impossible. Why? Because people want proof before they change their perception. If the WHO or CDC is being prevented from providing this basic service, they should start ringing the bell. Really loud. If they don’t, the majority of the world will not be prepared.”

Well, I just disagree. I think there is already enough information for governments to do many things that they should be doing which they are not.

I have been to conferences and met policymakers from different countries recently. You can cut the air with the apprehension and heaviness that hang around people. Lots of decision makers already know how bad the problems are. Nowhere did I hear that the reason why they are not doing certain things is because they need more viral sequence. Not even the vaccine manufacturers.

The lack of sequence data is NOT the bottleneck.

anon_22 – at 13:49

Just to give you an example. The top concerns that vaccine companies were discussing were legislative and licensing, liability, production capacity, commitment of governments to purchase, policy about whether to make pre-pandemic or pandemic vaccine (since this affects safety, investments, and distribution, etc.)

Roman – at 14:02

anon_22, The lack of sequence data is not the only issue. What about the reluctance to report H2H transmission, etc? I the two go hand and hand. I am trying to help organize my community and friends. Everytime a new report comes out with CDC, WHO … comments that play down the serious nature of our current situation, I get emails from some folks I’m trying to help. They quote or link the article and tell me “cool down, this has been going on for years.” This is happening to a lot of people here on the fluwiki. We need all the current, honest, data we can get. Using machine translated news articles from Indonesia is just not cutting it.

“Lots of decision makers already know how bad the problems are. Nowhere did I hear that the reason why they are not doing certain things is because they need more viral sequence. Not even the vaccine manufacturers.”

Really? That does not make sense to me. If they know how bad things are. Why are they not making sure their “public” is making plans? What kind of leaders are they if they can’t cause this to happen? It’s not. And it will not happen until the WHO, CDC, start to provide current data to the public, so that we can motivate our communities to act. Obviously, our leadership is paralyzed by the political implications of this problem. Fine, move out of the way and let us (public) handle it.

Leo7 – at 14:03

anon 22:

I agree with you. Without the critical planning food will rot in warehouses and that will lead to the starving breaking in on Roman’s preps. Monotreme is probably right about the human sequencing being held back in time for publishing, but how can releasing the human sequences last week have saved the lives of those who died?

As for vaccines that are rushed and not tested (Think rotoviurs for children) what a mess that was. I’m not sure I want to be the first to get the flu vaccine. Not only are they testing a new procedure but also shortening the normal production time and what about the children that might take it? Children are not short adults.

Leo7 – at 14:04

Sorry, did not mean to go off topic in second paragraph. I think the WHO workers do a great job under adverse circumstances.

DemFromCTat 14:07

Complicated stuff. Wonky, even. That’s what makes policy work, but it’s really tough to explain. I disagree with those that think the pols and the health organizations are running away. Some are, i suppose. some have commercial interests that outweigh health interests.

But for the most part, people in positions of responsibility are dealing with these complex and complicated issues as best they can and not running away.

We should call out the ones that are not doing their job, but we should also not oversimplify and tar everyoine with the same brush.

anon_22 – at 14:17

“If they know how bad things are. Why are they not making sure their “public” is making plans? What kind of leaders are they if they can’t cause this to happen?”

Good question. We should go and ask the politicians.

“It’s not. And it will not happen until the WHO, CDC, start to provide current data to the public, so that we can motivate our communities to act.”

Nobody disputes that they should provide more data.

I just don’t think that is the most important reason why things are not happening.

We can agree to disagree.

Melanie – at 14:24

The news media also carry some responsibility. They’ve done a truly sh*tty job of telling this story.

DennisCat 14:28

I posted this over at the news thread but thought it might be nice here to.

Annan names coordinator to prepare UN in case of human outbreak of bird flu

Annan today named Imelda Henkin of the Netherlands as the world body’s new Pandemic Influenza Preparedness Coordinator.

Ms. Henkin will work closely with the main UN point man on the bird flu threat, Dr. David Nabarro, the UN System Influenza Coordinator.

http://tinyurl.com/hr5xl

ANON-YYZ – at 14:41

Melanie – at 14:24

What is the measure of responsible journalism? Who sets those standards?

Are the news media just as scared as the government about possibly causing a panic if they report the truth? I remember Ann Curry of dateline NBC taking pains to say something like ‘I am not an alarmist’ and ‘don’t panic’.

There’s also this thinking: I don’t want to be yelled at twice by telling the bad news twice. Oh well, thrice - it’s about to happen, it is happening, it has happened.

Is there a way out of this dilemma? Tell the truth now, people panic now which will be seen as self-inflicted injury - the cure is worse than the disease and career is over now. Tell nothing now, people panic even more when TSHTF. No one wants to be the first bearer of bad news. We need a true leader or a whistle blower to get things rolling, then the band wagon effect takes place and other journalist will join in.

Melanie – at 14:49

Anon-yyz,

The fact of the matter is that most science reporting in the US stinks. Americans are scientifically illiterate, and reporters are no exception. Editors are tired of this story because it’s been reported for a year and nothing has happened yet. They don’t “get it.” I was talking with Mike Osterholm earlier in the week and this is a subject that makes him livid.

BroncoBillat 15:21

Here’s a thought: Since the WHO is sponsored by/is part of the United Nations, and is “responsible” for reporting any cases or changes in the the virus, how’s about the United States lobbying the UN Security Council, on behalf of the WHO, to bring sanctions against the virus if it should try to mutate?

They thought sanctions would work in Iraq.

They think sanctions will work in Iran.

Why wouldn’t sanctions work against another entity that just thumbs it’s little nose at us?

lugon – at 15:54

I have been to conferences and met policymakers from different countries recently. You can cut the air with the apprehension and heaviness that hang around people.

Those who go to such conferences are already in the choir.

Policymakers, public health people, they all go through their adjustment reactions. They all listen to each other. They all find it hard to wrap their minds around a “bad+soon” pandemic.

I think it’s all (well, a lot) about perception.

And perception works at all levels.

Can we change perception without resorting to more data? More data has never changed perception. A different interpretation of the same data does the trick. Just like when you suddenly start thinking a friend has been betraying you, and has been doing that for a long time. (I’m not implying betrayal from WHO. It’s just an example of the same little facts seen under a different light.)

How can we get influential people to look at things differently? What would a “perception shift” look like?

It would include at least:

We should also look at the different people (groups of people) implied. Not just the WHO or us. Who are those groups? What do they really think? What “should” they think? How do we facilitate that perception shift?

These are not idle questions. They need some cooperative work. We are *the* thinktank.

goosebumps – at 16:02

Would attempting to create a signed ‘Concerned Citizens of the World’ type of petition, stressing all of the above mentioned shortcomings, sent off to media and the powers that be (CDC, WHO, politicians, etc), be of any value? Just grasping at straws here, I don’t know if that would be plausible or effective, but am feeling everyone’s frustration. ..Also would like to add that please know that what y’all are accomplishing here though your debates and simply your presence is invaluable to folks like myself who know virtually nothing! :) Tom DMV, Montreme, Anon_22, et al, thank you for being on this site!

inthehills – at 16:03

could the answer be that really isn’t a damn thing any of us can do? prep?by all means.but for how long? tamiflu?great,but only if you can increase dosage four or five times.where are you going to get it? WHO releases the sequence codes and you confirm what you already believe. then what? no one knows a thing. we can only speculate among ourselves while it plays out.

Grace RN – at 16:07

Fighting about the WHO stages is like fiddling while Rome burns.

and speaking of Rome-

Roman at 0928: re: “When hungry, desperate people break into my house for food and water, I will think of your affection. It was so kind of you to save “civilization.” As some of us preppers get beaten for the goods we stored and left to die, I will thank you, again”.

If this is what you think will happen, what are you doing in your area to help improve the knowledge of your neighbors, local officials?

crfullmoon – at 16:32

How’s Mike Osterholm’s local community preparing? (Tell him even some of the lowly are livid, too. And, no one listens to us, because we don’t have a degree nor write officials’ paychecks.)

The international, federal, and state levels have all given their warning already.

(without using their power to put the smackdown on no “need to do anything, today” reassurances, nor the spin, “pandemic-denier” doctors. If the “control of the media to prevent misinformation, rumors and panic” is really job 1 on every agency’s pandemic influenza plan once pandemic starts, why not say, “You’re muddying the waters during a pandemic alert, sit down and hush up if you can’t help prepare”??

Even if pandemic hasn’t started yet, the crap in the media is hindering political and public will to get educated and get preparing and will negatively affect outcomes. Plenty of misinformation out now, that will cause true panic and extra deaths by keeping everyone so calm now that they do nothing against pandemic, and once it starts, it is too late to prepare)

The local level officals are the ones who don’t want to deal with the public -the voters and taxpayers who are why they have jobs now- they don’t want to hear adjustment reactions, nor questions no one has good answers for, so, they are failing to prepare the public.

People make economies, stupid. Put today’s economy ahead of post-pandemic’s people and it’s just going to result in a world of hurt.

Maybe there isn’t a damn thing that will really be *enough* to do, but we need, and the officials who think “the public doesn’t need to know” need, to do all we can in the time we get.

ANON-YYZ – at 16:58

Even those on death row have the ‘Faint Hope Clause’.

Those not prepared stand a better chance than that, cause the day of reckoning may never come.

So don’t worry, be happy.

It’s your fault if you can’t figure out the lies, misinformation etc. Natural selection takes over. Thinning the herd.

TPTB is judge, jury, jailer, and executioner. Putting all those trusting people on death row.

There is the ‘Faint Hope Clause’.

Except the governor cannot commute sentencing. The virus makes the decison.

(Sorry mod, can’t help it.)

Roman – at 18:03

Leo and Grace, I made it really, really, clear. I have been trying to organize my community. I have sent information to the city planner, I have talked with the fire chief, I have met with my home owners board, I have compiled info and given it to my friends. I even tried to produce some prep videos. I could not find any “medical” expert to help. Many of the volunteer crew decided this situation may not be urgent. It all gets neutralized when the WHO/national journalists/local journalists make comments that the situation is “worrisome” but a pandemic is not likely. If individuals do not succeed in preparing/stabalizing their community, they will be surrounded by very desperate individuals. Can we agree on that? It’s common knowledge that desperate people do desperate things. Theft and violence are included. Does this concern make me a paranoid extremist? No. It makes me and others that have the same concern, wise. Thanks for asking.

