Tuesday, May 23, 2006

Stockpile information underload

Yesterday Department of Health and Human Services Michael Leavitt told the World Health Assembly, WHO's governing body, that the US was sending some of a Tamiflu stockpile to an undisclosed Asian nation. The lack of specificity has created an information vacuum that is being rapidly filled by speculation, much of it well-informed, but still by necessity, speculation.

We are left wondering whether this is WHO stockpile stored in the US or US stockpile, how much was sent, where it went and why it is being sent now. Indonesia was the first thought of many because that country presents, on its face, one of the most threatening places for a potential development of a pandemic strain. It is populous and has endemic H5N1 infection in poultry throughout the country. Human cases continue to appear, including the largest cluster to date bearing all the marks of human to human transmission. The country has very substantial numbers of pneumonia cases at any one time so that avian flu could easily be missed in the noise of background disease. A colleague made the important additional observation that cases have mainly been reported around large cities like Jakarta (and now Surabaya) where there is medical expertise. Thus there might be a major reporting bias underestimating the true number of cases and distorting their distribution.

On the other hand, two in-country informed sources told me that so far they know of no triggering event for suddenly sending Tamiflu to Indonesia. The Tamiflu could be going to more routine WHO staging locations like Bangkok or Singapore or elsewhere. Why can't we know this? Why should anyone be guessing about it?

Transparency, credibility and trust are becoming collateral damage in the bird flu battle. WHO has squandered much of their credibility and CDC is following suit. In particular, failure to release sequence information to the scientific community is not just a scandal, it's a disgrace.

Leavitt's uniformative announcement about Tamiflu was a major blunder. We are not seeing competence at a time when we need it most.