From Flu Wiki 2

Forum: The Director General Speaks

17 January 2006

Monotreme – at 23:19

from Monsters and Critics

WHO Director-General Lee Jong-Wook said the WHO had developed a strategy for improving monitoring and control of bird flu over the next two years.

‘Each new case and each new outbreak is a chance to fine-tune the approach,’ Lee said. ‘We have to reduce people’s exposure to the virus.’


I see. Improve monitoring. Control bird flu. Yes, perhaps a little fine-tuning is in order.

And

18 January 2006

Quartzman – at 00:12

lol… “…over the next 2 years.” ???

Well - maybe he’s just saying that so once it breaks out:

“Oh look, we can follow it so much better now.. Wow - that looks pretty bad. Hmm, too bad we didn’t think of improving monitoring.. I dunno… LIKE 3 YEARS AGO.”
dubina – at 00:15

“‘Each new case and each new outbreak is a chance to fine-tune the approach,’ Lee said.”

For my part, I’d think of changing stations. WHO would not get an ear or a tail for Turkey and how many Turkeys do we have for the WHO Executive to get it right?

Monotreme – at 22:27

NY Times Jan 8 2006

Dr. Lee Jong-wook, the director general of the World Health Organization, said in an interview this afternoon that he believed China’s central government was now fully committed to sharing information openly and freely about bird flu cases. But he cautioned that in a country as populous as China, with 1.3 billion people, it was hard to be fully informed about every health development.


Especially when the PRC autocrats lie through their teeth and the spineless Director-General grovels at their feet.

Grace RN – at 22:34

From the WHO website

“Experts at WHO and elsewhere believe that the world is now closer to another influenza pandemic than at any time since 1968, when the last of the previous century’s three pandemics occurred. WHO uses a series of six phases of pandemic alert as a system for informing the world of the seriousness of the threat and of the need to launch progressively more intense preparedness activities.

The designation of phases, including decisions on when to move from one phase to another, is made by the Director-General of WHO.

Each phase of alert coincides with a series of recommended activities to be undertaken by WHO, the international community, governments, and industry. Changes from one phase to another are triggered by several factors, which include the epidemiological behaviour of the disease and the characteristics of circulating viruses.”

Changes from one phase to another are triggered by several factors, which include the epidemiological behaviour of the disease and the characteristics of circulating viruses? Aren’t we seeing this occur now??

Monotreme – at 22:50

Here’s a good article, don’t know if its been posted yet here.

Alarms ring over bird flu mutations by Declan Butler

Scientists studying virus samples from the human outbreak of avian flu in Turkey have identified three mutations in the virus’s sequence. They say that at least two of these look likely to make the virus better adapted to humans.

[snip]

The results so far are not comforting. The first mutation found, announced last week, involves a substitution in one sample of an amino acid at position 223 of the haemoagglutinin receptor protein. This protein allows the flu virus to bind to the receptors on the surface of its host’s cells.

This mutation has been observed twice before — in a father and son in Hong Kong in 2003, and in one fatal case in Vietnam last year. It increases the virus’s ability to bind to human receptors, and decreases its affinity for poultry receptors, making strains with this mutation better adapted to infecting humans.

The same sample also contained a mutation at position 153 of the haemoagglutinin protein, Nature has learned. Cheng says this information was not included in WHO statements, because “it is not clear what role this particular change plays”.

Finally, both samples from the Turkish teenagers show a substitution of glutamic acid with lycine, at position 627 of the polymerase protein, which the virus uses to replicate its genetic material. This mutation has been seen in other flu sequences from Eurasian poultry over the past year. It was also present in the one person who died during an outbreak of H7N7 in the Netherlands in 2003, and in a few people in Vietnam and Thailand.

The polymerase mutation is one of the ten genetic changes that gave rise to the 1918 pandemic flu virus. Like the 223-haemoagglutinin mutation, it signals adaptation to humans, says Alan Hay, director of a WHO influenza laboratory at the NIMR. “There is this glutamic acid–lysine flip,” he explains. “Glutamic acid is associated with flu-virus replication in birds, and lycine is in primates.”

The Turkey strains are the first in which the polymerase and receptor-binding mutations have been found together. They could make it easier for humans to catch the virus from poultry. But they might also favour human-to-human transmission. This is because the polymerase change helps the virus to survive in the cooler nasal regions of the respiratory tract, and the haemoagglutinin mutation encourages the virus to target receptors in the nose and throat, rather than lower down in the lungs. The virus is thought to be more likely to spread through droplets coughed from the nose and throat than from infections lower down.

---

WHO knows the virus has changed. And they know the epidemiology has changed. But no phase 4. Why? See above.

