She’s running the show

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MARGARET CHAN

With two pandemics under her belt, few are as qualified

Avoiding open fights is kind of the sine qua non of working for an international organisation. But when it comes to protecting public health, I don't think she would hesitate for a second to do whatever is necessary, including being at odds with a WHO member state.

Dr Jeffrey Koplan, former director of the US Centers for Disease Control and Prevention, on Dr Chan

BORN in Hong Kong in 1947, Ms Margaret Chan never intended to study medicine.

That did not stop her from eventually being appointed Director-General of the World Health Organization (WHO) in 2006, putting her at the frontline of the battle against viruses which have the potential to sweep across the planet and kill millions.

She trained as a teacher at the Northcote College of Education in Hong Kong and then spent a year at the Queen Elizabeth Government High School teaching English, geography, mathematics and home economics to junior students.

She became a doctor out of love, not for medicine but for her then new husband, David Chan.

When he left Hong Kong to study in Canada in 1969, she worried the long distance would end their relationship. Her mother told her to follow her heart.

When he decided to become a doctor, she worried that his medical studies would leave little opportunity for them to spend time together.

So, she enrolled alongside him at the University of Western Ontario.

The couple returned to Hong Kong after graduation, but Dr Chan found few openings in her field of interest, pediatrics, and instead joined the health department. Her rise was rapid, although she modestly attributes her success to luck and the departure of many senior people from the island in the run-up to Hong Kong reverting to China in 1997.

She earned a Masters in Public Health from the National University of Singapore before going to Harvard Business School in 1991 for a three-month management course.

"I learned that there is a cost to every decision, and whether or not you impose a public health order has costs to industry and the public," she said.

"There is also a cost for investing in preparedness (for an outbreak), and a much bigger cost for not investing."

Over this past week, as the world has watched the spread of swine flu, Dr Chan has been holed up in a WHO "war room" at its Geneva headquarters, which is running around the clock to co-ordinate an action plan against the virus.

"Dr Chan is running the show; she is holding morning and evening briefings. She is very much driving the process," said Mr Mike Ryan, the manager of WHO's Strategic Health Operations centre.

Colleagues describe her as relaxed, affable and media-savvy, a "dynamic leader" who can bind together a consensus.

She once reportedly even sang a song from the musical The King and I in front of British civil servants.

From Bird Flu...

But in 1997, Dr Chan's public health career had an inauspicious start.

In May that year, a three-year-old boy in Hong Kong fell sick and died. The laboratory analysis was so surprising that samples were sent to Holland for molecular analysis.

The results came back in August: The boy had died from a virus that ravaged Hong Kong's chicken farms earlier in the year, killing thousands of birds.

No one had ever seen it in humans before. Bird flu had made its first leap over to humans. Over the summer, no new victims emerged and the authorities quietly marked the case down as a one-off.

In November, however, the virus began to spread. By early December, panic was rising.

At the time, Dr Chan was in charge of the island's health department. Her response would catapult her on to the world stage.

As tensions rose in Hong Kong, Dr Chan appeared on local television, advising shoppers that chicken was safe. "I eat it every day, don't panic," she said, perhaps rashly.

Two weeks later, after another 17 infections and five deaths, she realised she had made a mistake. She boldly ordered 1.5 million birds culled, the island's entire population of chickens and ducks. More than 1,000 officials, some of whom had never touched a live chicken before, descended on Hong Kong's markets clad in surgical masks and gloves.

They gassed the birds or slit their throats, dumping them in heavy-duty waste bags. By the end of the week, piles of the bags had built up in the streets and were being torn apart by dogs and rats. "Things could have been done better," Dr Chan admitted.

Despite the botches, her strategy worked. Avian flu was contained and the plaudits poured in.

Thailand gave her the Prince Mahidol award. The Royal College of Physicians gave her the Fellowship of the Faculty of Public Health Medicine and the Queen awarded her an OBE.

To Sars...

Six years after its first pandemic threat, Hong Kong suffered another: Sars.

Severe Acute Respiratory Syndrome, a pneumonia that killed some 300 people in Hong Kong and infected another 1,755, may also have jumped from animals to humans, with the finger being pointed at bats and palm civets in the Chinese mainland province of Guangdong.

Once again, Dr Chan came under fire for her handling of the situation. This time, a Hong Kong government select committee decided that she was responsible for the city's slow reaction to the disease, and for not pushing the Chinese government for details about an outbreak on the mainland.