1mother – at 19:00

Roman,

I am sorry to see we live in “sister” communities. I have to pinch myself somedays just to be sure I’m not living a nightmare. I have never been discribed as paranoid and now at 48 in an established community, my neighbors think I have too much time on my hands and have flipped out. I am exercising alot of restraint while working the phones, (largely because I don’t want to be a visible target later.) My community assures me they are prepared because they have had numerous hazardous disaster drills. Eventually they will realize that preparing also means stockpiling.

1mother – at 19:06

The numbers posted by the WHO ARE misleading and have deterred my neighbors from taking minimal precautions.

DemFromCTat 19:09

Roman – at 18:03

We don’t always agree on the issues, but I gots to defend Roman’s commitment and efforts. He’s certainly tried, and no doubt, will try again. ;-)

niman – at 19:10

WHO has published it’s Indonesia update, and although the disease onset date of the index case, April 27, is given, the disease onset dates for the other family members (around May 3) are not given. Now why would that be?

WHO withheld disease onset dates and relationships between the three sets of cousins in the Turkey clusters. Now the disease onset dates, which indicate H2H, are withheld.

WHO definitely considers the readers of their updates to be morons who can’t read a calendar and can’t notice the obvious omission.

Melanie – at 19:13

Never ascribe to malice that which can be attributed to incompetence, Henry.

DemFromCTat 19:20

WHO’s update is here, since niman brought it up.

Medical Maven – at 20:17

Tom DVM: Seems like we have a pregnant pause here. I would dearly like for you to get back with us (on this thread in particular).

You are already sorely missed, and we need your weighty presence.

And while I am at it. Where in the heck is Fla_Medic? Did I miss his goodbye? I hope he is okay (and has not given up on us).

Melanie – at 20:19

Med Mav,

People occasionally have outbreaks of “real life.” Or so I’ve been told. It hasn’t happened to me yet. ;−0

Tom DVM – at 20:42

Medical Maven. Thanks. Actually I’m speechless.

Watching and Learning – at 20:57

New UN Pandemic Coordinator

Melanie: “Outbreaks of real life”--cute :-)

Does anyone know anything about this person: Imelda Henkin of the Netherlands. The UN Secretary-General just named her the new Pandemic Influenza Preparedness Coordinator?

niman – at 21:09

Melanie,

The omission of disease onset dates from the two largest H5N1 familial clusters (Turkey and Indonesia) is NOT an error or incompetance.

It is VERY obviously deliberate (and the withholding of the human sequences from Indonesia is also NOT an accident).

Medical Maven – at 21:25

How could that not be the case? It is the most elementary of omissions and so glaring-it has to be intentional. I don’t want to be a conspiracy freak, but the consistency of such omissions and their flagrancy (as opposed to standard practice) makes one wonder. How close to the rabbit-hole are we?

Adirondack Mountain Man – at 21:36

To Lugons thoughts at 15:54

I remember back to the time I was deeply engaged in the “drug wars” A buddy of mine used to like to say “We threw a drug war, and no-one came!”

But, we kept plinking away at it, and today we se incredible progress in some areas (nicotine, treatment availability, treatment efficacy, science based prevention) and dissapointing progress in others.

But we keep plinking.

I’m going after this in similar ways. Working the social policy angle as I facilitate meetings in the national public health arena, challenging Key Opinion Leader Docs that respect me much as the editorial in the post-Asia Forum did, dropping mild factual references about my personal planning and business continuity planning, etc.

All the time, finding the bravery to ride the edge of ridicule, but also finding the emotional intelligence to avoid crossing the line (except while deep in my own adjustment reaction about a year ago)

So I think that’s the path. Collective multiple action…a million points of light (yes I’m laughing out loud…laughter improves immune response)

Melanie driving the wiki boat. Henry bitching about dishonesty with some level of credibility Lugon thinking systems and getting others to do the same Dem thinking through the community PCP implications Anonymous whoever going throug an adjustment and adding to the collective noise Lysol.com doing an amazing site Me extolling people to write compellingly…I could put some respectful comment in here for us all…Tom DVM, Medical Maven, Doc in Fla, Roman, Broco Bill Grace, and still miss someone who’s done a lot

It’s the collective, and we should all allow us to have episodes of real life knowing that there are many others.

Melanie, I predict a bout of real life for you In June in Chicago.

So, I’m choosing to breath into this…to have some fun with it…to enjoy the Don Quixote De Lamancha archetype manifesting itself in my day to day, knowing that all of you are my trusty side-kick Pancho, and I am yours.

Adirondack Mountain Man – at 21:38

And yes, you montreme, starter of this thread! *Smiles, thinking I want to respect everone by mentioning their name…but gottsa go have an episode of real life…

Roman – at 21:45

“I don’t want to be a conspiracy freak,”

Why is this fear coming up more and more on fluwiki? We are observing reality. This is really happening.

Dem, please consider placing all the threads on the fluwiki on a DVD or CD. I will buy many, many, copies. You can use the cash for server security/updates. I would like to keep this information to help tell the pandemic story in the future. It will be very easy to revise history. Lets make it a little harder. Can anyone,now,justify the World Health Organization’s actions? Dem, I have a duplicator and printer. Come on lets do it!

Monotreme – at 21:59

anon_22 How much is the world worse off today, right now, cos the WHO covered up (assuming they have, which to a degree I think they have)?

Would it change our policy towards poultry outbreaks? More culling? Less culling?

You bet. We’d start testing pigs. We might start culling pigs. If we had this information a year ago, that family in Indonesia might still be alive.

What about human influenza epidemiology? Yes, having access to that kind of data would certainly enhance our knowledge. But by how much? And again how would it translate into actions on the ground?

Absolutely no doubt about it. If people are getting infected from pigs and not birds, we can warn them.

What is the percentage of these patients for whom the WHO or CDC do have sequence data that they are not releasing? … Is that sample going to be big enough for us to draw any REAL conclusions, right now, today?

Yes. We need sequence data from three groups, Turkey, Azerbaijan and Indonesia. That’s where the big clusters are. We need to correlate sequence with epideminology to know the current threat level.

… do we really believe that come a pandemic cat transmission is going to be the big killer and not h2h via droplets? Or pig transmission, or environmental contamination? Because none of these methods of transmission will come anywhere close to the number of people who will die from straight-forward h2h via the respiratory route.

H2H will be the big killer. The key is to delay that event as long as possible. People need to be told how to avoid getting infected, now. The fewer people infected, the longer we have before pandemic onset.

…Niman’s theories are not accepted by mainstream thinking at the moment?

Niman’s theories don’t matter. He is not the only virologist who wants the sequence data. Trust me on this.

The bottlenecks are in our dependence on global transport, in overpopulation, in insufficient healthcare services, in local cover-up’s by clueless or corrupt governments, in ignorance and human pigheadedness exhibited for example in patients who will run away from isolation.

All true. But none of this negates the importance of the sequence data.

… as I laid out in my summary on vaccination strategies for H5N1 pandemic, the bottleneck is again not in the lack of sequence data. .

I don’t agree. DNA vaccines are critically dependent on sequence information. If this method can be shown to be safe and effective, the other bottlenecks you list won’t apply.

I agree with Roman. People won’t get ready unless the threat is revealed to them. The mixed messages from the WHO have undermined preparedness.

Nightowl – at 22:02

As to access to sequence data, it is worth noting what some leading virlogists have to say on the issue:

http://tinyurl.com/ngtbb

As to Monotreme’s “public service announcement” regarding the peril of using WHO for threat assessment. I agree and will express my understanding in my own words:

At this time, we cannot rely on the WHO to be our primary information source. Unless things change, the WHO can only be a secondary source to confirm what we generally already know from media, people on the ground, etc. So far the WHO’s usefulness as a secondary source of information is questionable, as well, because of delay and lack of detail. Officials at the WHO have considered having “flucasters” during a pandemic. Clearly, officials within WHO view the organization as acting as a primary source of information for people worldwide. IMHO, they have already lost that credibility and will have to make some changes to regain it.

What does an official from the WHO have to say? With comments from the reporter, here is a voice from WHO: (WSJ article posted by Dem on Indonesia cluster thread 6, 17 May, at 08:33):

…The delay in defusing speculation about possible rapid human-to-human transmission of bird flu highlights a predicament for the WHO: The United Nations agency is bound to investigate cases but loath to go public with what it discovers before local governments do.

“We’re always waiting for them to take the lead on these things. We provide advice, but after all, this is a sovereign nation, and they represent the authority of the government,” said Dr. Bjorge. He, along with two other WHO officials in Indonesia, declined to release specific information they had about the cluster of cases before the central government had a chance to make it public.”

DemFromCTat 22:23

Roman – at 21:45

we will talk about that early june at our summit.

wetDirt – at 22:29

To add to what monotreme said:

And if we know it’s in pigs, and if pigs can get it and survive, they might be suitable for growing immune globulin that people can use. Wayyyy easier than killing chicken embryos. We need to free the sequences.

Roman – at 22:32

Dem, I got all the gear, just tell me what you need.

Melanie – at 22:48

Adirondack man is correct. We should just spend a little time exhaling, take some deep, cleansing breaths and move on. I actually learned this from Dem many years ago.

Henry, I hear what you are saying and we may need to talk on the phone, my email is on the site.

The mods will meet in a couple of weeks to take all of your considerations into some planning. Since we are already a good team, this meeting is mostly about being able to eyeball each other before TSHTF. It seems to me that a crisis team should have visual knowledge of each other. We’ve also become good friends through doing this work together and we just need to spend some time together.

We hear you and your fears and want to bring back the best science to meet your needs.

You’ll get what we’ve got. We do “transparency” here.

19 May 2006

anon_22 – at 06:48

Monotreme,

“All true. But none of this negates the importance of the sequence data.”

I never sought to negate the importance of the sequence data. HOW MANY TIMES DO I NEED TO REPEAT THAT?

“We’d start testing pigs. We might start culling pigs. If we had this information a year ago, that family in Indonesia might still be alive.”

Really? Countries are having significant problems culling chickens cos the farmers will go destitute. Farmers have committed suicide because of that. Do you really think that in that Indonesian village or neighbouring villages there were NO chicken die-off’s? Why was there no culling of chickens?

In fact, Indonesia as a country has NOT ONCE embarked on systematic culling of whole chicken flocks in a designated zone in areas of outbreak, as was done in Vietnam and Thailand, ONLY OF INFECTED POULTRY. One needs to read extensively about government policies and news etc, and not sit inside a bubble and jump to conclusions about WHAT MIGHT HAVE BEEN when in fact WHAT IS ALREADY KNOWN is not carried out at all.