Many Cats – at 23:52

Scarier and scarier……

19 January 2006

007 in the USA – at 10:20

If anyone believes that the WHO will save the world from this pandemic horror, look no further at the ‘Oil for Food’ bribery fiasco for confirmation of how well the WHO manages programs it’s charged with. But hey, maybe Kofi Annan’s son will get another Mercedes out of this H5N1 deal… Ugh.

Cheerio! 007

crfullmoon – at 10:23

(For some reason I keep thinking of Nikolai Gogol’s “The Inspector-General” when I see this thread title…)

21 January 2006

Monotreme – at 22:20

Times Online Jan 22 2006 The WHO’s director-general, Lee Jong-wook, warned that an outbreak in Britain was “inevitable and possibly imminent”.


But we’re still at stage 3, so none of Britian’s flu preps have kicked in. That Director-General, what a card.

LBaumat 22:24

I just read this Times Online article from the New Reports thread. That “possibly imminent” remark means they know so much more than they can or will tell us. That’s what scares me. It’s what they know and won’t tell.. thats what I can’t prepare for.

Monotreme – at 22:27

If they told us everything they knew, the fear level would go down. If they were trying to set the world up for panic, they couldn’t be doing a more effective job. More and more, I think the Director-General is not the sharpest pencil in the box.

LBaumat 22:55

Any speculation on what they aren’t telling us?

Many Cats – at 23:49

Maybe the Director General is stupid…like a fox.

22 January 2006

NW – at 00:06

“If they told us everything they knew, the fear level would go down” Lets say they know that a h2h is occuring and a worldwide pandemic will happen soon and bring modern societies to their knees. How would that announcement bring the fear level down? I would expect the more dire the situation the more tight lipped they will become to preserve order as long as possible.

gs – at 00:42

OK, so what might they know which they don’t tell us ? There are other virus-sequences with more mutations which are withhold ? Secret experiments with h2h-chains ? Secret political preparations like government bunkers being frequented in Turkey or such ? As I said earlier, it can’t hurt if we found a new independent panflu-organization. Double-check the WHO-samples sending out their own spies to look for sick birds and humans, questioning the farmers for sick birds and the patients for symptom-dateline and hospital-tests. Maybe even a mobile hospital to treat victims with own stuff and own testing.

dubina – at 02:32

gs,

You’re getting downright konspiratorial.

One thing I suspect is that they don’t want to tell us that they can’t do what we think they can do.

Recall….

(1) EU considers forming a rapid reaction force.

     Is that a good rumor or what?

(2) US sends inspectors / fact-finding team / whatever to Turkey.

dubina – at 03:04

Your tax dollars at work

Declan Butler, reporter January 4, 2006 Avian flu maps in Google Earth Filed under: avian influenza, Google Earth — @ 8:16 pm

Nature has a Google Earth map of avian flu outbreaks online tonight.

I compiled data on human cases from World Health Organization bulletins.

No single database, or precise spatial data on cases could be obtained from WHO because, it says this would require the lengthy process of it requesting permission to provide it from each affected country.

I found locations for many cases in WHO bulletins, although these case data, which come from governments, often themselves provide no detail of even where the case came from, let alone their clinical or epidemiological characteristics — locations were found here by cross-checking cases described in WHO updates with case descriptions in the literature, using dates, sex, and age to identify distinct cases. Errors no doubt remain though, as a result, so I would be grateful if any scientists who take a look at it would let me know if you spot any incorrect case data, so that these can be corrected.

http://declanbutler.info/blog/?p=16

gs – at 03:06

it’s not yet “konspiratorial” to question WHO’s monopoly on gathering birdflu patient-information and pathology-samples. (and not fully informing us about the results). I think, they have no right to hide the information what they can do and what they can’t. They want our money. We want to know for what they want it. We don’t want to pay WHO for things which they think, they can’t do. So they should tell us what they can do and what not.

dubina – at 03:26

Hey, gunter, just kidding. No smilie face, but just kidding all the same. I agree with you.

You may have seen this already.

Governments are taking the threat seriously and last week pledged £1 billion to fight avian flu in the worst-affected countries.

http://www.timesonline.co.uk/article/0,,2095-2003468,00.html

12 January 2006

dubina – at 00:08

Old news, (from 10 November, 2005), but today Nabarro reiterated the call and “the major players gather again in Beijing for a funding conference Jan. 17 and 18″.