She said that no one suspected a new virus. "At that time, what concerned us most was influenza. It was the winter peak for flu as well," she said.

Her media performance, however, was dazzling, as she presided over 61 of the 104 emergency press conferences, held each day at 4.30pm.

"What amazes me most is that the media and I have fostered a close relationship," she later said.

She became a public hero through her regular and calming appearances on television.

"New diseases like Sars and bird flu cause anxiety in the community. People get worried, some to the extent that it even affects their health.

"You feel very sad, and yet you must carry on and maintain your cool in very trying and difficult moments. You have to tough it out," she said.

The 62-year-old, who has a son, was later headhunted by the WHO.

Praised for her role in containing the outbreak, Dr Chan caught the attention of the late former WHO chief Lee Jong Wook.

His team recruited Ms Chan to Geneva, where she headed the department responsible for fighting infectious disease threats. She became WHO's director general after Mr Lee's sudden death in 2006.

"She has the courage to make decisions and make the right decisions based on the scientific evidence", recalled Mr David Heymann, a former assistant director-general at WHO.

Agreeing Dr Jim Yong Kim, the incoming president of Dartmouth College who recruited Dr Chan when he worked at WHO, said: "I couldn't imagine the world in better hands."

And with the experience of dealing with two major pandemics under her belt, there can be few people as qualified as Dr Chan to tackle the current crisis. Adapted from The Daily Telegraph

WEEKEND XTRA

From TODAY, World – Weekend, 02/03-May-2009

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Swine flu goes person-to-pig; What's next?

By MARGIE MASON,AP Medical Writer AP - 2 hours 44 minutes ago

MEXICO CITY - Now that the swine flu virus has passed from a farmworker to pigs, could it jump back to people? The question is important, because crossing species again could make it more deadly.

The never-before-seen virus was created when genes from pig, bird and human viruses mixed together inside a pig. Experts fear the virus that has gone from humans back into pigs in at least one case could mutate further before crossing back into humans again. But no one can predict what will happen.

"Could it gain virulence? Yes," Juan Lubroth, an animal health expert at the U.N. Food and Agriculture Organization in Rome, said Sunday. "It could also become milder. It could go in both directions."

Canadian officials announced Saturday that the virus had infected about 200 pigs on a farm _ the first evidence that it had jumped to another species. It was linked to a farmworker who recently returned from Mexico, where 19 people have died from the virus. The farmworker has recovered, and the mildly infected pigs have been quarantined.

Agriculture officials believe the worker may have sneezed or coughed near the pigs, possibly in a barn. About 10 percent of the herd experienced loss of appetite and fever, but all are recovering.

Experts say pork _ even from infected pigs _ is safe to eat.

Lubroth stressed that sick people should avoid contact with swine, but said healthy farmworkers don't need to take any extra precautions because the chance of catching flu from a pig is small.

Unlike the H5N1 bird flu virus, which infects the blood, organs and tissue of poultry, most swine flus are confined to the respiratory tract, meaning the risk of a human getting infected by a pig is "probably 10 or a 1,000 times less," Lubroth said.

But pigs are of special concern because they share some basic biological similarities with humans, and they have served as "mixing vessels" in which various flu strains have swapped genetic material. That's what happened to create the current swine flu strain.

Scientists are unsure when the virus leaped from pigs to humans _ possibly months or even a year ago _ but it was identified as a new strain about a week and a half ago. Since then, nearly 800 cases have been confirmed worldwide. The only death outside Mexico occurred when a Mexican toddler died in a Texas hospital.

There have been sporadic cases of pigs infecting humans with influenza in the past. Most cases resulted in mild symptoms, typically among people who were in close contact with sick pigs. A few deaths have been recorded, and limited human-to-human transmission also has been documented, but nothing sustained.

Dr. Tim Uyeki, an epidemiologist with the U.S. Centers for Disease Control and Prevention who has worked on SARS and bird flu outbreaks, said there may be more pig-to-human cases that have gone unnoticed because surveillance among swine populations tends to be weaker than among poultry stocks.

Given that the past three flu pandemics _ the 1918 Spanish flu, the 1957-58 Asian flu and the Hong Kong flu of 1968-69 _ were all linked to birds, much of the global pandemic preparedness has focused on avian flus.

"The world has been watching and preparing and trying to prevent a pandemic from an avian influenza reservoir," he said. "The focus has been on birds, and here is a virus that's coming from a swine reservoir. Now it's a human virus."

