With all the talk of transparency, we learn that China has yet to share its avian flu isolates with the world scientific community. This is different than the sequence issue. China has shared its sequences, but the sequences don't tell the whole story. In particular, we are still not able to make the jump to biology, for example host range, virulence and tissue tropisms. Correlating the sequences with the biology is a critical scientific goal. For that you need the viruses themselves. And since 2004 the Ministry of Agriculture, despite promises to the contrary, has not shared its isolates.
There are lots of reasons, among them issues of national pride, commercial interests regarding use of the isolates for vaccine strains, scientific priority. These are no longer sufficient (if they ever were), given the threat of a pandemic. The current excuses by Chinese authorities are just that, excuses:
"When viral strains cross international borders, special protocols are needed and we are working to complete those," vice director of the ministry of agriculture's veterinary department, Li Jinxiang, told a news briefing.Li said Beijing wanted "to conform to WHO (World Health Organisation) standards for international transfers". (Reuters)
Bullshit.
This is not unexpected behavior from Chinese authorities. Their record on truthfulness, let alone transparency, is notorious. It could make things difficult for their preferred candidate, Dr. Margaret Chan, in the election for WHO Director General,. Or it should make things difficult for her.
That election is coming up. Even as this Labor Day weekend marked the official opening of the US elections for congress, this week also marks the opening of the election campaign for the post of World Health Organization Director General, left open by the sudden death of Dr. Lee Jong-wook in May. WHO has lots of problems, but in the field of international health, it's the only game in town. The DG position is critical because it sets the tone for this important UN agency.
There have been some strong and effective DGs in the past, but the record recently has been decidedly mixed. With a tightly interconnected world facing critical problems from emerging and re-emerging infectious diseases, we need a DG that can handle the sovereign states that still do what they want to do and don't want to do what they don't want to do, the rest of the world be damned. This will take a willingness to get rough. But selecting the next DG is not a pretty process, nor one designed to produce the right person for the right time:
"I think everybody is aware that the system is open to huge corruption at the moment," Dr. Richard Horton, editor of the medical journal The Lancet, said in an interview Monday.
"It's pretty clear to me that there are some candidates who really shouldn't have an opportunity to get the WHO DG (director general) job, but they will be strong candidates because of their governments and what their governments can do for them."
"In the modern world this is no way to run a massive organization. The candidates should be evaluated on the basis of their achievements and their vision. And that should be done in a way that is maximally transparent," Horton said from Barcelona, Spain.
Horton suggested open balloting by members of the WHO's executive board would go a long way to shifting the emphasis away from political horse-trading and onto a debate about which candidate is best equipped to serve as the.world's public health ambassador.
"There should not be secret ballots. Every member of the executive board who votes, it should be public knowledge who they have voted for." (Helen Branwell, Canadian Press)http://www.570news.com/news/international/article.jsp?content=w090461A
The executive board will put forward a single candidate, which is then confirmed by a formal vote of the World Health Assembly on November 9. The Board makes its choice from a set of candidates who have now been officially nominated by their member states. This is done via secret balloting in the days before the WHA on November 9, and it is this balloting that Horton says lacks transparency. The board consists of 34 members, representing all six WHO regions (the Americas, Africa, Southeast Asia, Europe, the Eastern Mediterranean and the Western Pacific). Helen Branswell, in her excellent article quoted above, gives us the countries on the Board:
Afghanistan, Australia, Azerbaijan, Bahrain, Bhutan, Bolivia, Brazil, China, Denmark, Djibouti, El Salvador, Iraq, Jamaica, Japan, Kenya, Latvia, Lesotho, Liberia, Libya, Luxembourg, Madagascar, Mali, Mexico, Namibia, Portugal, Romania, Rwanda, Singapore, Slovenia, Sri Lanka, Tonga, Thailand, Turkey and the United States.
It should be obvious that some among these are more equal than others. In particular, China, Japan and the US have major influence on the other countries and the politicking that is already going on will not be a model of virtue and dedication to global public health.
Do we have a favorite? No. But we have some opinions. Within WHO, Margaret Chan is considered a frontrunner because of her excellent interpersonal skills, the strong championship of China and the belief of many that China's stake in her candidacy will enable her to be more effective with this difficult member state. This is a reasonable argument, but we don't buy it. In fact, China's sponsorship of Chan we view as a negative, just as we would view any candidate championed by the US. If US Ambassador John Bolton, who cares little for the United Nations, thinks candidate X should be DG, it is our view this is sufficient to disqualify candidate X. And if China wants Margaret Chan, it isn't because they think she will be a tough DG who will push hard for transparency. China doesn't believe in the virtues of transparency, and with Beijing being the site of the 2008 Olympic Games their word is even less trustworthy (if that is possible). It is hard not to suspect China wants Chan because they think she is more controllable, by virtue of culture, manner or diplomatic tendencies.