BBC ran Nabarro’s statement 3 separate times in its 30 minute newscast.

http://health.dailynewscentral.com/content/view/0001894/48/

Experts Put $1.5 Billion Price Tag on Pandemic Preparations 10 November, 2005 18:34 GMT

In the event the bird flu virus started to mutate and transmit from human to human, initial estimates of costs to fight a pandemic ‘will be multiplied by several orders of magnitude,’ says a World Bank official. Fighting the deadly H5N1 bird flu virus in poultry and preparing for the next human flu pandemic will cost about $1.5 billion over the next three years, excluding the cost of stockpiling anti-flu drugs, experts estimated Wednesday.

The figure includes $1 billion the World Bank forecasts will be needed to combat the virus in poultry in Asian countries already afflicted or at high risk of contracting the disease, as well as the cost of drawing up pandemic flu plans in countries that don’t yet have one.

At the close of a three-day global coordination meeting on the issue, the World Health Organization said it would cost another $500 million over three years to develop and produce a pandemic vaccine and to research new antiviral medications.

The estimates do not include the cost of stockpiling the anti-flu drug Tamiflu, WHO said, because the agency’s ongoing negotiations with Roche, the drug’s maker, over the price, supply and distribution of the pills means it is impossible to accurately predict the expense. WHO plans to buy millions of courses of the drug to ensure that poor countries can get some.

First Approximation

Delegates from the United States said they were hoping that by the time the major players gather again in Beijing for a funding conference Jan. 17 and 18, more precise cost estimates will be available.

Notice this.

“In the event the bird flu virus started to mutate and transmit from human to human, initial estimates of costs to fight a pandemic ‘will be multiplied by several orders of magnitude,’ says a World Bank official.”

What that all about? All-out containment effort? We don’t know, do we? How to find out?

Monotreme – at 09:12

gs: “it can’t hurt if we found a new independent panflu-organization. Double-check the WHO-samples sending out their own spies to look for sick birds and humans, questioning the farmers for sick birds and the patients for symptom-dateline and hospital-tests. Maybe even a mobile hospital to treat victims with own stuff and own testing.” Wow, I actually agree whole-heartedly with this! Science is based on the premise of independent verification. I never trust anything anyone publishes, no matter how eminent they are, until it has been independently verified. Yet, we are expected to accept everything WHO says without question, and our lives may be forfeit if their information is incorrect. Boy, do I NOT like that situation.

What are they hiding? First the facts: 1. DNA sequences 2. Seroprevalnece studies 3. Onset dates of sympotoms in Turkey 4. Relationships of infected people in Turkey

Now, some guesses: 1. Widespread outbreaks throughout China. 2. H5N1 became as lethal as it is because China used improper vaccinces 3. Very close relationships between some WHO personnel and Chinese politicos 4. Many H2H cases since at least 2003 5. Cluster sizes have been growing, possibly to a size that warrants phase 5 6. WHO personnel are personally afraid of going to Van

Monotreme – at 09:29

NW: “Lets say they know that a h2h is occuring and a worldwide pandemic will happen soon and bring modern societies to their knees. How would that announcement bring the fear level down?”

The idea that a pandemic will bring modern societies to their knees is an opinion, one that I don’t necessarily agree with. I am no pollyanna, especially as regards the likely case fatality rate, but I don’t think the situation is hopeless, at least not everyone. The US has tremendous scientific resources which, for the most part, have not been enlisted against H5N1. They should be. The US is, still, enormously rich in resources, food, energy etc. They are more than sufficient for the US to survive total global isolation. The US has considerable information technology skill and infrastructure. This could be used to limit the need for person to person contact. It could also be used for the rational distribution of essential resources. If the WHO and the US gonvernment were to indicate the seriousness of the pandemic threat, they would find that the citizens of this country ready to respond appropriately. I view the pandemic as threat on the order of WWII. Total mobilization of the economy and the population are necessary to fight it. But this can be done. The tragedy is that it is in not, in part, because an unelected bureaucrat in Geneva is making bad decisions.

NW “I would expect the more dire the situation the more tight lipped they will become to preserve order as long as possible.” What would be the point of this? If everything is goint to hell in a handbasket shortly, what’s the advantage of delaying the news for a few weeks or months? If the Director-General is lying, its to protect himself from blame, IMO.

DemFromCTat 09:39

Monotreme, thanks for labelling that last section ‘guesses’ (Monotreme – at 09:12). That’s all they are. I would suggest the data argues otherwise.

Monotreme – at 09:45

Yep, guesses are guesses. The WHO encourages speculation due to its policy of opaqueness. If they were totally transparent, we wouldn’t need to guess at why they do what they do. Reading WHO press releases is like reading Pravda during the Soviet days. We know they’re not telling the whole truth, so we carefully parse their sentences to try to figure out what’s really happening. This would be a waste of time , if our lives weren’t at stake.