“If people are getting infected from pigs and not birds, we can warn them.”

Do TPTB in Indonesia and Romania and Egypt know about the link between H5N1 and chicken? Are they warning people? Are they warning people sufficiently so everyone gets it? What about Africa?

Those poor farmers on the edge of destitution, when they are warned, how many would still risk their lives anyway because they have no choice?

POVERTY KILLS A LOT MORE PEOPLE, every day, not just lack of information.

“don’t agree. DNA vaccines are critically dependent on sequence information. If this method can be shown to be safe and effective, the other bottlenecks you list won’t apply.”

I know of companies (and have personally had discussions with them) actively working on DNA vaccines and they are NOT compaining about lack of sequence data, not even in the presence of senior WHO representatives. It’s true that DNA vaccines ARE critically dependent on sequence information. BUT AT THE MOMENT it is in licensing and regulatory process, which is in the order of years, not months. Not having the EXACT sequence of the pandemic strain is NOT stopping their research. They can always (and they are) keep working with existing available strains until all other issues are resolved, before the exact sequence becomes the issue.

I used to have a lot more simplistic thinking about things, but I go out there and seek answers to questions like that. And when I found information that causes me to change my thinking, I do.

anon_22 – at 06:54

Monotreme,

“Preparedness - If the secret sequences suggest widespread infections in pigs and pig to human infections, the pandemic clock is 5 minutes to midnight. Everyone needs to know this.”

Absolutely. I agree.

I want to know that too, so please keep digging.

anon_22 – at 06:57

Monotreme, if you want info on specific vaccine companies, email me.

niman – at 07:02

WHO has once again withheld disease onset dates from a large suspect cluster.

anon_22 – at 07:03

“Does anyone know anything about this person: Imelda Henkin of the Netherlands. The UN Secretary-General just named her the new Pandemic Influenza Preparedness Coordinator?”

She is being appointed as the new Pandemic Influenza Preparedness Coordinator of New York based UN organisations.

ie UNICEF, UN High Commission on Refuggees, IAEA, etc etc.

anon_22 – at 07:04

Niman,

“WHO has once again withheld disease onset dates from a large suspect cluster.”

I agree. I saw that and I got upset, just like everyone here.

I will get more upset if we still don’t get those dates in 2 weeks or 1 month, allowing them the time to complete their own investigations.

anon_22 – at 07:15

Monotreme, I also agree about the PCR.

However, since I have very little faith in containment, I’m a lot more pessimistic that being able to diagnose outbreaks more quickly is going to avert a pandemic.

It would save some of the people immediately involved, and it would give those of us who are watching intensely a bit of warning about onset. But the longer term big picture of millions of deaths would not be altered, IMHO.

Not that individual lives are not important, I just want to be a bit more ambitious and see if we can save millions.

Getting governments to stockpile critical medicine like insulin will save millions.

Please fluwikians go out there and make this happen.

Roman – at 07:20

Good morning, anon_22, This has been a very good discussion. Thank you.

lugon – at 07:38

Getting governments to stockpile critical medicine like insulin will save millions.

AND keep fridges running.

Simple, if you pay attention. And useful in other circumstances too. Just balance the price of stocking up against the price of not stocking up. Oh, yes, and doing it late just won’t cut it.

Could “diabetic associations” we warned about this?

niman – at 07:43

anon_22

WHO has never relased the disease onset dates or relationships in the Turkey cluster that began in late December, 2005, nor have they identified which 9 positives in Turkey were not confirmed by Weybridge, nor have they relased the data on the 1000 serum samples from over a year ago in northern Vietnam, nor have the released any data about the 10,000 serum samples they were collecting in Turkey in January 2006.

WHO has disease onset dates for Turkey and Indonesia. These dates are key to any cluster investigation. They are being withheld because they strongly support H2H.

European – at 08:53

I think the questions or problems can be seen from a very different angle.

Lets go a few years into the future and assume that a pandemic has happened with devastating consequences. The questions then becomes: “What could we have done better and smarter?”, and “Could we have prevented the pandemic?”.

I believe the answers to the first is a definite “YES”, and the answer to the second is a “MAYBE”.

It would have meant that we had to react very differently to information when the information became available. The politicos should have taken some really, really hard and difficult decisions, but that is what they are there for (If they are not up to mettle then they should be booted out). Information should have been made public when available. More resources should have been poured into education, erradication, prevention and compensation. The media should have been more aware and consistent in their reporting. Restriction on travel and trade should have been put in place at a far earlier stage.


Etc. You can go on and add to the list. The only thing I can say is that those who do not learn from history are bound to repeat it, and what I am seeing now is that we are well on our way to repeat previous generations actions.

NS1 – at 08:57

Each new generation has the shortsightedness and expected invulnerability of a teenager.

European – at 09:00

That is what worries me :-)

Monotreme – at 09:15

anon_22, I don’t disagree about the need to do things like get governments to stockpile insulin, or better yet, let diabetics know that they need to stockpile insulin. I agree this would save millions of lives. My general point is that it’s not either/or. We can demand sequences and epidemiological data and work on preparedness issues at national and local areas.

As regards DNA vaccines, we should discuss offline. Suffice it to say that what they say in front of WHO personnel and what they say privately may be different. Big pharmaceutical companies may have a different view than small biotechs.

As regards the problems of communicating in the third world, no disagreement there. Poverty, lack of education and corruption are huge problems. But some farmers are being more careful after being warned, see Viet Nam and Thailand. These countries enforced draconian culls of chickens after pressure from the international community. If pigs are the reservoir for H5N1 in Indonesia, we need to know that, right now. If the Indonesian government won’t take the appropriate steps, international pressure can be brought to bear.

There are many obstacles to success, but I maintain greater transparency from the WHO would be hugely beneficial. It’s true that even with perfect behaviour from the WHO there will still be enormous challenges, but that’s no reason not to demand competence and integrity from the agency that holds data that our lives depend on.

anon_22 – at 09:29

Monotreme, suffice it to say that I do not disagree with you on substance on many issues, but I do disagree on how most people’s energy should be spent.

And I do believe that on balance we do too little to hold individual countries responsible. We need to remember that as members of the UN, they are required to comply with international regulations. However, the current regulations leave way too much room for blatant disregard of responsibilities and general obstructiveness.

The proposed new International Health Regulations, although as always not going to be in force as quickly as we would want, are a step in the right direction.

That said, please keep up your good work.

Medical Maven – at 09:39

Without information we are “flying blind”. We, the whole world, need more information. This is humanity’s problem, and all of us that are willing to apply ourselves to this problem should be doing so with ALL of the information available. That being said, if we don’t have much time before a H5N1 panflu, anon_22 is probably more correct in her take on the situation.

But I would not bet the farm on that assumption. We are not God. Remarkable unthought-of-solutions could emerge in a short period of time if ALL of us had ALL of the information.

Monotreme – at 09:40

anon_22, I agree completely that we need to hold individual countries accountable. Those of us in the US have a particular responsibility in this regard and I think Flu Wiki is one venue for stimulating action. Once the bad practices of individual countries are publicised, international pressure can and should be applied.

Thanks, and don’t worry, I’m indefatigable ;-)

Adirondack Mountain Man – at 09:40

To the question of getting the WHO to release its data more rapidly, perhaps stepping dieways and looking at it from another angle might create some ideas. I’ll provide some stimulus here, do some thinking down the pathways I’ll present (not that you haven’t already, but not together, and not here)

Observations about the thinking patterns evidenced above:

  • There is a general belief that the WHO is less forthcoming than it could be
  • this then gives rise to three distinct patterns of thinking
    • Those bastards
    • The need to prove to others that this is happening (i see no disagrement with the basic premise above — they’re less than forthcoming
    • A struggle about whether it matters that the WHO is doing this or not

I propose a new line of thinking

The Goal

In what ways might we get the WHO to share nicely?

Next step: Generate ideas Next step: Strengthen those ideas Next step: Plan for action Next step: Implement

It might be an interesting experiment to use the Wiki to increase the divergent field of ideas for the next step by starting three strings, one for each of the above problem statements, and seeing what thinking shows up as a spark to our own.

I don’t feel it’s my decision as to whether or not to start those strings, as the particular issue here is not one that I have a lot of ownership around. I gladly play role of facilitator here though, because I get that the WHO and this issue is a powerful lever to pull to increase good preparation.

A request: Take a look at the three problem statements above, add to, modify or improve them. Post to three separate strings. See what shows up over next few days.

Monotreme, Anon_22 and Niman. You three have a good amount of skin in this issue. Please, one of you step up and say you’ll start the strings.

Or tell me to shut up. *smiling with eyes somewhat downcast*

Adirondack Mountain Man – at 09:43

dieways is not a new word, although it’s an interesting slip… Should have been “sideways”

anon_22 – at 09:59

AMM,

A very commendable post, and very thoughtful. thank you.

My initial brief reaction is still that the people most likely to inflict pain or pleasure on the WHO are the member states.

aka THEIR BOSSES

So the chain of reaction/command goes like this:

Fluwikie/public → officials inside individual countries → official representatives of those countries in the UN, aka your country’s ambassador to the UN → UN General Assembly and/or Secretary General’s office → UN World Health Assembly → office of the Director General of the WHO → officials working inside the WHO

The WHO has no mandate to respond to public opinion.

It is not a moral or ethical issue. (And please do not quote this one sentence out of context. Read the whole thing to understand what I mean.)

It is an organisational structure issue.

Go figure.

lugon – at 10:06

AMM, we could just start … a wikiproper page + a thread to keep us on track. We did this regarding Water Supply and it worked - well, actually, Monotreme worked.

Count me in, but this will not work without Monotreme, Anon_22, Niman and others wanting to jump in too. Thinking without information is useless. Likewise the other way round.

anon_22 – at 10:07

AMM, follow my link to International Health Regulations.

Read about the regulations, the revision proces, etc on the WHO site

Those of you who feel strongly about this issue should read ALL the documents on this WHO page. It is a very instructive exercise.

Medical Maven – at 10:09

“It is not a moral or ethical issue”. I agree. Amorality runs riot through the whole United Nations bureaucracry. Machiavelli could have devoted three chapters to their machinations.

