Birds and Bureaucrats

WHO Knows Better
Neither the world, nor the World Health Organization, is prepared for a real pandemic.

Saturday, June 10, 2006; A18

IT'S LONG BEEN the world's public health monitor, responsible for detecting and eradicating infectious diseases. Now the World Health Organization has accidentally acquired another role -- as a source of disarray in global financial markets. When the WHO announced a while back that the sixth member of a single Indonesian family had died after contracting the virus strain known as H5N1, stock markets that were already jumpy plunged. The Indonesian rupiah, the Singapore dollar and the Thai baht all fell against the U.S. dollar.

In fact, the agency had concluded that there was no bird flu pandemic: The family members who contracted the disease were all blood relatives living in close proximity to one another. Other family members, unrelated by blood, did not get sick, suggesting both that those who died had a genetic susceptibility, and that the virus has not in fact mutated in such a way that it is spread easily from human to human. Markets concluded otherwise.

The lesson for the WHO, and for governments, is clear: Managing both the medical and the economic reaction to bird flu now requires superb communication of good information in real time. Yet information coming out of Indonesia has been sporadic and incomplete. This is both because understanding of the disease is not very good in general -- the health agency did say it was not raising its alert level to the pandemic phase -- and because the WHO is still understaffed in rural Indonesia and most everywhere else. Unofficial reports also indicate that medical facilities are so bad in parts of rural Indonesia that people there are reluctant to go to hospitals, because they see others enter them and die.

The long-term implications are also clear: Any international response plan that relies on sending caches of Tamiflu or another antidote into the less-developed world to stamp out early signs of an epidemic is unrealistic. Instead, the developed world needs to work harder on coordinating and targeting its work on vaccine production -- and on helping the WHO, which, despite all the scare stories about bird flu, still has neither the staff nor the funding to deal with a serious outbreak of infectious flu.

The WaPo is generally correct in the editorial, but it misunderstands some basic facts about the WHO: the member states control the information they have and won't release it to WHO if there might be economic blowback on them; vaccine technology is about 50 years out of date and we won't have a vaccine using the old technology which can be delivered to anything like the bulk of the population until years after a pandemic outbreak.

Our colleagues the reveres have more here this morning, with links to the long series on WHO they wrote last week.