Eccles – at 10:09

Monotreme - I think you are perhaps over estimating the scientific mobilization capabilitiesin the US. You must remember that the “Just in Time” mentality has also hit the Corporate R&D sector just the same. Thus, the huge flagship facilities like Bell Labs are no more. Facilities like Sarnoff labs have had to turn to hired R&D work. If a researcher doesn’t bring in money, he “outta there”. Since they did not contribute immediately and tangibly to the bottom line, most non-applied corporate R&D capabilities been dispensed with by corporate cost cutters. In almost any large corporation which used to support such work, there is almost nothing left.

So what is it that you expect to mobilize? And how quickly do you think ut can be done. The US had a 2 year warning before WW-II became our problem and we still needed most of 1942 to spin up. In the event of a running pandemic, how much time to mobilize do you think we will get? A month or two at the very most? And what do you think the current Panjandrums will be doing with that time? Giving more speeches congratulating Brownie?

LBaumat 10:13

All very interesting comments, observations. The release of the info about the relatively long life of the virus in bird droppings and the “imminent” comment concerning GBrit makes me think there is more going on in the “bird world”. Just speculation for the sake of speculation.

Monotreme – at 10:21

Eccles: I should have been clear about scientific mobilization - I did not mean big pharma (I agree with you on the problems there). I meant small biotechs and academic labs. Osterholm proposed a “Manhattan project” style effort to deal with the pandemic and I agree with this. As I’m sure you know, during the Manhattan project, scientists in many fields were pulled together to accomplish one task. Most had no experience with bomb-making. And in any case, no-one had built an atomic bomb before. I had a chemistry teacher in college who worked on the fuse. He had never worked on anything like that before the project, or after. But he had the right expertise for that task. What we need is another Oppenheimer, and I’m thinking of Osterholm here, to lead and organize a project that will apply the best minds in American science to the problem at hand.

We had a 2 year warning before WWII, but we didn’t use it. Pearl Harbor and all that. I agree the WHO isn’t the whole problem. GWB is no FDR. And I think Gerberding is actually making things worse. But… if we could get the word out about how serious the situation really is, and that means telling the truth about the case fatality rate, we could get more scientists, and others involved in getting ready. We have one thing they didn’t have for WWII: Flu Wiki.

DemFromCTat 10:25

re case fatality see a few new reports today in the new reports thread. Unconfirmed, but a critically ill child may make 5 deaths, and a death (to be confirmed) might make 6 of 22. Looking more like Asia, iow.

Monotreme – at 10:32

Yes, DemFromCT, I saw this. I’m beginning to think that the lethality of H5N1 has not changed since 1997, although it seems to have gotten better at infecting people. This may mean another myth will fall, that H5N1 has to become less lethal to adapt to humans. Sorry for the pessimissm.

April – at 10:36

Ever since I read here that the mortality rate needs to fall before it is H2H-able, I have wondered why we think that. I wondered why the mutation to allow it to transmit H2H would have to have any effect on the mortality rate or what if it made it even MORE deadly. Who is to say?

Eccles – at 10:37

Monotreme - The big difference between now and the Manhattan Project is that we had a nation that perceived that it was in a war for its survival, and would mobilize any personnel,any treasure and any facility that would contribute to the effort.

This time around, we are blessed with an Administration that thinks the way to deal with a problem is to make a grandiose speech about what we’re going to do, then do nothing about it, then make it an unfunded mandate for someone else to solve.

I fear that this situation will not change until the wolf is not only AT the door, but THROUGH it and eating the occupants of the house.

April – at 10:51

This administration mobilized resources after 9/11 and has prevented terrorist attacks in this country since that time. I support the president’s efforts in that area. Too often, we people who support this administration just sit silently and we let cracks like Eccles’ stand without any comment. So it leaves the impression that we agree with you. Just because we don’t correct you all the time, it doesn’t mean we agree with what you say. (I don’t mean just you, Eccles.)

I have been very critical of “government” on this forum, but it is not about this administration or any political party. I’m afraid that if the other party was in power, pandemic planning would be even worse than now because the bureaucracy would want to completely take over and we’d all really be screwed.

Monotreme – at 11:02

“The big difference between now and the Manhattan Project is that we had a nation that perceived that it was in a war for its survival, and would mobilize any personnel,any treasure and any facility that would contribute to the effort.”

Agreed. Which is why I am so adamamant that we not undermine the message by letting the myth that H5N1 has to get much more mild than it is today. May be Oprah will rise to the occasion and do what our leaders have not. Strange world we live in today.

April: I don’t like the current president, but I agree there is no reason to think a President Kerry would be doing things any different. I actually sent him (Kerry) an email before the last debate asking him to bring the question of improper allocation of flu vaccine and asking him to bring up the issue of pandemic flu. I got a canned, irrelevant response. When Bob Schieffer asked him a soft ball question about problems with flu distribution, he responded with an irrelevant sound bite from his stump speech.