Hurricane Alley RN – at 10:19

The WHO or any other agency involved in the research of BF are not going to release this information. Especially if it has gone H2H and create panic. Don’t you think they already know that if their research teams/scientists know it has gone H2H, then it would not take long for others scientists to come to the same conclusion? Do you honestly think they would trust these scientists to stay quit? Would you stay quit Henry? For now, BF is contained due to the fact that it is in an area where the people can not afford to travel. This is what they are hoping for. For governments all over the world are not yet ready for a pendemic. They never will be. I believe time has ran out. Hence, we are being told, “ You are on your own.” gina

anon_22 – at 10:35

The following is from the document ‘Revision of the International Health Regulations’ Italics and highlights mine.

PART II – INFORMATION AND PUBLIC HEALTH RESPONSE

Article 5 Surveillance

1. Each State Party shall develop, strengthen and maintain, as soon as possible but no later than five years from the entry into force (June 2007) of these Regulations for that State Party, the capacity to detect, assess, notify and report events in accordance with these Regulations, as specified in Annex 1.

2. Following the assessment referred to in paragraph 2, Part A of Annex 1, a State Party may report to WHO on the basis of a justified need and an implementation plan and, in so doing, obtain an extension of two years in which to fulfil the obligation in paragraph 1 of this Article. In exceptional circumstances, and supported by a new implementation plan, the State Party may request a further extension not exceeding two years from the Director-General, who shall make the decision, taking into account the technical advice of the Committee established under Article 50 (hereinafter the “Review Committee”). After the period mentioned in paragraph 1 of this Article, the State Party that has obtained an extension shall report annually to WHO on progress made towards the full implementation.

3. WHO shall assist States Parties, upon request, to develop, strengthen and maintain the capacities referred to in paragraph 1 of this Article.

4. WHO shall collect information regarding events through its surveillance activities and assess their potential to cause international disease spread and possible interference with international traffic. Information received by WHO under this paragraph shall be handled in accordance with Articles 11 and 45 where appropriate.

Article 6 Notification

1. Each State Party shall assess events occurring within its territory by using the decision instrument in Annex 2. Each State Party shall notify WHO, by the most efficient means of communication available, by way of the National IHR Focal Point, and within 24 hours of assessment of public health information, of all events which may constitute a public health emergency of international concern within its territory in accordance with the decision instrument, as well as any health measure implemented in response to those events. If the notification received by WHO involves the competency of the International Atomic Energy Agency (IAEA), WHO shall immediately notify the IAEA.

2. Following a notification, a State Party shall continue to communicate to WHO timely, (Part 1 of the document includes a long list of definitions, but none for ‘timely’.) accurate and sufficiently detailed public health information available to it on the notified event, where possible including case definitions, laboratory results, source and type of the risk, number of cases and deaths, conditions affecting the spread of the disease and the health measures employed; and report, when necessary, the difficulties faced and support needed in responding to the potential public health emergency of international concern.

Article 7 Information-sharing during unexpected or unusual public health events

If a State Party has evidence of an unexpected or unusual public health event within its territory, irrespective of origin or source, which may constitute a public health emergency of international concern, it shall provide to WHO all relevant public health information. In such a case, the provisions of Article 6 shall apply in full.

Article 11 Provision of information by WHO

1. Subject to paragraph 2 of this Article, WHO shall send to all States Parties and, as appropriate, to relevant intergovernmental organizations (ie not the public or media), as soon as possible and by the most efficient means available, in confidence, such public health information which it has received under Articles 5 to 10 inclusive and which is necessary to enable States Parties to respond to a public health risk. WHO should communicate information to other States Parties that might help them in preventing the occurrence of similar incidents.

2. WHO shall use information received under Articles 6 and 8 and paragraph 2 of Article 9 for verification, assessment and assistance purposes under these Regulations and, unless otherwise agreed with the States Parties referred to in those provisions, shall not make this information generally available to other States Parties, until such time as:

(a) the event is determined to constitute a public health emergency of international concern in accordance with Article 12; or

(b) information evidencing the international spread of the infection or contamination has been confirmed by WHO in accordance with established epidemiological principles; or

© there is evidence that:

(i) control measures against the international spread are unlikely to succeed because of the nature of the contamination, disease agent, vector or reservoir; or

(ii) the State Party lacks sufficient operational capacity to carry out necessary measures to prevent further spread of disease; or

(d) the nature and scope of the international movement of travellers, baggage, cargo, containers, conveyances, goods or postal parcels that may be affected by the infection or contamination requires the immediate application of international control measures.

3. WHO shall consult with the State Party in whose territory the event is occurring as to its intent to make information available under this Article.

4. When information received by WHO under paragraph 2 of this Article is made available to States Parties in accordance with these Regulations, WHO may also make it available to the public if (WHA58.3 14) other information about the same event has already become publicly available and there is a need for the dissemination of authoritative and independent information.

Monotreme – at 10:43

Adirondack Mountain Man, very thoughtful post. Give me some time to think about it and maybe I’ll start another thread on how to apply pressure to the WHO.

anon_22 – at 10:50

Monotreme, the last paragraph of the post that I just made may give some clue as to how to apply pressure.

anon_22 – at 10:54

Article 12 Determination of a public health emergency of international concern (portions only)

1. The Director-General shall determine, on the basis of the information received, in particular from the State Party within whose territory an event is occurring, whether an event constitutes a public health emergency of international concern in accordance with the criteria and the procedure set out in these Regulations.

2. If the Director-General considers, based on an assessment under these Regulations, that a public health emergency of international concern is occurring, the Director-General shall consult with the State Party in whose territory the event arises regarding this preliminary determination. If the Director-General and the State Party are in agreement regarding this determination, the Director-General shall, in accordance with the procedure set forth in Article 49, seek the views of the Committee established under Article 48 (hereinafter the “Emergency Committee”) on appropriate temporary recommendations.

3. If, following the consultation in paragraph 2 above, the Director-General and the State Party in whose territory the event arises do not come to a consensus within 48 hours on whether the event constitutes a public health emergency of international concern, a determination shall be made in accordance with the procedure set forth in Article 49.


anon_22 – at 11:00

Remember these are proposals to improve and tighten existing regulations, which presumably is a lot less stringent.

Medical Maven – at 11:03

anon_22 at 10:35: It is one thing to envision the runup to a pandemic and to actually be experiencing one. The U.N. has tied themselves all up in knots with their rules and regulations. It is time to cut the Gordian Knot by means of individual acts of disobedience.

For you who have such information and are under the constraints of such rules where lies your allegiance? To the U.N., to your country of origin, or to humanity in general?

Are you so sure it won’t make any difference, if you follow the rules and keep this information bottled-up?

And when possibly millions die (including members of your family) will you wonder whether you could have made a difference, however small?

anon_22 – at 11:05

OK, this is the last piece, for now :-)

If you are in overload by now, pause and consider the meaning of that overload.


Article 49 Procedure (ie if the state does NOT agree that a ‘health emergency of international concern’ has occured)

1. The Director-General shall convene meetings of the Emergency Committee by selecting a number of experts from among those referred to in paragraph 2 of Article 48, according to the fields of expertise and experience most relevant to the specific event that is occurring. For the purpose of this Article, “meetings” of the Emergency Committee may include teleconferences, videoconferences or electronic communications.

2. The Director-General shall provide the Emergency Committee with the agenda (I wonder how much notification time is required? Gotta look that up.) and any relevant information concerning the event, including information provided by the States Parties, as well as any temporary recommendation that the Director-General proposes for issuance.

3. The Emergency Committee shall elect its Chairperson and prepare following each meeting a brief summary report of its proceedings and deliberations, including any advice on recommendations.

4. The Director-General shall invite the State Party in whose territory the event arises to present its views to the Emergency Committee. To that effect, the Director-General shall notify to it the dates and the agenda of the meeting of the Emergency Committee with as much advance notice as necessary. (notice the word NECESSARY) The State Party concerned, however, may not seek a postponement of the meeting of the Emergency Committee for the purpose of presenting its views thereto.

5. The views of the Emergency Committee shall be forwarded to the Director-General for consideration. The Director-General shall make the final determination on these matters.

6. The Director-General shall communicate to States Parties the determination and the termination of a public health emergency of international concern, any health measure taken by the State Party concerned, any temporary recommendation, and the modification, extension and termination of such recommendations, together with the views of the Emergency Committee. The Director-General shall inform conveyance operators through States Parties and the relevant international agencies of such temporary recommendations, including their modification, extension or termination. The Director-General shall subsequently make such information and recommendations available to the general public.

7. States Parties in whose territories the event has occurred may propose to the Director-General the termination of a public health emergency of international concern and/or the temporary recommendations, and may make a presentation to that effect to the Emergency Committee.

Tom DVM – at 11:06

So the agency that boasts of and has assumed world-wide authority for pandemic prevention and preparedness: including targeting millions of dollars so that they can do flu-casts on TV if and when the pandemic begins…

…is the ‘Wizard of Oz’… a gutless wonder…I still do not see your point.

We are to excuse their actions because they have no real authority even though they pretend to have it.

We are to ignore the precepts of science including honesty.

We are to let things just take their course instead of standing up…take what comes and say oh well, it couldn’t be helped.

Anon 22. I didn’t see your point the other night…and I do not see your point now so please explain it in terms that I can understand.

anon_22 – at 11:09

MM,

“For you who have such information and are under the constraints of such rules where lies your allegiance? To the U.N., to your country of origin, or to humanity in general?

Are you so sure it won’t make any difference, if you follow the rules and keep this information bottled-up?

And when possibly millions die (including members of your family) will you wonder whether you could have made a difference, however small?”

Good questions.

You are now beginning to get to the heart of the dilemma: if you are employed by the WHO, aka UN, your personal morals have to be left at the door. They have huge armies of lawyers with water-tight confidentiality clauses. No individual has a chance against such a machinery.

anon_22 – at 11:10

Tom,

“We are to excuse their actions because they have no real authority even though they pretend to have it.”

Welcome to the real world of international diplomacy.

THAT is the description that you can apply to pretty much anything related to the UN.

As I said, not that we like it.

It’s all we’ve got.

FrenchieGirlat 11:17

Just a thought, the Fifty-Ninth World Health Assembly is due to start in Geneva on 22–27 May 2006. This is the perfect gathering for Heads of State to discuss the required course of action in a round of formal and informal talks.

Especially since the dates of the Assembly cover the Ascension holiday which means not many people in some countries will question the whereabouts of some countries’ Health Ministers (or Ambassadors or high-up civil servants) during this bank holiday.