This is a shame, because people who know Chan think highly of her. She is said to be tough and straight-talking inside the agency, where she is assistant director general for communicable diseases and a pivotal person in the battle against bird flu. But outside the agency she is diplomatic to a fault, a phrase we use deliberately to describe her reticence to use her position as a bully pulpit to coerce or shame recalcitrant member states to do what they should do. That's not her way, but we think it's what's needed.
Branswell reports that The Lancet's Horton favors Mexican Health Minister Dr. Julio Frenk, who also served as a WHO executive director under former director general Gro Harlem Brundtland, because of his experience. We don't know Frenk so we don't know if that will be enough, although we have great respect for Horton and his judgment. Horton also believes Japan's Shigeru Omi is a strong candidate, mainly because Japan is a tenacious fighter for its candidates in international agencies. Not a good reason to be DG.
So we'll see. When the list of candidates is complete and announced, we'll post it here. We'd be interested if any readers have any information or insight about the candidates.
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This is William calling NASA in Houston . Houston we have a problem. WHO may sink if the TB strain described below spreads over the earth in combination with a bird flu pandemic.
World health officials last night put out an unprecedented warning that deadly new strains of tuberculosis, virtually untreatable using the drugs currently available, appear to be spreading across the globe.
The new strains are known as extreme drug-resistant TB, or XDR-TB. They have been identified and have killed people in several countries, including the United States and eastern Europe, and they have recently been found in Africa, where they could swiftly put an end to all hope of containing the Aids pandemic through treatment.
Yesterday Paul Nunn, who heads the World Health Organisation's TB resistance team, said the situation was very serious. There are 9m cases of TB in the world and the WHO estimates that 2% of them - or 180,000 - could be XDR-TB.
"This is raising the spectre of something that we have been worried might happen for a decade - the possibility of virtually untreatable TB," said Dr Nunn.
Even in the United States, which has the best medicines available, a third of those who have been diagnosed with XDR-TB have died. In March, the Centres for Disease Control in the US registered that there had been 64 cases of XDR-TB; 21 of those ended in death.
Significant numbers of cases have been confirmed in Latvia and Russia, but in many parts of the world, XDR-TB could be rife but unrecognised. One of the reasons the WHO is concerned is that tuberculosis spreads easily in confined places, such as aircraft.
Multi-drug resistant TB strains - those that are resistant to the two basic, first-line drugs used to treat the disease - have spread everywhere, including to the UK.
Multi-drug resistant TB is increasingly common and is difficult and expensive to treat. The patient must be given four out of the six existing second-line drugs.
But the XDR-TB strains now appearing are a medical nightmare because at least three out of those six second-line drugs have no effect. There are no third-line drugs.
The WHO report on XDR-TB is here.
You can find the article shown in the above post at:
http://crofsblogs.typepad.com/h5n1/
If Chan becomes DG it will ensure that we will have a pandemic and her straight forward talking inside of the WHO doesnt mean shit. She deliberately dodges questions on the outside for political reasons. We need someone who will call a Chinaman an H5N1 carrier and then declare Pan 4. Period.
I would like to introduce to you the next director general of the who (doesn't deserve capatilization)...Lapdog of the Government of China...Dr. Margaret Chan.
"I think everybody is aware that the system is open to huge corruption at the moment,"...kind of says it all, doesn't it?
Who should be Director General of a new and professionally competent World Health Organization...
...Dr. Capalari from Italy!!
Margret Chan has done a pretty good job in Hong Kong SAR.
She was effective and decisive in both the SARS outbreak and the 1997 H5N1 breakout.
Kevin. I believe that after an inquiry into SARS in Hong Kong she was relieved of her duties by the Government.
You mean dr. Ilaria Capua, Tom?
I sometimes make such mistakes when I'm very tired.
Do you have some article about Margret Chan's replacement?
http://www.legco.gov.hk/yr03-04/english/sc/sc_sars/reports/sars_rpt.htm
Seems the Hong Kong government thought she didn't pick up on the Guangdong SARS cases in February 2003.
Does not say she was replaced though - just held responsible. Learn something new every day.
tan06. Thanks for the correction. I should have double checked her name. I do not have an article but the public inquiry was referenced on flu wiki when Dr. Chan's name first came up for Director General about a month ago.
Tannie..Tom is right on this one. He cant spell worth shit about Ilaria Capua's name but hi gits et riot must o d teme. Sorry for the pun Tom. Hey whats the name of that water soluble electrolyte compound thats like Pedialyte?
So it's all about names, huh? :) (Think, Randy, think! I wrote you about that some time ago!)
More in general, I like Ilaria Capua for her avant garde actions on sharing the sequences. So a little respect!!
I am seeing that as the counterpart from the F words here that the Reveres are entitled to use... Can we give some positive reinforcement, after learning about many sad cases in this blog... I like to stay positive...
And now there maybe is some break through coming from China in a positive sense: they blame US labs for not being able to do something with the virus samples of H5N1:
http://www.alertnet.org/thenews/newsdesk/HKG147715.htm
So maybe after the un-blaming and recapturing of honour by themselves they will share the samples as well.