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From Yahoo! News; source article is here.

Irate pig farmers clash with police in Egypt

By MAGGIE MICHAEL,Associated Press Writer AP - Monday, May 4

CAIRO - Egyptian police and armored cars charged into a crowd of a 1,000 irate pig farmers armed with stones and bottles, leaving 12 people injured as residents of a Cairo slum resisted government efforts to slaughter the nation's pigs to guard against swine flu.

Cairo security chief Maj. Gen. Ismail Shaer said 14 people were arrested. Seven police were among the injured in the clashes with largely Christian garbage collectors who raise pigs on the refuse and live in the teeming slums of Manishyet Nasr outside the capital.

The farmers blocked the road leading to their pig pens and hurled rocks and bottles at police, who responded by charging them with armored cars and firing tear gas. Some 200 policemen then surrounded the neighborhood backed by a half dozen police trucks.

Egypt last week ordered the slaughter of all the country's 300,000 pigs even though no cases of swine flu have been reported here. The World Health Organization has said the move was unnecessary because the virus is being spread through humans.

On Sunday the organization reiterated its message that pork, ham and sausages are all safe to eat.

Authorities have now expanded the rationale for the slaughter beyond swine flu to a larger campaign against unsanitary pig farming conditions, particularly in the Cairo slums where the garbage collectors live.

The campaign has been met from the start by protests and resistance from pig owners. The consumption and raising of pigs is largely restricted to the country's Christian minority, estimated at 10 percent of the population. Muslims consider pork unclean and generally do not eat it.

"We were surprised by the tremendous objection by the garbage collectors. They fired guns, and they threw stones and bottles," Maj. Gen. Mohammed Nabawi, head of the Cairo Beautification Authority, told The Associated Press. He said that healthy pigs are being slaughtered for their meat while the pregnant and babies are being destroyed.

Cairo's predominantly Christian population of garbage collectors, known as the zabaleen, roam the streets of the sprawling city's wealthier neighborhoods collecting its garbage. They bring the refuse back to their homes and dump it in their courtyards, sorting through it for material to recycle. Pigs and other animals feed off the organic matter while the rest is reprocessed in crude workshops.

Isaac Mikhail, the head of the garbage collectors association, said 65,000 pigs live in the slum of Manishyet Nasr, providing a livelihood for some 55,000 people in the area.

He said farmers were enraged when the government slaughtered 600 of their pigs and then only paid them half of the going market rate of about 55 cents a pound ($1.20 a kilogram).

"If the government wants to slaughter (the pigs), they should pay a just price. How can people live?" he asked, estimating that a quarter of a million people in Cairo, a city of 18 million, are involved in pig farming.

Milad Ladid, a 33-year-old running a recycling workshop, couldn't understand why Egypt was killing its pigs when no one else in the world was.

"In Mexico, and elsewhere in the world, where they had infected people, no one decided to slaughter pigs. Why us? Why are we slaughtering pigs here while we have no reported cases?" he said.

Pigs flowed around Marzouqa Moussa, a middle-aged woman standing outside her small home, where she also sorts through trash.

"We bring the garbage here and sort it and we feed the pigs," said Marzouqa Moussa, a middle aged woman dressed in a dark robe, surrounded by dozens of pigs. "We were born here and we live here," she added, gesturing toward her simple living area adorned with a picture of Jesus Christ next to a room piled high with reeking garbage bags. A third room of the house was given over to the pigs.

The introduction of modern garbage services in many parts of the city over the last five years has already cost the zabaleen some of their livelihood.

In 2008, President Hosni Mubarak ordered all animal rearing, particularly pigs and chickens, to be moved out of populated areas for hygienic reasons. The order was never implemented, however, and authorities say the current crisis is a perfect opportunity.

Pig raising will be restarted in two years at specially constructed farms in the countryside using newly imported animals, officials from the Ministry of Agriculture told Egyptian media.

"Everything Egypt has decided to do _ despite the noise it caused here and there _ first and foremost aims at protecting human health, and the health of the Egyptian people which is worth all the efforts and the measures taken," presidential spokesman Suleiman Awwad said Sunday.

He added that the measures had the full support of the leaders of Egypt's Christian community.

The Egyptian government has come under criticism in past years for being caught flat-footed by crises.

Egypt was severely affected by the outbreak of bird flu in 2006 with more than two dozen fatalities in the past two years. Some 25 million birds were slaughtered and the rearing of poultry in households largely ended.