I wonder what are the rules for convening the Emergency Committee ? I’d think a paper convening such a meeting is sent out with a provisional agenda some days in advance of the meeting, with a request for countries to submit additional items on the agenda before a particular time-limit ? Are such documents public (I doubt it).

Could it be that WHO has shown information procrastination symptoms because it needs to wait to have all countries assembled in the World Assembly to put some particular motion to vote after a recommendation of the “Emergency Committee”???

I’ll have to see if I can find/read the Assembly documents (at least the public ones) during the weekend. They must be somewhere on the WHO site…

anon_22 – at 11:33

Tom, if the IAEA cannot stop a looming nuclear conflict, what makes us think that the WHO has more real power?

anon_22 – at 11:41

To find out where real power is, it’s instructive to follow the money.

WHO is funded mainly by contributions from member states. This document of assessed contributions gives you an idea of how much each country pays or takes away from the table.

This programme budget is rather instructive.

Whereas HIV, malaria, and TB have separate budget allocations, that is not the case with pandemic influenza. Download the document and search for ‘influenza’ and ‘pandemic’ and you will get 0 results.

Tom DVM – at 11:45

anon

A gutless wonder that does nothing…is just a gutless wonder…

…you work around including having national authorities step on their toes…point out their shortcomings and ineffect supersede their authority and castrate them.

a gutless wonder who runs around deliberately misleading not only citizens but national authorities, makes it look good when in effect they are not leaving their hotel rooms…and sustains a program to grossly understate a risk despite overwhelming objective evidence to the contrary is a not just a ‘pain in the ass’ but a threat to the world.

In Rwanda,we turned our heads and approx. 800,000 people died…not a good thing to turn one’s head because now we are going to get a pandemic where a lot more than a few million are going to die…except this time it is going to be our mothers and fathers, brothers and sisters, aunts and uncles and most importantly children.

We should never forget Chamberlain in 1939: he was just trying to do his best. There are many other similar examples in history.

If what you say is true then we should not excuse it but fight it because this time the war isn’t going to be in Africa or in some other far away place but in our country, our town and our house.

anon_22 – at 11:50

Oh, while you are looking at the ‘assessed contributions’ document? Remember that it doesn’t matter how much you pay, each member gets one vote.

Now read the d****d thing and ask yourself how many of the countries/governments listed are likely to agree with us Fluwikians? Especially on issues that may affect their interests? Remember those interests are not just the interests of their country, more likely their own and their crony’s interests.

I’m sorry if I made this a sad day for some of you…

anon_22 – at 11:55

Tom,

“If what you say is true then we should not excuse it but fight it because this time the war isn’t going to be in Africa or in some other far away place but in our country, our town and our house.”

Of course.

However, the machinery of the UN is so big that it may take a lot longer than H5N1 will wait for.

And people are dying today, Darfur, for example. People are being killed and maimed, take female genital mutilation. Look at Burma, North Korea.

Lots of people more worthy than I have dedicated their lives to these and other issues. The UN still stands, unchanged.

It may be easier and faster to work AROUND it, not AGAINST it, IMHO.

anon_22 – at 12:00

Some of you may want to re-read my original post at 23:54 and reflect on the dilemmas.

Tom DVM – at 12:08

Fine with me.

Lets work around it and not excuse it or appease it.

Lets just do what we have always done which is to fulfull our responsibility as scientists and simply tell the truth…

…and the truth is as Dr. David Nabarro so eloquently pointed out, that the 2–7 million maximaum mortality figure for a pandemic as quoted again and again and again, in the last 16 months, was ‘complete un-adulterated bullshit’…it was deliberately misleading in that a monkey could have read the document it was lifted from and known it shouldn’t have been used…especially since they were told not to use it specifically in the limitations of the document they lifted it from.

Re-inventionist history is a wonderful thing…if you can get away with it. As I remember it, the WHO announced that there was a respiratory outbreak in China that the world should watch out for about 5 days after it arrived in Toronto unannounced from Hong Kong and regulators were desperately trying to figure out what it was.

SARS is the great success that they trumpet themselves with? They lucked out with SARS and they damn well know it. To say otherwise is…oh yeah…again deliberately misleading.

Albert – at 12:15

Anon-22 : heartfelt thanks for all your insights, information, and the time you devote to enlighten us here at the Flu Wiki.

The WHO does not have a lot of significance anymore. Many blunders were committed in the past, e.g. their regional office in Africa was a complete disaster. For serious and imminent health-related problems, it is not the WHO that plays the big role. We had an outbreak of a mysterious disease here in Bangladesh not so long ago and it was a mission from the CDC, accompanied by other experts, that identified the cause, the Nipah virus. As for HIV/AIDS, there is a separate UN Head, Dr. Peter Piot. I don’t think UN Aids falls under the WHO, they have their own offices and people in most countries.

WHO is not the only UN agency that lost credibility. Unesco became a joke many years ago, the FAO has been severy criticised for environmentally disastrous programmes that it promoted (clearing original mangrove forests for shrimp culture, to name just one). The UN itself has lost the moral high ground and authority it once had.

Within the WHO, the Director General has a lot of power. The present DG was chosen as a third choice candidate because petty political retributions did not allow two better candidates (Piot, Feachem) to get elected.

MaMaat 12:28

anon_22, your posts here have really helped me to understand why WHO has done some of the things it has. Not that it makes me happy, but it makes sense that the UN members would run things in the way that was most advantageous to them, whether or not it was the good or right thing to do. They brought to mind this, which is useful no matter your belief system:

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and to have the wisdom to know the difference…

We can’t change the nature of the WHO or the UN, but as you said we CAN work around them. Kudos to everyone who is working to affect positive change, there are too many to list.

Thanks.

anon_22 – at 13:00

“In Rwanda,we turned our heads and approx. 800,000 people died…”

The head of UN peacekeeping at the time of the Rwandan massacre was Kofi Annan. His deputy in the field, the Canadian general Dallaire, sent him a cable clearly stating a list was being drawn for genocide and weapons were stockpile. Annan sat on the cable for days without informing the Security Council, and ordered Dallaire to shut up, and, later, withdraw.

After the massacres were revealed, the Clinton administration repeated the famous ‘never again’ phrase, urged reform, kicked out the existing Secretary General Bhoutros-Ghali (who admittedly was also a rascal), and installed Annan in his place.

Rwanda and Screbrenica both happened uder Annan’s watch as Under-Secretary General for Peacekeeping. And he was ‘rewarded’ by promotion to Secretary General.

That’s just FYI.

banshee – at 13:10

Anon_22, Clinton and most other world leaders were also aware that genocide was about to take place. The CIA even suggested jamming the radio signals which were giving directions to the militas to slaughter their neighbors. The US chose not to do anything because of our ill-fated intervention in Somalia (remember BlackHawk down). World leaders tend to make decisions based on national interests - not global interests.

anon_22 – at 13:14

banshee, international politics is a hard bloody game. It’s not for the faint-hearted.

2beans – at 13:18

ANON-22: Are the odds impossibly long that a very public and very noisy demonstration in Geneva - very pointed at this disconnect - would accomplish anything? I mean shaming the Indonesian PTB, not the WHO. Would it get press coverage?

anon_22 – at 13:27

2bean, I don’t have much experience with public demonstrations, but I suspect these have no chance of working unless there is at least a lot of public awareness of what the issues are, and right now we don’t.

There is another thing to consider: the 80/20 principle. In a nutshell, in any project, 80% of the results can be achieved by 20% of your efforts. The final 20% will require 80%.

If you have a situation that is multi-factorial, rather than chase the last 20% of one aspect, it may be easier to make sure that 80% of all the other aspects are covered.

So if the final mortality of a pandemic is determined by personal stockpiling, antivirals, vaccines, infrastructure support, healthcare upgrading, new technology, institutional reform (aka WHO changing its skin), etc, you may be able to achieve a better result by putting your energy into several or many of these aspects, even if none of them are achieved to perfection, than butting your head on one thing and neglecting others. So balancing your priorities is important.

2beans – at 14:03

ANON 22: I’m very well-stocked for 6 mos. (for my 2 beans as well). I have tried and been markedly unsuccessful at informing and motivating my coworkers, been trying since at least this time last year. I’ve placed myself on the list for cert training and am passing out cert brochures in my neighborhood. But. My experience with local administration tells me that going further than gentle questioning on this sort of topic gets you branded as a nut case and effectively silenced. I may yet try a couple of contacts on what passes as our local citywide ecumenical council. I don’t believe anyone has given serious though to what happens to all the homeless (our own homegrown as well as New Orleans’ homeless now) when TSHTF. Still, it seems we could and should do something to put a spotlight on the WHO dilemmas you so wisely have set before us.

Mstrbubbie – at 14:23

Hi again. No one has consitered the homeless or the children who’s parents may have died because of this.what do you do when you see one of your neighbors kids (one that has been in your home and has played with your children)crying on the street hungry and alone knowing that the people in that home are all dead and that this child may have the flu in there body???? Tough one huh?………This what you guys and ladies are fighting for on here everyday.so this doesn’t happen as bad as we all fear……..This all just came to my mind while I was mowing the lawn. So come on troops……lets get it done!!!!Make phone calls to local official state officials lets start pissing some people off. I know my govenors office hateS me already………Keep to faith and keep doing the great job that you are doing…….Oh if you picket a have yours kids picket with you that really get there attention……Later Y’all

BroncoBillat 15:11

FrenchieGirl – at 11:17 --- This is the perfect gathering for Heads of State to discuss the required course of action…

That, in a nutshell, is exactly the reason nothing will be done and nothing will come out of these meeting. Heads of State. All concerned only about their own nations’ welfare, and not one iota of the others. There will be lots of lipservice paid after the meetings, and all will stand at the podium and declare that the convention was a roaring success.

But, the fact is, nothing will be decided. Nothing will be done. What this convention should be is the collection of representatives of actual citizens of the world, not politicians who have their own agenda. Don’t know if GW is going, or if he’ll send someone else, but either way, the US will have absolutely no say-so over what the WHO does or says. Nothing.

FrenchieGirlat 19:14

BoncoBill — at 15:11
Anon_22

I beg to differ. I happen to work in an international organisation, and although I am not a high-up international civil servant, I have seen them work for many years. My own great-grand-father was the first Medical Adviser of the United Nations, which was then called the League of Nations.