The Democratic politicians don’t really get this issue any more than the Republican politicians. The fundamental problem is that politicians don’t know anything about science. They could understand tanks moving through Paris but they don’t get viral evolution. And we will all pay the price.

DemFromCTat 11:12

The above is why I like to keep politics off this wiki. This is not the time and place for terrorism discussion. Let’s skip terrorism and concentrate on flu. See rule 4; I want April to feel as comfortable here as Eccles. Republicans, Democrats and Independents all get the flu.

April – at 11:15

Over the last few years I have tried to get people to listen to some of my ideas for improving flu vaccine distribution. I contacted both Republicans and Democrats. One of my Republican senators replied with a note thanking me for my interest in bioterrorism. Huh? When I tried to contact my other senator, I decided to do it by phone. The phone flunky was completely uninterested in talking to me for more than 15 seconds. I also tried Democrats and did not fare any better. At least when I called Senator Clinton’s office, the person on the phone sounded like she wanted to hear what I had to say, which was more than I can say about my own senators. Of course when a senator is running for President, her staff HAS to at least sound like they care. I suspect it was not genuine interest however, because my ideas involved letting the free market fix flu vaccine shortages and getting the government out of the way.

April – at 11:16

Sorry. I was composing and did not see your message. No more politics!

Monotreme – at 11:20

Perhaps we could start an “Educating Politicians” thread. This would be non-partisan as politicians on both sides of the aisle are pretty ignorant about pandemic flu. Since these people are going to be making life or death decisions about us, it would be nice if we could find a way to get them appropriate information. We might start by sending them a link to Flu Wiki.

DemFromCTat 11:29

Obama actually has flu wiki link on his web page; I don’t knopw who else does. There is a politics section for speeches and links. Note both Frist and Reid officially agree and agree with us. This approach must be non-partisan and bi-partisan. There is no alternative.

DemFromCTat 11:32

There will be a lobbying effort for passage of enabling legislation in April when the budget reconciliation bills need to pass. In the meantime, notifying your local officials in House and senate, either party, is always relevant.

Grace RN – at 12:11

‘French Ministry of Health announced Sunday that some analysis is in progress to determine whether a French woman, who came back from Turkey, is contaminated by the avian flu virus, reported MAP news agency.

L’institut de Veille Sanitaire (InVS) said that the case of the young woman presents “a fear of avian flu.” Ph: Archives.

“The first test proved to be negative. The other tests are under way,” confirmed the Ministry.

The young woman was taken to hospital in Montpellier right away after her return from Turkey, where she spent 15 days in a region “reported to be unaffected by the avian flu,” said the same source.”

link:http://tinyurl.com/7gk7p

While any case of avian flu is bad, IF it is determined she has H5N1, it’s not as bad as say, a case in France that had not traveled to Turkey. OTOH, IF it’s H5N1,I hope her stay in Turkey is dissected minute-to-minute to determine where and when she picked it up, and her contacts closely monitored.

Grace RN – at 12:12

Sorry, wrong thread!

Monotreme – at 13:49

WHO organizational structure Scroll down to meet the team.

At 09:12 My third guess at what the WHO has to hide was “Very close relationships between some WHO personnel and Chinese politicos” I was wrong about that one. This is hidden at all. The adviser to the Director-General, and former Director-General himself, is with the Ministry of Health in…China. Doh. And the Director-General hired the odious Margaret Chan. You know, the one who left Hong Kong wide open for SARs. Yeah, we’d know if there were any clusters of H5N1 in China. Right.

Re: Margaret Chan

Hong Kong Officials Reacted Too Slowly to SARS 2004.07.05

HONG KONG — Top Hong Kong health officials were unprepared to meet last year’s outbreak of SARS, reacting too slowly to a major public health crisis that killed 299 people in the territory, a legislative report said Monday.

Secretary for Health, Welfare, and Food Yeoh Eng-kiong, former director of health Margaret Chan, and Hospital Authority chairman Leong Che-hung were among five key figures found to have mishandled the outbreak in a six-month probe by Hong Kong’s Legislative Council.


Guess who the Director-General appointed to be Pandemic Flu Czar? That’s right, Margaret Chan.

And now we are concerned that WHO is not responding quickly enough and that outbreaks in China may be being ignored. Hmmm. Could there be a pattern here?

gs – at 19:41

I had been speculating WHO had some secret agreement with China, like sequences for politically positive statements or such. I guess, China had been threatening to close borders for WHO completely and give no more virus-sequences.I wouldn’t be surprised (even hoping ?) if China were “creating” long h2h chains for research.