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From Yahoo! News; source article is here.

Politics play big role in world health decisions

By MARIA CHENG and ALEXANDER G. HIGGINS,Associated Press Writers AP - Monday, May 4

GENEVA - At the U.N. agency spearheading the fight against swine flu, key decisions are based on more than just health issues _ politics plays a big role, too.

With global powers like the United States and China all lobbying for their own national interests behind the scenes, measures such as travel bans, border closures, and raising alert levels can meet stiff political opposition. Some have even wondered if granting the World Health Organization beefed up powers to independently tackle health crises might help, giving it authority to make key decisions or send doctors into a country to investigate the spread of a disease.

WHO's mandate is to direct and coordinate U.N. health policy: It makes recommendations and global assessments on issues including HIV/AIDS, malaria, and tuberculosis, and also coordinates responses to health crises like disease outbreaks and humanitarian disasters. But its recommendations are not binding _ and countries are free to disregard WHO's advice.

"WHO is in an incredibly difficult position," said Richard Horton, editor of the Lancet medical journal. "On the one hand, its entire modus operandi is that it responds to government requests. But in this situation, what governments might want may not align with what WHO thinks is best."

Horton cited the 2003 SARS outbreak as a prime example. When the illness began spreading in Toronto, WHO issued a recommendation advising against nonessential travel to Canada's largest city. Similar recommendations were made for cities including Hong Kong, Beijing and Taipei.

The recommendations sharply cut travel to affected economies, dealing them a big economic blow _ but the aggressive WHO action was credited with being key to containing the illness.

The advisory incensed Canada, and Toronto's then-mayor publicly lambasted the agency, declaring it had no right to issue such guidelines. A delegation of Canadian diplomats and journalists flew to Geneva and camped out at WHO's Geneva headquarters, forcing the agency to reconsider _ and eventually lift _ the advisory.

"I suspect the reason WHO has been very reluctant to make any comments about travel (during the swine flu outbreak) is because of that experience with Canada during SARS," said Horton.

By issuing the controversial advisories, WHO's director-general at the time, Gro Harlem Brundtland, proved she was ready to confront countries.

WHO's current chief, Margaret Chan, has been both praised and criticized for her less confrontational leadership _ which only recently helped to end a decades-long standoff between China and Taiwan to allow the island to participate in global health meetings. Critics contend that her unwillingness to publicly pressure member states can undermine efforts to protect global health.

Notably, Chan has come under scrutiny for being publicly neutral over Indonesia's refusal to share bird flu samples with the scientific community _ which leaves a gaping hole in experts' ability to see how bird flu is evolving.

"Indonesia's behavior isn't helpful, but WHO did not confront them about it," said Adam Kamradt-Scott, a global health governance expert at London's School of Hygiene and Tropical Medicine. He said Chan, as the head of WHO, can only do what her member states allow her to do.

"Avoiding open fights is kind of the sine qua non of working for an international organization," Dr. Jeffrey Koplan, an ex-director of the U.S. Centers for Disease Control and Prevention. "But when it comes to protecting public health, I don't think she would hesitate for a second to do whatever is necessary, including being at odds with a WHO member state."

Koplan said chastising countries publicly can only lead to "short-term victories" and that it is essential for the WHO chief to keep open channels of communication with all countries.

WHO'S flu chief, Dr. Keiji Fukuda, insists the agency's discussions on how to react to outbreaks are "focused purely" on medical issues, such as how the disease is being transmitted.

But he conceded in a press conference this week that the agency's experts are "very aware" that raising the global alert level has quite significant political and potentially economic implications for all countries."

He added that Chan "did listen to all of these considerations but the main focus and most of the discussions really focused on what do we know about the epidemiology and what can we infer about it."

Many international health experts doubt whether granting WHO enhanced powers to fight disease would make a difference to curbing international disease threats. And most member nations bristle at the idea.

A delegate from an Asian country that has faced bird flu outbreaks said he did not want more powers for WHO than those granted by the International Health Regulations, which require countries to report major disease outbreaks and public health events to WHO.

He spoke on condition of anonymity because he was not authorized to speak to the press.

WHO can request information from countries about rumored or suspected outbreaks, but it cannot unilaterally enter a country to respond to a health crisis without an invitation from the government.

Some have wondered whether it's time to grant WHO such powers when faced with potential health catastrophes that may cross borders.