The first point is:

One has to realise that these international bodies are essentially Secretariats which give service to their Members. As a result, one cannot say WHO (or any other int.org) does this or does not do that. WHO is not a person. It is a place where governments gather, define the politics they see fit and an international organisation is merely the place where such decisions are recorded and applied. As a result, the Director-General of any international organisation is merely the person who gets to apply what all Member Countries have decided through a vote, whether a majority or consensus vote. I may remind you also that such international organisations, through their Members, make international treaties which are signed by these Members. These international treaties have strength of international law and are applicable to all Signees. Many of these international treaties are incorporated as domestic law in the countries of the Members. If a Member does not observe the treaties which it has signed, it places itself in an unlawful situation, and many of these Treaties also grant the power of enforcement. With the result that if one Member Country complains about another not respecting the law, there is a sort of international court that will judge the merits of the case and assign rights and wrongs, and also binding corrective measures.

The second point is:

In order to arrive at some form of consensual decision among Members, discussions or negotiations have to take place between them, some of which are confidential and very high level and which are not discussed in the press or in the University books. It is not just a question of exchanging one or two flimsy pieces of paper. Hard bargaining has to be done. This is done through various committees which are chaired by either the Director-Generals or other influential individuals chosen by the Members themselves. Such consultations take place throughout the year, in both formal and informal modes. The various Secretariats of the International Organisations facilitate the venue of the meetings and offer good offices to mediate various positions. Member Countries, through their Ambassadors or Ministers or High Level Civil Servants make their positions known and bargaining can start. At some point, Member Countries, either in one group, or in a few groups, manage to get agreement on various texts (decisions), which are submitted to the whole of the Committee. These are discussed further for a majority or consensual agreement. The Committee then elaborates the final text to be submitted in a General Assembly, Executive Board or such Executive Body of the International Organisation, so as to be voted on and adopted. From the moment of its adoption, the text becomes a law or a treaty.

As a conclusion,

it is this process which may sometimes be seen as long and drawn. If there are 150 or so Member Countries, it is difficult to get agreement, because Governments do have a varied set of priorities. However, once a text is approved in the last Executive Instance of the International Organisation, it is binding on all Members.

In the case of the WHO, and in particular in the area of contagious unknown illnesses, one has to realise that Government officials, Ministers and Ambassadors, even though they have their national experts to guide them, are usually civil servants and not doctors. Even if they were doctors, some of the research in such illnesses is way above their heads. Of course, WHO has its own team of experts which do make recommendations, but the process is not one that dictates from WHO to Governments, but the reverse. This means that whatever the experts of WHO may recommend as a course of action to Governments has to be vetted by the Member Country’s own experts, which may or not have the necessary expertise to understand what is going on. And only after this may a Government decide to adopt a particular attitude in a negotiation for an international text or treaty.

Belonging as I do to the “select few” in an international organisation, I tried very hard this afternoon to fault Anon_22 in her reasoning. I checked sources and budgets, I checked archives as well. Because I actually have a high opinion of international civil servants inasmuch as I am inside and can well imagine what it must be like in WHO in times like SARS and Avian Influenza. I have not yet any ammunition that is sufficient to answer the criticisms above. However, I do believe that the staff in such organizations is doing the best it possibly can. The machinery is heavy, but it’s fairer than most other places of decisions for world-wide settlement of difficulties.

I have seen the process of negotiations/discussions at meetings, and I can assure you that there is very hard bargaining and not only to the benefit of one or two States, or of a group of States. I cannot imagine WHO is different to my International Organization because I happen to know some other International Civil Servants, including at WHO, and this far and for the last 25 years, I can only recommend them on the professionalism, integrity and fairness with which they accomlish their duties. Which duties, incidentally, are dictated by the decisions taken by the Member Countries.

Of course there are politics, after all the job of governing one country is about politics. Of course there are business interests, after all the job of running a country is also about business. In the end though, I cannot see that individual countries’ interest would prevail if this entailed the fall of the rest of the world, simply because by doing such evil, that one country would fall also as the whole world is interlinked. I cannot imagine that a government would be prepared to risk its own downfall by being a lone player dictating the rest of the planet.

If one has to lay fault somewhere, I am not sure it should lay straight at the door of the WHO itself. I think if there has to be a fault, it is that of our Governments, the Member Countries of the WHO, individually, which are to blame, by not giving political/business will to achieve a consensus on the WHO platform.

Because of this, if FluWikians wanted to organise some sort of protest, I would think it would be better directed at the Governments themselves, which voices are carried over to WHO. One can do this with the power of our votes, with demonstrations at the Ministries of Health of Member Countries. Running like headless chickens (pardon the pun) on the Place des Nations in Geneva is simply bound to be inefficient and a total waste of time and energy.

I will try to spend some time on Sunday to unravel the various documents of the 59th Session and the previous ones too. I have seen a number of encouraging texts, though those not familiar with such language may not necessarily understand them well. I reserve my judgment with respect to WHO. I also believe that WHO will come to par, once it has managed to get agreement of its Member Countries. It is unfortunate that the machinery is so heavy at a time when we need speed, but the WHO Statutes were never made to allow it to take unilateral action without full agreement by its Members. Only the Members of WHO have the power to dictate the course of action and whether WHO can speak up or not. The Director-General does not have that much power on his own.

I have no vested interest in what I am writing other than trying to show a little fairness in a difficult situation. Were I identified, I could get in trouble for writing this, even though I am mitigating in favour of WHO, a sister International Organization.

anon_22 – at 19:26

FrenchieGirl,

I don’t see that your point of view differ from mine at all!

My recent interactions with some very senior WHO people confirms most of what you say. I have sat in a room where the 2 people who spent the most time persuading country officials to prepare and to communicate with the public and to plan for antiviral distribution are the WHO officials.

The only (relatively minor) point where I might differ is that I do believe that countries can obstruct progress, not as individual countries, but by block votes. And that’s one big reason why good intentions do not always prevail.

anon_22 – at 19:28

FrenchieGirl,

One possible course of action would be to name and shame any country suspected of being obstructive. Turkey, China, and Indonesia come up high on that list.

anon_22 – at 19:40

The following document was published recently, and it gives a good summary of the WHO’s stance on pandemic preparedness

Strengthening pandemic-influenza preparedness and response, including application of the International Health Regulations (2005)


Excerpts of main points of interest here:

1. Evidence has mounted that at least some species of migratory birds have acquired an ability to carry the H5N1 virus in its highly pathogenic form over long distances.

2. 48 countries had reported the virus in domestic or wild birds. Of the 29 countries with outbreaks in poultry, only two have successfully eliminated the virus from their territories and maintained a disease-free status.

3. On present evidence, the species barrier is substantial: the virus does not cross easily from birds to humans.

4. Investigation of instances of possible human-to-human transmission is difficult, Several instances of limited human-to-human transmission have occurred, but in no case has the virus spread beyond a first generation of close contacts or caused illness in the general community. Data from these incidents suggest that transmission requires very close contact with an ill person.

5. surveillance of both human cases and poultry outbreaks remains weak in most affected countries in Africa and Asia. In humans, surveillance is complicated by the non-specific early symptoms of influenza caused by the H5N1 virus, the high incidence of other respiratory diseases in affected countries, and the technical difficulty of diagnostic confirmation.

6. Some evidence of adaptive mutation during 2005 has emerged. Recent studies of the virus responsible for the exceptionally lethal pandemic of 1918–1919 have yielded better understanding of the genetic determinants of both transmissibility and virulence, and this understanding should improve the precision of early warning signals derived from virological investigations. These studies have also found some genetic similarities between the 1918 virus and H5N1 viruses circulating in 2005.

7. Vaccines are considered to be the first line of defence for reducing morbidity and mortality during a pandemic. The Secretariat has undertaken several activities aimed at expediting the development of a pandemic vaccine and increasing manufacturing capacity.

8. In the first half of 2006, WHO is convening workshops on regulatory preparedness, aimed at expediting the licensing of pandemic vaccines, and a consultation on access to pandemic vaccines, aimed at developing a global action plan.

9. Countries that are building domestic stockpiles of antiviral agents need to have plans to distribute them, decide whether these drugs are to be used for treatment or prophylaxis, and be ready with appropriate prescribing advice.

10. recommended that antiviral agents be used at the start of a pandemic, pending the availability of vaccines, for the treatment of patients and the protection of workers in essential services, including health care. Because of the risk that the virus will develop resistance, it is not recommended that these agents be given to large numbers of healthy people, for prophylactic purposes, for extended periods.

11. For cases of human infection with the H5N1 virus, these agents, if administered early, may reduce the severity of disease and improve prospects of survival but clinical data are limited.

12. WHO will have a stockpile of antiviral agents (oseltamivir), sufficient for three million treatment courses, by early 2006. these drugs could be used prophylactically near the start of a pandemic to reduce the risk that a fully transmissible virus will emerge or at least to delay its international spread.

13. To increase the likelihood that early intervention using an international stockpile of antiviral agents will be successful, surveillance in affected countries needs to improve, particularly the capacity to detect clusters of cases closely related in time and place.

14. As supplies of antiviral agents and vaccines will be inadequate in all countries at the start of a pandemic, governments will need to advise their populations on the use of non-pharmaceutical measures to protect them from infection or, at the population level, to slow transmission.

15. For example, should schools prove to play an important role in disease dissemination, as has happened in past pandemics, their temporary closure could be recommended as a means of slowing spread. Any measure that flattens the peak incidence of cases over time will relieve some of the burden on health services and reduce some of the social disruption that accompanies high rates of worker absenteeism.

16. In February 2006, WHO issued interim guidelines, specific to the H5N1 virus, for infection control in health-care facilities.

17. A document submitted to the Board at its 117th session2 reported on the outcome of a meeting on avian influenza and human pandemic influenza at which delegates discussed the possibility of voluntary compliance with the relevant provisions of the International Health Regulations (2005) before entry into force.

18. Should a pandemic begin, all countries could be rapidly affected. Many Board members expressed the need to improve access to antiviral medicine and pandemic vaccines as a strategy for mitigating morbidity and mortality during a pandemic.

anon_22 – at 19:45

This document puts WHO on the same side as me, IMHO.

And it is a very useful document to hold governments to account. Everyone should download it, get familiar with it, and wave a copy at any official that does not think they need to tell people to prepare.

Melanie – at 19:47

Wow, anon_22. Awesome summary.

anon_22 – at 19:48

I’m going to put up a new thread for this last document to increase visibility.