Monotreme – at 20:24

gs: I don’t think China has to threaten WHO because China IS WHO, to some extent.

I have a low opinion of the PRCs human rights record, but even I have hard time believing that they are experimenting on people.

007 in the USA – at 20:55

DemFromCT – at 11:29 “Obama actually has flu wiki link on his web page; I don’t knopw who else does.”

Dr. Bill Frist has been talking about H5N1 for about a year now and gave several speeches on the Senate floor long before anyone else even had it on the radar. I have been receiving H5N1 email updates from him for at least that long. And that is many months before the esteemed Obama got on board. Nice try though.

Cheerio! 007

Many Cats – at 21:04

TRUCE, GUYS, PLEASE!!!!!It seems the only thing spreading faster than H5N1 is the political virus. At least let’s kill one virus!

Monotreme – at 22:58

Many Cats is right. This is not a partisan issue. And its true that Senator Frist is aware of the consequences of a severe pandemic. Its also true that Senator Obama is emphasizing this problem. I don’t really care who was first. The more politicians who wake up and make this a priority, the better. We should all contatct our representatives and try to get them to take this seriously.

DemFromCTat 23:12

Frist’s and Reid’s speeches are here. They’re both excellent. The Obama reference was to him linking Flu Wiki, not anything else, 007. If Frist or any other senator links Flu Wiki, let me know.

23 January 2006

DemFromCTat 18:12

The Director General speaks:

WHO says not overplaying threat of flu pandemic 23 Jan 2006 11:53:34 GMT

Source: Reuters By Stephanie Nebehay

GENEVA, Jan 23 (Reuters) - The World Health Organisation (WHO) denied on Monday it was exaggerating the risk of a human influenza pandemic and called for improved surveillance of birds to ensure early detection of the deadly avian flu virus. The example of Turkey, where children fell ill almost simultaneously with the first confirmed outbreaks in birds, showed the urgent need for all countries to develop early warning systems, said Lee Jong-Wook, WHO director-general.

DemFromCTat 18:16

same article:

LESSONS FROM TURKEY

Unlike in East Asia — where outbreaks had been detected in poultry well ahead of human cases — the “unique feature” in Turkey had been “almost no prior warning of infection in poultry”, said Lee, a South Korean doctor.

“The Turkey experience demonstrates the dangers poised by avian influenza in birds and the vital importance of surveillance and effective early warning systems,” he added.

“A pandemic could arise with little or no warning from the animal side.”

The outbreak in Turkey had also shown how fast national authorities, backed by international experts, can move in a health crisis, Lee said. Within a day, samples had been taken from suspect cases and shipped to WHO laboratories in Britain.

“Results were available within 24 hours; 100,000 treatment courses of oseltamavir (Tamiflu) were available were available one day after the first cases were confirmed,” he added.

Lee also backed a proposal by several Western countries to bring forward compliance by member states with new International Health Regulations, specifically regarding bird flu. The rules, agreed last May, cover all health emergencies of international concern. They are mandatory from mid-June 2007, but some states have proposed immediate voluntary compliance on bird flu to share information and clinical samples rapidly.

Name – at 20:06

One wonders who is accusing WHO of overplaying the threat of a pandemic — certainly not anyone on Flu Wiki! This however supports what many here suspect — that WHO faces tremendous pressure to downplay the threat due to fears over economic disruption.

Dr Lee is also putting some breathtaking spin around what happened in Turkey. Turkey had plenty of prior warning that they had suspiciously sick birds as far back as October—they simply chose to ignore it. The Van hospital waited for something like a week for that shipment of Tamiflu; doctors there also had to put out an impassioned appeal for extra ventilators when they were still just treating a handful of patients. It took WHO many days to arrive at the scene to begin their investigation. And now we learn that all but the first four Turkish samples only got sent to the UK today for official lab confirmation because of delays due to the holidays there.

If starting treatment as early as possible can make the difference in an individual’s survival, these things are critical. If identifying and containing an H2H outbreak in the first week or two can make a difference between averting or failing to avert a pandemic, these lapses would have been fatal. If the Turkish mutations have brought us a step closer to a global pandemic, their lapse in not addressing the disease in poultry more urgently may be something the world regrets for years to come.

Pointing fingers is the easy part. We need to pressure our governments to help WHO and to help all these countries to do much, much better.

Monotreme – at 20:48

Only one government has influence at WHO - China. Report by the Director-General to the Executive Board at its 117th session “Dr Margaret Chan, from China, is Assistant Director-General of the Communicable Diseases Cluster, and the WHO Representative for Pandemic Influenza”.