I would really like that, go on China and make me happy!
tan06: Capua is not a candidate and wouldn't be DG material anyway. She's a scientist, and a good one, not an administrator. The list of 13 is the final list of possibilities.
I saw the Chinese "explanation." The problem is that it could be partially true (I don't underestimate the ability of US bureaucracy to screw things up) but it could be another falsehood and excuse -- or a combination. That's the problem with these two rogue countries when it comes to international public health.
For awhile, I was hoping that Dr. Chan was strategically biding her time so that she would have a chance to push hard later as DG. I knew that she feared becoming too popular under the reign of Dr. Lee, because he did not like assistant DG's to become popular with the public. But after he died, Dr. Chan remained as low-profile as before.
Then I began to suspect that she was afraid to make bold statements. This could still be strategic; I don't know. She was certainly bold during the 1997 H5N1 outbreak. With regard to Dr. Chan being chastised by the outside team evaluating HK's SARS response, I felt that was unfair, because Health Secretary Yeoh was guiding HK's response much more than Dr. Chan. But I have not seen recent signs of the great Margaret Chan who responded to H5N1 in 1997.
Dr. Omi is very bold and outspoken. He has not kow-towed to Geneva enough to please headquarters, that's for sure. This may be very attractive to westerners, but I can't be sure it would be effective with the Cover Up Countries. It would certainly be refreshing, though.
Revere, I know Capua isn't on the candidate list, my writing was just about Tom's nick-naming her.
About China, if it goes the same path we saw with Indonesia, it's a diplomatic opening and since they seem to have a vaccine capacity right now it might be a play about just-in-time exchanges to, and arising goodwill from, other countries?
tan06: Wouldn't count on their vaccine capacity. There's a billion people in China. We need someone to beat them over the head. I don't think Dr. Chan is that person. Just a personal opinion.
First timer to this blog. As for the delay of transferring these H5N1 samples, I can believe that US is also accoutable for it, as indicated below. I think this is the select agent issue that CDC and USDA, along with DOT and other US agencies have yet to learn how to handle, especially transferring the diagnosed H5N1 into the country. CDC in the pass has not been compliant to these SA Rules if you know what I meant. Look at the chaos they are in now! Anyone read the Select Agent Rules? Give the Chinese a break! And please do watch your mouth next time. by calling them "bullshit".
US procedures delay samples sharing
By Zhao Huanxin (China Daily)
Updated: 2006-09-08 06:32
The government yesterday blamed the "prolonged delay" in sharing bird flu samples on procedural problems faced by the importer designated by the World Health Organization.
"The China National Avian Influenza Reference Laboratory has already prepared the 20 samples as required by the WHO-designated lab of the Centres for Disease Control and Prevention (CDC) in the United States," a Ministry of Agriculture spokesman said.
But the US lab has not yet completed import procedures, causing an indefinite delay in the shipment of the virus, the spokesman said.
The US Embassy in Beijing was not immediately available for comment.
On Tuesday, Julie Hall, a WHO official in Beijing, said "the logistical arrangements are there to ship those viruses" and questioned the delay.
A ministry official, speaking on condition of anonymity, said the government is committed to sharing bird flu information and virus samples with the international community, and had provided five live poultry viruses to the WHO in 2004.
But the WHO made the samples available to foreign researchers who twice published the genetic sequence and other data of four of the five samples without giving credit to Chinese scientists who made the genetic sequencing and done an analysis.
Both the WHO and the researchers apologized to the ministry for the incidents, according to the official and Hall.
In February, the WHO and the ministry reached an agreement under which China would share bird flu samples by transferring them from the ministry's lab to WHO-linked labs.
In line with the arrangement, the ministry helped the Chinese lab complete all the formalities for the export of the 20 virus samples to the CDC lab, the official said.
But the ministry's lab learned from the US lab that the US Government allows the import of only undiagnosed samples; while those to be shipped by China are diagnosed samples whose full genetic sequencing analysis has been completed, according to the official.
For scientific research, those samples have to undergo strict screening by the US Government before they are allowed in, he said.
"It is therefore against fact for the WHO official to claim that it had completed the 'logistical arrangements' for the shipment of Chinese samples, and that the Ministry of Agriculture had failed to share the viruses that are needed for the global fight against bird flu," he said.
The official added that the ministry has insisted on dispensing with the "logistical arrangements" of the WHO.
In response to the ministry's comments, Hall yesterday said determining who was to blame for the delayed shipment was of no help.
"What is important is to have the samples shared as soon as possible," she said.
Mark: China has been cut more slack then she deserves, by me among others. We are fed up with the MoA's foot dragging. China has behaved badly -- no, reprehensibly -- and no one trusts her for damn good reasons. Her control over information is a symptom of a deep disease, and controlling isolates is controlling information. US CDC is quite capable of bureaucratic nonsense and I have no doubt a few weeks delay rests at their doorstep. But not two years worth. As for "watching my mouth," I am sorry your sensibilities are so delicate. Bullshit is bullshit, however, no matter how you cut it. Bullshit doesn't refer to the Chinese. It refers to what the Chinese government is saying.