Tom DVM – at 19:49

Anon 22. Excellent document. Maybe you should send a copy to Dick Thompson…I don’t think he could have read it.

Many don’t believe and are gambling on that substancial species barrier. My question is…what is the function of the WHO after the pandemic spreads out from one country (probably Asian)to other continents?

Medical Maven – at 19:52

So WHO is a cumbersome, unwieldy, slow-as-molasses organization. And it was created that way precisely so no one’s toes gets stepped on. Does the Virus Care?

Looks like the Achilles Heel of this most eminent organization with many extraordinary personnel working within it is that it is incapable of effectively countering a fast-moving viral threat with very high-impact possibilities.

WHO is the “Maginot Line” and H5N1 is conducting a Blitzkrieg. Guess who has no hope of winning?

And as for the best strategy on this sector of the battlefront I will keep pleading for somebody within WHO (or some National Health Ministry) to risk their careers (and their house and their marriage) by releasing ALL of the pertinent information to ALL of humanity.

You may not even get caught, and, what the Hell, you may save a few million or more lives. You never know. Don’t take solace in the certainty of your expert opinion. None of us are that smart. Do Not rationalize away your obligation to humanity.

anon_22 – at 19:58

Tom,

“Anon 22. Excellent document. Maybe you should send a copy to Dick Thompson…I don’t think he could have read it.”

Maybe you can do it.

It’s not my country.

Besides, I’m busy…. :-)

anon_22 – at 20:02

Tom, and everyone else,

Let’s move discussion on this last document to this new thread

FrenchieGirlat 20:15

Medical Maven – at 19:52

WHO was created so that the best experts could have a forum where decisions would be made to eradicate illnesses in the world. And to do this, it necessitated the agreement of all parties to it, i.e. the Member Countries. Therefore, it is not WHO as an international organization which is a cumbersome, unwieldy, slow-as-molasses organization and incapable of effectively countering a fast-moving viral threat . It is the Governments that fail to agree on a course of action. Protests would really be better directed at those Governments which slow down or stop the process of agreeing on a fast course of action.

anon_22 – at 20:29

FrenchieGirl,

“Protests would really be better directed at those Governments which slow down or stop the process of agreeing on a fast course of action.”

I have exactly the same opinion.

FrenchieGirlat 20:40

Well then, maybe there are Public Relations people reading us that would be willing to offer writing skills in the form of a draft letter which we could all reproduce and send to Ministers of Health of those countries which we deem are remiss in their duties to the world people? (We’d need to get hold of an internal WHO directory of all Member Countries for the addresses of Health Ministries). Or a Java/HTML Guru could create a form-petition on FluWiki which we could fill in and sign? (but what would we do with anonymity though? because without names, it will have no weight)

FrenchieGirlat 20:42

Unless some FluWikian has enough money to pay for whole-page ads in the national press of these countries, shaming them… (though that’s utopian in countries where censorship prevails…)

Tom DVM – at 20:46

FrenchieGirl.

I repect everything you have said…

…but where I come from, an agency that is responsible for nothing…is good for nothing…

…in the case of the United Nations generally and the WHO in this discussion, it always seems to be someone elses problem…and that is the real problem.

Medical Maven – at 20:46

FrenchieGirl: You are splitting hairs. Regardless of the reason, WHO is fatally flawed for the situation that we face.

An army can have the best armament in the world, but if it can’t get permission to deploy it in a timely fashion, it is worthless.

Timing is everything in life, including viral progression and the means to counter it.

So pat WHO on the back all you want. It won’t change the facts on the ground.

And nothing has changed as to our likely outcome. The clock is ticking. Any INDIVIDUAL heroes out there?

Tom DVM – at 20:49

Medical Maven. You’re my hero…so you just keep pushing and we might actually get somewhere.

Medical Maven – at 20:51
DemFromCTat 20:57

Medical Maven – at 20:46

FrenchieGirl isn’t splitting hairs, she’s explaining how things work in the real world. (Very informative, and thank you).

If you find the organization less than stellar, at least have the courtesy to not shoot the messenger.

FrenchieGirlat 20:58

1. I am not in the business of trying to pass the buck around and I don’t think I’m splitting hairs. But so long as our readership continue to bash WHO per se, it is not devoting its energy at righting the situation where it should be, which is at the door of Governments.

2. WHO is not useless. Thanks to the Member Countries of the WHO, small pox is gone from the world. Some of us, do you remember the nasty jabs we had to have as kids not to catch it? We have scars to show for this achievement. No more small pox. Not to talk about other illnesses which are either eradicated, or which are in the process of being eradicated. It is too easy to remember the negative and forget the positive. I hold in my hand a copy of a certificate of one of my ancestors who rose with the French Revolution. His physical description, among other features, reads: “marked by small pox”…

We’ll continue this discussion tomorrow if you will - it’s almost 3 am where I dwell, so I’ll go and sleep and re-energize myself for a yet other beautiful morning (while it lasts)…

seacoast – at 21:01

Anon_22 All I can say is EXCELLENT summary…thanks for the time you put in for all of us!

Nightowl – at 21:07

The significant problems we face cannot be solved at the same level of thinking we were at when we created them. - Albert Einstein

seacoast – at 21:12

The brain, once expanded, can never go back to its original size. - Oliver Wendall Holmes

anon_22 – at 21:48

My only consolation, as I said on the other thread, is that having the UN and the WHO still beats NOT having them.

I guess technology and knowledge and human aspirations all grow a lot faster than the institutions that are supposed to provide the framework for them. Notice how governments always work slower than individuals. The bigger the institution, the slower and ineffective it is.

Medical Maven – at 22:07

DemFromCt: Believe me, if I ever go off half-cocked and shoot at a messenger, you and everybodyelse will know it.

FrenchieGirl: Thanks for your courageous input. I have always enjoyed your posts.

Monotreme – at 23:57

First, anon_22′s Graham Greene-ish world-weary cynicism re: international institutions. I appreciate her concerns regarding the many complexities involved in international treaties and organizations and agree with them.

Second, there’s the incredible frustration felt by Tom DVM at the mixed messages and sloppy science exhibited by some at the WHO. I feel the same frustration.

Most of us never gave the WHO a second thought until we became concerned about pandemic flu. I now think we have to recognize that the WHO will not warn us a pandemic is about to start or even notify us after a pandemic has started. We cannot fix them. Nor can we influence what they do except indirectly.

We do need someone at the international level we can trust during a pandemic. That person is most definitely NOT the Director-General of the WHO. I think our international champion should be Dr. Nabarro, UN coordinator for avian influenza. He used to be at the WHO, but is no longer answerable to the Director-General. I don’t agree with everything Dr. Nabarro says, but I think he’s an honorable man doing the best he can to warn and prepare the world. We should support him and think about ways to strengthen his hand.

I also agree with anon_22 that we need to apply pressure to countries blocking sequence and epidemiological data. First stop, Indonesia. Perhaps it’s time for a boycott.

20 May 2006

Adirondack Mountain Man – at 00:05

What might be all the ways we could take action to strengthen Dr Nabarro’s hand?

Monotreme – at 00:16

Adirondack Mountain Man,

My plan is to say nice things about Dr. Nabarro on Flu Wiki ;-)

We need input from the UN experts on this.

Swann – at 03:17

Monotreme @23:57: May I make a suggestion? Before attempting negative attention-getters, might we try something a bit more positive, and possibly unique? I am suggesting something along the lines of a Fluwiki Award of Excellence to be presented to the courageous scientists or administrators or government heads of state who possess the moral and ethical backbone to step forward as leaders in this impending crisis. They who openly and publicly provide newly acquired scientific knowledge to ALL scientists to study, or government heads who implement education programs and teach methods for sheltering in place, provide some means of simple food and water stockpiling for the family caretakers of their countries, community church members who open food pantries specifically for those in need during a pandemic; all of these would be eligible for consideration as a Fluwiki awardee.

I have no idea how many Fluwikians would contribute to a fund to establish an awards program like this, so I will simply guess that if 5,000 of us contributed only $2, we could present a small, but probably useful check for $10,000 to someone like the scientist who insisted on providing the sequence data she had to GenBank (I cannot recall with certainty, but I believe it was Ilaria Capua; please excuse me if I am incorrect, I have misplaced my notes).

As the public face of Fluwiki, perhaps Melanie would do us the honor of presenting the check in person, with press coverage, of course. We Fluwikians could use the power of email to target favorite MSM journalists with requests to cover the story, mention our organization and that Fluwikians around the globe are searching for more candidates for such an award. Perhaps it will inspire some to seek us out. Regardless, it will give us satisfaction to search for those individuals who are putting the welfare of mankind ahead of their personal aspirations.

As an aside, Oprah used her Angel Network to publicly honor individuals who were making a difference in their communities by celebrating their successes on her show and presenting them with substantial monetary gifts or expensive items required for their innovations to continue to succeed. These were very popular shows and I am certain they inspired others to push forward with their own attempts to make a difference in this world.

NS1 – at 05:42

Swann-

Pay for play?

Do external motivators ever really garner virtue?

Remember, most of those that we would like to turn are holding thier current positions at substantial profit, a profit which we cannot hope to surpass.

Let’s not start a bidding war.

Let’s define what is right and appeal to the decency of the few for the benefit of the many.

lugon – at 07:41

I find I like the WHO as a technical body, even if as a political body it carries a paralyzing crust all over it’s well intentioned inside.

One way to make it more powerful might be to act as interpreters for the rest of the world. We’re already doing it - for ourselves. But we might also write a cooperative summary, one that could be widely linked to and copied around (with the last-updated date). Such a cooperative document would be in the Opinion part of the wikiproper (fluwikie.com), would have short and clear sentences, with links to several places (among them, to the forum topics where things have been discussed in more detail).

I think I’ll start a new thread later (I need to catch up first, as I’ve been sleeping for a few hours and you guys have gone on and on disrespectfully ;)), and also the apropriate wiki-proper page. As usual. (And yes, later.)

In any case, the name might be something like “Cooperative Summary For Action” and might include at least the following headings:

Ok, this can and will be refined. My guess is we will fight every word, and come up with a nice (useful!) piece of “cooperative sense-making”. It may end up being a bunch of pages but it should not be longer than 3–5 printed pages (I have a 3 page draft with some parts missing, so I think it can be done).

