Commentary
WHO Oversight Failures Raise H5N1 Pandemic Concerns
Recombinomics Commentary 20:02
June 19, 2008
"The minister has told WHO they will not continue to share publicly whenever there is a new case but they will inform the WHO in conformity with IHR," David Heymann, WHO assistant director-general for health security and environment, told Reuters by telephone.
"We anticipate that promise will be honoured," he said.
The above comments from the WHO lack credibility. Indonesia is clearly not reporting cases to WHO on a timely manner consistent with IHR regulations, and is clearly not reporting clusters. The WHO situation updates lend credibility to these reporting failures, and reduce the ability of WHO to enforce regulations in other countries.
Reports from other countries remain highly suspect. The report of the large outbreak in Pakistan at the end of 2007 was delayed until the transmission chain had been ongoing for over a month and two family members had died. By the time WHO investigated, samples had degraded and only one case was confirmed by PCR. Subsequently two more were confirmed by antibody titer, but most of the cases that were reported positive by local lab tests were not confirmed. Similarly, Bangladesh claimed that there was only one human case associated with the massive outbreak at the beginning of the year. and India sill maintains hat there were no human cases in the associated outbreak in West Bengal. More recently South Korea has declared that the H5 PCR positive soldier/culler was not H5N1 infected.
This lack of oversight in these other outbreaks, has been followed by Indonesia’s new policy of delaying reports, which clearly happened in the two cases confirmed today. One case was confirmed in May, while the other was confirmed in early June, indicating reporting to WHO was delayed, as evidenced by today’s WHO update. In the past WHO has promptly issued an update when notified of a confirmed case.
Moreover, three of the last five confirmed cases in Indonesia were part of three distinct familial clusters. In each case a relative died with bird flu symptoms within days of the death of the confirmed case, yet these associated cases were said to be due to “lung inflammation", dengue fever, and typhus. None of these diagnosis is credible, since H5N1 has been confirmed in a contact in each cluster.
Thus, Indonesia has clearly made a decision to cover-up clusters and to not report cases to WHO, in violation of IHR regulations. The two most recent clusters were widely deseminated in international media reports and WHO’s failure to address these issues raises serious oversight concerns.
These actions, or lack thereof, by WHO, continue to be hazardous to the world’s health.
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