Wednesday, February 16, 2005

An Open Letter to WHO

The following letter has been sent to WHO via email at the address of the WHO Global Influenza Programme. Their email address is:

We suggest readers similarly concerned email WHO at that address.

Open Letter to WHO

Public health is a global enterprise, transcending national and political boundaries. As an international agency WHO has understandably been oriented to its member states and their public health authorities. Now, due primarily to new communications technologies like the internet, the nature and composition of technically competent and concerned individuals and communities has enlarged dramatically. A new kind of virtual public health community exists and needs to be taken into account.

In such a setting, it is important WHO recognize that information can circulate requiring corroboration, disconfirmation or a status report if misunderstandings are to be avoided. To be more concrete, three issues related to the public health aspects of avian influenza A/H5N1 have become the subject of discussion via email or various websites. Each would benefit from a statement by WHO:

i. What are the criteria by which statements regarding possible person-to-person transmission of H5N1 are made in the face of evidence that initial testing produces some false negatives? In particular, what does WHO know about the negative predictive value of the diagnostic tests now in use in Thailand and Vietnam where time-space clusters of cases have been reported?

ii. The Recombinomics website ( raised the possibility that in a number of instances certain events could conceivably represent H5N1 infections. These include the meningo-like outbreak in the Philippines and reports of sudden bird deaths in North America. There was no claim these were H5N1 infections, only the reasonable question whether anyone had thought of the possibility and bothered to verify it or not. It was announced that WHO sent a team to the Philippines to investigate the outbreak there. Given the level of concern regarding an H5N1 event, a response from WHO would be useful.

iii. Recently there has been some discussion, both on the Recombinomics site and via email, about influenza A/H1N1/WSN/33 sequences in Korean swine influenza A/H9N2 reported to GenBank in October 2004. There are rumors that WHO has looked into this and resolved the issue. If this is true, a statement to that effect is necessary. Because of the gravity of the implications, we believe some public explanation is required.

We urge WHO to recognize the new setting regarding public health information generation and dissemination and act accordingly. Failure to do so will only create confusion where clarity is desperately needed.

The Editors (
Effect Measure