WHO officials are welcome to lend a hand. We thank you personally. You know who you are. Hint us as to which technical documents (obscure and arcane as they may be) we might give more public light to.

lugon – at 07:45

In short: maybe we can be the agile arm of the WHO? Sort of? Maybe? Can we focus on each of our strenghts? What can WHO do for us? What can others do? How can we cooperate?

What are the good things about WHO?

lugon – at 08:46

I think a few of the things I imagine we could have in the “summary” would be from the 5 page document Anon_22 links to. Printint it out as suggested!

Snowy Owl – at 08:47

I feel I have to land here and express myself.

I have started my work on the ground 3 1/2 years ago, I have been pro-active via International Institutions, Nationals Governments, Québec Govern, Montréal Local level, Religious, cultural, communautary and district level. I have been pro-active and still in communications with Public Health and Public Security in many sectorial levels. As I have said over and over on the web, one sole person can do a lot, above and beyong expectations.

Two and an half year ago, I have decided to do my best to get the word out on Public Forums. Again it is very surprising what a sole person can do.

Now comes the 59th Assembly of the WHO. From an historical and a contextual perspectives, it appears that this 59th assembly, that started quite a few months ago in the shade is, up to now, the most important general assembly of the WHO since its creation, aside the first Assembly.

I have few years of expertise on the International level and with the UN, and here is what, IMHO, I wish we would do, all of us, who on the Internet are; flu Trackers, pandemic preparedness Promoters, Autarcic Promoters, Public Health Officers, Commonwealth Officers, and all these Internautes that consider Life as a privilege and an experience worth living and contribuing in order to let a viable Future manifest itself in our surroundings.

Some timely cultural pro-activeness insistence of very stubborn people like us, have granth some privileges for all of us in this 59th Assembly.

Yes we do have the priviledge, if we can deliver timely and accordingly, we do have the priviledge to present our Wishes and Condoleances at this Gathering.

If we cant abide by the Diplomatic Language, forget about it, I have so much to do, but if we agree to abide to Diplomatic Language, I am willing to contribute and present to you first what I am presenting at the 59th Assembly as an Individual.

Above and Beyong all expectations.

DemFromCTat 08:53

I’d love to get anon_22 invited to go.

lugon – at 08:59

As promised: wikipage and forum thread?.

DemFromCTat 09:04

thanks, lugon.

lugon – at 09:05

Snowy Owl – at 08:47

Please give us more details about what you’re suggesting.

Information about said Assembly. It’s on 22nd-29th May? Is this what you’re talking about?

Monotreme – at 09:08

Swan, I appreciate your intentions and I do agree that it’s always best to start with positive re-inforcement for good behavior… but time is getting late and I don’t think any honorarium we could come up with would convince the autocrats who run Indonesia to see things our way.

SnowyOwl,if you can think of a diplomatic way to get the WHO to release the sequence data and epidemilogical data from the WHO, by all means give it a try.

DemFromCT, I think it would be great if anon_22 could go as well.

However, I think the only way we are going to convince the Indonesian government to behave correctly will be with negative reinforcement - boycotting anything made Indonesia, cancelling tourist trips there, not building factories there, etc. I could be wrong, but this is my opinion at this point. They need to know that the financial cost of hiding information is higher than transparency.

Adirondack Mountain Man – at 09:08

Snowy Owl, If I understand your offer, I would enjoy being of assistance, and being assisted. And, it appears, we ar relative neighbors. Reach me here. or here beckert@newandimproved.com

Snowy Owl – at 09:17

After all these board nasty wars and comments, I do not know if Flu Wiki is the proper place or not to get into this path.

Still, I am going forward with it at Flu Trackers at http://www.flutrackers.com/forum/showthread.php?p=13488#post13488

But I would be proud that as much observations, coordinations and redaction be done here, but if the harsh delirious attack of Lisa the Great Pharmaceutical and acolytes repeat again as it is systematically the case since few months, understand that I will go at my nest at Flu Trackers.

Sorry, just too much work to do.

Snowy Owl – at 09:37

Lugon,

If you mean http://www.who.int/gb/ebwha/pdf_files/WHA59/A59_16-en.pdf

It is the Path that I considering yes.

DemFromCTat 09:38

Do whatever you thinks works best. It’s not here vs there vs. somewhere else.

Snowy Owl – at 09:41

DemFromCT, there are great skills everywhere IMO, but as a constant promoter of Flu Wiki at many levels since its creation, I believe that Flu Wiki must be part of this.

Snowy Owl – at 09:51

Monotreme – at 09:08

SnowyOwl,if you can think of a diplomatic way to get the WHO to release the sequence data and epidemilogical data from the WHO, by all means give it a try.

Sorry the thread is long and I am not sure I fully understand the implicity of your atatement; do you mean that you contemplate the release of the sequences as an objective or a condition sine qua non of your input ??

Monotreme – at 09:58

Snowy Owl, asking for the release of sequences and epidemiological data is my input. I’m not sure what else I have to contribute. But I may be misunderstanding what you are asking us to do. Could you explain further how we can help you?

Snowy Owl – at 10:25

The seats via wich this can be forward is via the Firs Nations Seats.

The framework window in this instance is Regional.

I know some regions do have University, labs, and/or vaccine capacities, but these regions are a very small percentage of the regions.

Therefore the Regional Path is contemplating thus;

How can we prepare at the regional level in autonomy development in order to reduce morbidity, mortality, social disruption, famines, security and inter-regional exchanges.

What is Present now, in each regions, in planifications, PPE, Security, Anti-virals (On this aspect we overwhelmingly contemplate Natural Antivirals), antibacterials, etc…

What is present in proteins in wildlife, industrial production and Handcraft productions.

What are the interegional communications and interegionals optimal exchange path.

Monotreme – at 10:42

Snowy Owl, OK now I understand. You want to know how to help the First Nations deal with a pandemic. I think the best that could be done is Shelter-in-place and stockpiling medicine for those who depend on it locally, insulin, etc.

Independence will be the key.

Florida1 – at 11:58

Good morning everyone –

Snowy Owl called me and asked me to express in plain English his comments. What he is saying is that there needs to be a new consciousness concerning WHO and the effort to deal with the potential H5N1 pandemic. By First Nations he means “regional”. WHO is an international body that operates with the consent of the world’s governments. It is a framework for the international cooperation of Public Health. WHO, alone, does not have the capability to “save the world”. It is the responsibility of every citizen, regionally, to identify the means for survival in an H5N1 pandemic. There will be no “knight in shining armor” that will swoop in and save the world. The effort must be regional with the planning for anti-bacterials, anti-virals (both natural and manufactured) water, food, PPEs etc. Also, regions must coordinate with each other to share the abundance from one to the other. With 7 billion people in the world, the emphasis on a vaccine is important, but not practical for the near future. The emphasis needs to be regional because only the local effort can be effective. The time is now to evaluate how your region will perform during a pandemic. Consider all of the elements of preparations including potential social unrest. During this meeting of the WHO there is an opportunity for meaningful dialogue on how to accomplish these regional and inter-regional preparations.

Swann – at 14:03

Monotreme: Thank you for your response. I am, admittedly, quite naive in these matters, however, not THAT naive! “Pay for play”, as NS1 commented, was most certainly not my intention. An honorarium would be a gesture of thanks to those brave souls, who then might use the publicity to propel their goals a step or two forward….taking Fluwiki with them. A boycott seems out of the question; it appears we are the few who acknowledge the need for preparations. Who will support a boycott because of a crisis that apparently doesn’t exist?

(swann reconsiders posting comments two hours after taking her Ambien!)

Lily – at 14:16

The Who is fatally flawed. We know it, they know it. Some of you possibly have more effect than you now realize. Its only after the game is over that we can really understand, and even then so much will have been covered up, glossed over and reinterrpreted. I am completly unqualified to assess any of this, but a debate like this pro and con, for an against, is always going on. Thank you for making it intellagable for those like myself who think in other ways. The right brained in a science based issue.

anon_22 – at 20:06

Snowy, FrenchieGirl,

I missed these posts earlier cos I was out all day. I am intrigued at the discussion about the World Health Assembly, but I’m not sure what exactly the suggestion is, action-wise? Let me know what I can do, either here or email me specifics anon_22 AT hotmail DOT co DOT uk. Thanks.

Monotreme – at 20:19

Swan, the scientists who are doing what’s right don’t need an honorarium. They know how they will be regarded in the history books. The one’s who are witholding sequences don’t get it, yet.

I think the most important sequences and epidemiological data are probably being witheld by nation-states (Indonesia, Turkey and China). No way to pry loose that information loose without negative pressure, ie, a boycott.

One negative news article might do wonders. Something like:

“What’s going on Indonesia? Critical information to determine whether a pandemic is about to occur there is being witheld by the Indonesian government. Sam and Suzy Tourist have decided not to vacation in Bali because they don’t know if it’s safe. Instead, they’re going to Vietnam which has cooperated fully with international authorities.”

Monotreme – at 20:19

Swan, the scientists who are doing what’s right don’t need an honorarium. They know how they will be regarded in the history books. The one’s who are witholding sequences don’t get it, yet.

I think the most important sequences and epidemiological data are probably being witheld by nation-states (Indonesia, Turkey and China). No way to pry loose that information loose without negative pressure, ie, a boycott.

One negative news article might do wonders. Something like:

“What’s going on in Indonesia? Critical information to determine whether a pandemic is about to occur there is being witheld by the Indonesian government. Sam and Suzy Tourist have decided not to vacation in Bali because they don’t know if it’s safe. Instead, they’re going to Vietnam which has cooperated fully with international authorities.”

Monotreme – at 20:22

WHO chief Lee undergoes brain surgery

The head of the World Health Organisation, Lee Jong-wook of South Korea, underwent brain surgery after suddenly being taken ill, the United Nations agency said.

In a statement posted on its website, the WHO said the 61-year-old director-general was operated on to remove a blood clot on his brain at the Cantonal Hospital of Geneva.

It said he was “currently recovering”.

Lee took over as head of the organisation in July 2003 after working for the WHO at country and regional level and at the Geneva headquarters for 23 years.

His illness means that he will miss the 192-state WHO’s annual assembly, which begins on Monday


Although I have been very critical of the Director-General, I hope that he makes a speedy recovery

DemFromCTat 20:39

we will need to close the thread and start a new one due to length.

Retrieved from http://www.fluwikie2.com/index.php?n=Forum.TheWHOAgain
Page last modified on August 29, 2007, at 11:02 AM