Saturday, June 18, 2005

War, peace and bird flu

As the slow trickle of hard information on new bird flu cases in Vietnam forces us into another start-stop cycle of hurry-up-and-wait, we catch only incomplete glimpses of what is happening. The most amazing report (not because it reports anything new but because of the source) is this one:
Washington -- Health officials in Vietnam have confirmed four new human cases of bird flu since June 1, and all are being treated at a Hanoi hospital. The total number of humans stricken with avian influenza during the Southeast Asian outbreak now comes to 107, according to the World Health Organization.


If the [H5N1] virus becomes able to cross the species barrier with ease, U.S. health officials warn of catastrophic consequences to life and the global economy.

"A pandemic of influenza could result in 350 million deaths globally,” said Michael Osterholm of the U.S. Department of Homeland Security, “and would cripple the global economy with the suspension of international trade." [Dr. Michael] Osterholm, associate director for the National Center for Food Protection and Defense, [said] at a Council on Foreign Relations meeting June 16.


Osterholm characterized a pandemic influenza as "the perfect storm" for the global economy because of its potential effect on countries that depend on overnight international trade for critical services.

"Collateral damage from the pandemic would also be significant because a suspension in trade would mean that countries will not have access to imported products used for manufacturing, life-saving medications and other consumer items," Osterholm said.
The writer is Todd Bullock, Washington File Staff Writer for an online publication of the U.S. State Department. Does Condi know what her minions are saying while she warns us about non-existent WMDs?

Meanwhile Agence France Presse (via Vietnam Tribune) says that the six new suspected patients reported yesterday have tested positive, although a second test on the doctor reported infected is now negative . Whether the doctor was a false positive followed by a true negative or a true positive followed by a false negative is impossible to say, but the latter has been common in Vietnam [and see this report from today's Thanh Nien News which says he is a case and is in stable condition]. The six new cases are said to be from the northern provinces and to be in stable condition at Hanoi's Institute of Tropical Diseases.

These media reports notwithstanding, Vietnam notified WHO on Friday about four new cases (not six). WHO could not determine if these four cases were part of the six or yet another four cases.
"The data which we have received do not suffice to determine whether these are the cases which we became aware of yesterday," Dr. Klaus Stohr said.

"We are not sure."


On Thursday the WHO received unofficial confirmation it felt was sufficiently strong to issue a statement saying it believed the media reports [about the six cases] were accurate.

But the Vietnamese government statement that came forward on Friday listed only four cases. And there was not enough identifying information to determine if they match up with the earlier reported cases.


Stohr could not explain the discrepancy in the numbers.

"It could be the case that two more cases could be reported tomorrow. We don't know," he said. "The reality is that is the piece of information that we have." (Canadian Press via myTELUS)
These are cases confirmed between now and the beginning of the month and bring to seven the number one source said are being treated at the moment in Hanoi (but see below).
The World Health Organisation says while it is still waiting for official confirmation from the Vietnamese Government, it believes the report [of six cases] is credible.

Peter Cordingly from the WHO's Asia Pacific headquarters in Manila says the fact that there are so many cases in one hospital is worrying.

"Clusters always send our blood pressure up, this is the biggest one," he said.

"The previous one was five so it's not an enormous jump but they do catch our attention and we need to have very swift information of this.

"While we dont know how a pandemic will start it will almost certainly start through a cluster so every cluster has to be very closely examined." (ABC Net [Australia])
Where does this leave us? Six new cases, maybe four more (or maybe just six that include the four), not to mention yesterday's media reports (local daily, Young People) of "23 local people with bird flu symptoms, of whom 11 have been confirmed to have contracted bird flu virus strain H5N1 by the hospital's officials." (via Xinhuanet; see also Thanh Nien today which reports specifies further 11 hospitalized cases and 12 more "being treated")

Maybe there is a reason why there is so much confusion here. This does happen, especially in chaotic and rapidly changing circumstances. But if the cause is a chaotic and rapidly changing situation, this in itself is a danger signal. If this is not the reason, then that leaves incompetence and disorganization or intransigence. The choices here are not palatable.

There is understandable impatience with WHO for not getting to the bottom of this faster. But while I have been critical of them in the past, their options here are fairly limited in the face of the conventional claims of national sovereignty. The US also resists acting in the global interest when it suits its parochial national interests. For policies like climate change, the global consequences might be as bad or worse than an influenza pandemic (climate change is a catastrophe in slow motion but just as unstoppable potentially devastating as bird flu).

An impending pandemic, global climate change, acts of genocide and wanton war-making all suggest the same thing: that a formal international social contract be forged that allows national sovereignty only to the extent a state's leaders act in accordance with fundamental norms of justice toward their own peoples and in ways that do not endanger the peoples of their region or the world. Failure to honor this social contract should result in ostracism from the comity of nations and presumptive abrogation of existing treaties, commercial agreements and reciprocal arrangements; and when crimes against humanity have been perpetrated those responsible should be subject to apprehension, detention and fair trial in the International Criminal Court once they enter the jurisdiction of another nation.

Many people would immediately assent to these sanctions in the case when the behavior of a nation's leaders increase the danger of a disastrous disease pandemic and would allow WHO to force a government like Vietnam's to provide urgently needed public health information. If it is desirable in tis circumstance, why not the same desire regarding matters of war, peace and fundamental human rights?

Under the surface, the serious public health situation of responding to an impending pandemic reveals a deeper connection with matters of war, peace and crimes against humanity. Something to ponder, even as we scramble to prepare for avian influenza.