Killer bug exposes WHO's shortcomings

Killer bug exposes WHO's shortcomings

Andy Ho

The Straits Times, Asia News Network, Singapore

On March 15, the World Health Organization (WHO) warned that a
mystery killer pneumonia, christened severe acute respiratory
syndrome (SARS), was spreading rapidly from East Asia to other
parts of the globe.

With 219 cases, excluding Guangdong province, already
reported, it released a rare "emergency travel advisory", calling
SARS a "worldwide health threat". Why did the WHO system for
global surveillance of infectious diseases fail to catch this
outbreak? If not for the impending Iraq war, the media would be
focusing on the SARS outbreak.

In 1918, as World War I was winding down, an influenza
pandemic began, which killed more people than the war.

Outbreaks swept through America, Europe, Asia, Africa, and the
South Pacific. By the time it ended, a fifth of the world's
population, or about 20 to 40 million people, mainly 20 to 40
years old, had succumbed. People struck with the disease died
rapidly, drowning in lung secretions that filled their airways.

It was never precisely established where the virus had
originated but scientists postulated that new strains seemed to
emerge from the Far East each year and spread to the rest of the
world.

The consensus among experts was that the big one in 1918
probably started in China where a rare genetic mutation in the
virus could have given rise to a variant so novel that all
natural immunity was useless.

The SARS epidemic seems to have also begun in China where an
outbreak occurred in November. It appears that news about it was
suppressed until February; WHO experts were called in this month.

Even then, the Asian Wall Street Journal reported on Tuesday,
WHO experts were not allowed to visit the afflicted areas.

Instead, they had to wait in Beijing to confer with provincial
health experts, according to whom the outbreak involved 305
patients, with five deaths. No patient samples, test results or
treatment details were shared.

The AWSJ report suggests that patients and hospital workers,
travelers to China and international experts "may have been left
in the dark about the disease's dangers because of official
reluctance to acknowledge a problem". It was left to an
unidentified American businessman traveling from Shanghai to
Hanoi, via Hongkong, to expose the cover-up inadvertently.

He caught the bug in China and died, becoming the first SARS
victim outside China. Soon cases were reported in Canada,
Germany, Indonesia, the Philippines, Singapore, Thailand, Vietnam
and Hongkong.

Clearly, international cooperation is critical if the spread
of infectious diseases is to be controlled. International health
regulations inherited by the WHO from the 19th century used to be
legally binding rules governing the global surveillance of
infectious diseases.

These required countries to notify other nations about
outbreaks within their territories, maintain adequate public
health capabilities at border points, and take rational,
scientific steps to prevent disease spread such that world
traffic and international trade are restricted minimally.

In 1995, however, the WHO moved away from its system of
binding rules to a reliance on information gathering through its
Global Outbreak Alert and Response Network. This, unfortunately,
depends on the voluntary compliance of member states.

Today, WHO's 192 member states determine for themselves,
without criteria laid down by WHO, whether an outbreak is a
"public health emergency of international concern". China felt it
had everything under control and chose not to disclose its
outbreak -- until it was too late.

There are also no legal consequences if WHO ascertains that a
member state has failed to report such an outbreak. Even now,
China refuses with impunity to cooperate fully.

Further, geopolitical tugs-of-war prevent WHO from being an
effective controller of disease. Taiwan, for instance, has seen
five SARS fatalities so far, but as it is not a WHO member, it is
unable to contribute its data or expertise.

By default, the role of international coordinator seems to be
falling to the Atlanta-based Centers for Disease Control and
Prevention. So it is not just the United Nations Security Council
that seems to risk irrelevance: Even the role of WHO in
infectious disease surveillance and control has become uncertain.

The writer is a medical doctor by training.