Dr. Chan ignored the SARS cases in Mainland China when she was a health official in Hong Kong. She resigned in disgrace after public rebuke and humiliation. Her reward, from the PRC, was flu czar at the WHO. The adviser to the Director-General is affiliated with the Ministry of Health of China. It doesn’t take a conspiracy theorist to see a clear conflict of interest when representatives from China are charged with making statements about the transparency of China. An example:

“Dr. Margaret Chan, the WHO global special representative on avian flu, praised Chinese government for its cooperative and transparent measures in curbing bird flu.” China Daily

Why no phase 4? Because its not in the interest of the autocrats who run China. They enrich themselves through graft and corruption. H5N1 evolved in China. The Chinese leaders know better than anyone else exactly how much of a threat it is. They have made whatever preparations they think necessary. They have no motive to warn the rest of the world. Stage 4 would trigger a warning to defer unncecessary travel to China. This would cost them dearly. So, make as much as money as possible before stage 6 and the hell with the rest of the world.

The director-general is trying to cover his ass with scary statements and protestations against being an alarmist. Meanwhile, according to the WHO official guidelines, there has been no increase in the alert level. The countries and states that have pandemic plans will only trigger them if phase 4 is declared. The verbal statements of the Director-General are irrelevant.

LBaumat 20:51

Geez, just wish Dr. Lee had said “avian side” instead of “animal side”. Hope no other critters are coming across bird droppings (with the ability to infect for upto 14 days in cold weather) and acting as carriers/hosts?

dubina – at 20:55

Shouldn’t we expect Leavitt and company to know what cooks or doesn’t cook and do something on behalf of “national security”?

Monotreme – at 21:27

Dubina: “Shouldn’t we expect Leavitt and company to know what cooks or doesn’t cook and do something on behalf of “national security”?”

Don’t overestimate our intelligence in this area. Not a partisan statement, Clinton ignored this as well. I suspect the intelligence agencies don’t have whole lot of biologists on the payroll. Further, I think first world countries gave money, but didn’t pay attention to what was going on at the WHO. They saw it as a charity case, not as a threat to national security.

Name – at 21:28

Yes, Monotreme, though I expect that as the biggest funders of WHO, the US government and the EU likely have considerable pull as well.

Monotreme – at 21:39

Name: If they wake up in time. BTW, I have hunch Nabarro was an attempt by the G7 to balance the equation a bit. The PR people at the WHO were pretty mad at some of his statements shortly after his appointment. Still, the Director-General holds all the cards. Only he can declare phase 4. The question is who does he fear more, China or the G7 countries? I think China.

DemFromCTat 22:02

There’s always the chance he’s waiting for data. Turkey wasn’t it - yet. China is (alas) sheer speculation.

Just saying. But the concept that WHO was right from an epidemiological pov can not be simply eliminated from the possibilities by fiat. That’s at least as likely a choice as that China is gaming the system. IOW, it might be simple caution, not corruption or stupidity. And Turkey’s diminishing human case number supports that concept.

Now, admittedly, that’s a much less interesting story line. Conspiracy theorists will claim everyone’s hiding cases, including Turkey. But in this internet age, that becomes harder and harder to do (how many countries are in on the conspiracy?).

DemFromCTat 22:09

btw here’s the speech in toto. Whatever else you think of WHO, note what they’re doing with polio, on the way to following smallpox as a disease to be eradicated from the earth. I’m old enough to remember neighborhood kids with it. Thank goodness for this.

Monotreme – at 22:12

DemFromCT: Include the Turkish government among the conspiracy theorists. They are convinced other countries are hiding cases. Of course, maybe birds just don’t like Turks and have decided to attack that country and none of its neighbors. Reminds me of a Hitchcock movie. Thrilling, but the science was a little weak.

As regards China and the WHO - I stand by my assertion that having a representative of China make statements about China’s transparency is a conflict of interest. How much confidence would the world have if former USDA chief Ann Venneman were the head of an international body investigating Mad Cow and she were to assert that the US was totally transparent and doing a great job of monitoring prion disease?

How long for due diligence? 1 week, 2 weeks, 1 month, a year? According to the Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO, updated yesterday, there are exactly 4 confirmed cases in Turkey, 2 of them fatal.

Monotreme – at 22:16

I don’t doubt the WHO has done good things. As I have mentioned previously, Carlo Urbani is one of my heroes.

But… if the Director-General doesn’t declare stage 4 now, when its warranted, hundreds of millions of people may die unnecessarily. No-one can stop a pandemic from happening at this point but preparing will reduce the carnage. This isn’t a matter of shooting the messenger because he has bad news, its shooting the messenger because he had bad news and didn’t tell his fellow world-citizens in time.

LBaumat 22:24

I remember WHO “shuffling” the numbers on the charts for SARS. That was a hoot…I just figured they thought we were dummies.