"Some countries might support that idea, but the problem is how to do it in reality," said Sandra Mounier-Jack, a global public health policy expert at the London School of Hygiene and Tropical Medicine.

When investigating outbreaks, WHO doctors rely on governments to help track down cases and strengthen surveillance systems. Mounier-Jack said it would be almost impossible for WHO to conduct these kinds of investigations if countries were not willing to work with WHO.

"Countries have to feel that WHO is there to help them, not to punish them," she said. "Many countries require visas for entry, so WHO could not just go in without their authorization."

Mounier-Jack suggested that instead of giving WHO more power, the agency could put pressure on countries via the media and the global community. She said it wasn't ideal, but that it had worked in the past, citing the SARS outbreak.

When China hid cases during that outbreak, WHO had no way of forcing the country to come clean, except by loudly voicing their concerns in the press. That eventually worked, and China agreed to allow in WHO teams to help stop the epidemic.

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AP Medical Writer Maria Cheng contributed from London; AP Writer Bradley S. Klapper contributed from Geneva.

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From Yahoo! News; source article is here.

Swine flu could worsen global recession: analysts

AFP - Sunday, May 3

SINGAPORE (AFP) - - The swine flu outbreak could shatter fragile signs of a global economic rebound, but the gravity of its impact depends on the death toll it inflicts and the panic it generates, analysts said.

For Asia, where some countries are in recession, the crisis has revived memories of the severe acute respiratory syndrome (SARS) outbreak in 2003 that killed hundreds, halted travel and sent economies reeling.

Asia's first case of the A(H1N1) virus was confirmed in Hong Kong Friday, the epicentre of the 2003 SARS outbreak when close to 300 people died.

"The global economy faces yet another huge challenge," research firm Moody's Economy.com said in a market analysis.

"The recent outbreak of swine flu in Mexico and its rapid spread to other countries could interrupt trade and investment, exacerbating the worldwide recession for an uncertain period."

The World Health Organization has raised its flu alert level to five out of six, signalling a pandemic was "imminent" as more nations announced cases.

At least 19 confirmed deaths from the virus have been reported in Mexico and one death in the United States.

If the swine flu outbreak is similar to SARS, the impact will be sharp but would last only for several months, economists said.

"The risk here is if swine flu is actually more lethal than SARS and containment measures are not effective," Leong Wai Ho, a Singapore-based regional economist with Barclays Capital, told AFP.

"Under that scenario, the impact is likely to be prolonged and more profound."

Song Seng Wun, a regional economist with CIMB-GK Research, said swine flu could stamp out any tentative signs of recovery from the worst global economic crisis since the Great Depression.

"If it stays as a flu bug... perhaps it may not do too much damage to the current signs of stabilisation," he said. "But if things were to take a turn for the worse, the early shoots of recovery may be snuffed out."

Song said business confidence has begun to show signs of revival after governments worldwide rolled out stimulus packages to fight the recession and some companies were starting to receive more orders.

"If there's any knock to the fragile business confidence at this point, it may easily die out again," he warned.

Swiss banking giant Credit Suisse said the economies most vulnerable to a fallout from swine flu would be "those having sizeable tourism, retail and transportation sectors" like Hong Kong, Malaysia, Singapore and Thailand.

Moody's said the world's poorer nations, where infections might be harder to detect and treatment may not be readily available, will bear the brunt of the impact should the outbreak escalate into a pandemic.

This could affect efforts to reduce poverty, Moody's said.

For more developed economies like Singapore, Hong Kong and Taiwan, "weak confidence may be a bigger threat than the disease itself," it added.

Private consumption, a key economic growth driver after exports have fallen, could suffer if swine flu forces people to stay indoors.

This could hinder an economic rebound in the same way as SARS, which came as the region recovered from the impact of the technology crash in 2001 and the Bali bombings in 2002, analysts said.

"The economic effects of consumers and travellers staying at home will most likely be larger than the costs of fighting the virus," Moody's said.

Economists said that Asia and other major economies such as the United States and European nations are better prepared now to tackle the threat.

"For a start, swine flu appears to respond well to treatment using existing drugs," said London-based Capital Economics, noting that most of the deaths have been in Mexico where the health care system is relatively poor.

"Secondly, the world is now much better prepared to deal with these sorts of crises, thanks to the experience of SARS and persistent threat of avian flu," the research consultancy said.

It noted that the main economic damage so far "has typically come from panic measures to control a potential pandemic rather than the impact of the disease itself."

 

From Yahoo! News; source article is here.