Flu Basics II

by DemFromCT

In the Flu Basics post, I tried to cover just what was going on with bird flu. This brief post will deal with politics and further issues.

First of all, the organization in the US that deals with flu and other infectious diseases is the Center for Disease Control (CDC). Long time readers will remeber a few articles on the politicization of this agency, with much of its focus geared toward bioterror rather than its traditional health role. The current Director, Dr. Julie Gerberding has embraced this role, and while she's not Mike Brown, her role has been more administrative tha hands-on health. For example, despite the threat from pandemic flu, it took the CDC ten years to finalize their draft plan. And it only happened because Mike Leavitt at HHS (who gets a lot of credit, despite bizarre lapses like advice to put cans of tuna fish under the bed) pushed hard.

Part of the issue is who's in charge... DHS, HHS, CDC, or Michael Brown. The political issue is that the CDC is far more trusted than the cabinet agencies, but they are doing a relatively poor job in taking the lead.

The international agency in the lead is WHO, the World Health Organization. Trusted around the world, they are also a UN group serving at the pleasure of the governments who fund them and allow them to operate. For example, Indonesia is the 4th most populous country in the world and the most populous Muslim country. When the US invaded Iraq, tensions rose and the US infectious disease surveillence unit, NAMRU 2, was officially kicked out. They were quietly allowed to stay, but can't say much publicly because of the need to keep up appearances. Nor can WHO simply swoop in, order Indonesia what to do, and then carry out those directives (assuming they knew what to do). So, everything is a delicate negotiation and dance.

Also, WHO maintains the stage level of pandemic status (currently stage 3 of 6). Should the WHO Director-General increase the stage, travel and tourism would suffer as it did in Canada during SARS. And the Director-General, who makes those changes, unexpectedly died last week. This means that countries like Indonesia or China, who do not want theoir economies hurt, pressure WHO to be terse with their pronouncements.

Interpreting WHO's statements, therefore, is like interpreting the Federal Reserve Chairman's. Each word is parsed in order to have the least possible effect on the market. We make a hobby of doing the interp at Flu Wiki, but if WHO says there's H2H, there's probably been H2H for some time, and the conclusion is inescapable.

There are some superb flu reporters, such as Helen Branswell for Canadian Press, Maggie Fox for Reuters, Nick Zamiska in the WSJ, and Declan Butler at Nature. AJC and USA Today also do a good job. But many of the reports you read are awful summaries by ill-informed reporters, and that includes our major papers. many of these just take what WHO and CDC says at face value. lat's just say that with this Admisniostration, and with a UN Agency, that's not always the best approach.

So, keep reading the news, try to find news from the better reporters, and keep reading here, and the flu  blogs, to try and figure out what's going on.

Comments

[DemFromCT]

here's an example of CDC politics from effect measure

The Atlanta Journal Constitution has another in a series of stories about poor morale at CDC. Finally the problems have attracted the attention of a congressional committee, the same one (the Senate Finance Committee) already looking into whether state bioterrorism funding has received adequate CDC oversight:

The U.S. Senate Finance Committee is investigating whether turmoil within the Atlanta-based CDC caused by a massive reorganization is "resulting in the loss of distinguished medical experts whose participation will be greatly needed in the event of future catastrophic health emergencies," committee spokeswoman Jill Kozeny said Tuesday night. (Atlanta Journal Constitution)

For some time complaints have been anonymously posted on an outside website, cdcchatter.net:

Some of the complainants are career CDC employees, many with distinguished scientific records, but they have unanimously refused to be identified, saying they fear reprisals on the job. The employees contend the reorganization has created new bureaucracies that hamper their work and that key scientists have been marginalized.