Monotreme – at 22:26

They did. They still do.

DemFromCTat 22:33

Why is it warranted? The data still doesn’t exist for sustained H2H. Not in Turkey, not in China. Or, at least, the data is not incontrovertable. You’re getting ahead of the facts.

What we have a problem with is witholding data on genome sequences and maybe seroprevalence. We have a problem (obviously) with trust, and there may be conflicts of interest. Hey, there may even be <gasp> politics.

Where’s your data for stage 4? It isn’t from Turkey. The numbers are 21 and 4, 1 suspicious fatality pending, no recent cases.

Monotreme – at 22:57

I agree no data suggests sustained H2H, but that’s not stage 4, that’s stage 6 (full blown raging pandemic). Stage 4 only requires “small clusters (less than 25 people) limited human-to-human transmission but spread is highly localized, suggesting that the virus is NOT (emphasis mine) will adapted to humans”. See WHO pandemic plan pages 2 and 8. Here are some of the clusters?. WHO doesn’t make it easy to extract this info, but even this partial list provides plenty of evidence for “small clusters” with “limited human-to-human transmission”. Now, one can always say one person in a family got infected from eating bad chicken, then a week later another person in the same family got infected from eating bad chicken and so on. But really, how believable is this? How many clusters with clear separation in symptom onset dates does one need to see to become convinced that limited human-to-human transmission is not a rare event?

DemFromCTat 23:17

New cases, health care workers getting sick. Both are lacking. I’m suspicious there might be some H2H buried in here, but not to the point of calling WHO out on it. If each case had bird exposure, there’s little to argue about H2H. That due diligence is ongoing.

I also think WHO should clarify their stages. I read the same stuff you do and don’t agree with you about what stage we clearly are in. Therefore, I withhold the accusatory language. Every day Turkey is quiet is a day in support of WHO’s position.

leistb – at 23:24

Or every quiet day in Turkey is another successful day of media suppression. Since they are the ones controlling the “official” flow of information for anything and everything related to bird flu, I think the conflict of interest is obvious.

Monotreme – at 23:27

Every day that WHO doesn’t update their cummulative confirmed cases from 4, I grow more suspicious. But perhaps we should call the Director-General Mr. Transparent. After all, more people see through him every day.

24 January 2006

dubina – at 01:06

“Every day that WHO doesn’t update their cumulative confirmed cases from 4….”

How long has it been now from the start of niman’s Turkey timeline? Who in the first 21 cases are still sick? Dying? Dead? What about new cases? Recovered cases? The Dogubayazit cluster?

For an outfit professing to know the importance of clear communication, they have strangely little to say.

viralprotein – at 02:35

--The fastest way to slice through the fog of Politics surrounding the current state of the Pandemic, is to send in an independent Epidemiologic Response Team to take samples from infected populations.

viralprotein

DemFromCTat 09:14

Only with permission. Yyou all discount the difficulty of getting that. See the answers to the 5 questions thread.

anyway, see China story:

WHO Negotiates with China for Handover of Bird Flu Samples

Medical Maven – at 09:58

DemFromCT: regarding CHINA STORY The Chinese scientists are not pulling the strings here. To the Chinese government this a national security matter to be leveraged to their advantage. The Chinese view themselves as the ascending power in the world, the trod-upon has-been who will soon “inherit the earth”. It is a heady mix of nationalism and racism that pervades the thinking over there, from top to bottom. Those last two statements are facts that anybody can glean from open-source materials.

gs – at 10:10

we already had this. (*) It ends with everyone doing its own science and keeping the results secret. All will suffer from this, so someone will get the brilliant idea to make everything public. That works quite well for some time until some local people will try to get some advantage by keeping things secret. That works for some time, until more and more follow this example goto (*)

EOD – at 10:14

I can well imagine that some in the Chinese government would also view this as an opportunity to “thin the herd” and get rid of some of their poor and uneducated who don’t “contribute”.

Grace RN – at 10:29

I’m not sure that the response of American gov’t to the NO/superdome disaster wasn’t that as well- ie “thin the herd/get rid of poor and uneducated” mentality.

Medical Maven – at 10:52

Grace “no comment”

luv2cmwork – at 11:09

GraceRN,

Please. I have a great respect for all you say and give your opinion much credibility. Don’t go down that road.

DemFromCTat 11:29

let’s concentrate on flu. Enough “what what their intent?” to go around. More speculation than facts, alas. we all want data.

Medical Maven – at 11:38

DemFromCT: I will take the blame on this. The topic of “governmental motivations” should have raised a “red flag” in my mind.

24 May 2006

DemFromCTat 13:07
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