TCS Daily


The Worst Emerging Disease of All

By Henry I. Miller - June 15, 2009 12:00 AM

Cases of H1N1 swine flu continue to appear -- especially in Australia, which has seen a quadrupling of cases in a week, with the number of confirmed cases surpassing 1200. But that is hardly a surprise: Flu virus is transmitted more efficiently in cold temperatures, and winter is just beginning in the Southern Hemisphere.

It must have surprised officials at the World Health Organization, however, because on Thursday they boosted the pandemic alert to the highest level, Phase 6, meaning that a pandemic is under way - the first time in 41 years that WHO has declared a pandemic. But like Rip van Winkle, they must have been asleep during that time, because ordinary seasonal flu, which sweeps the world annually - and which is invariably far more lethal than the mildly virulent H1N1 swine flu — certainly meets their definition of a pandemic: widespread geographical spread. A June 11 New York Times headline said it all, "To Flu Experts, 'Pandemic' Confirms the Obvious."

Something else has been obvious: From the beginning of the H1N1 swine flu outbreak, WHO's decisions and pronouncements have been far from reassuring. Most flu and public health experts consider WHO to have been overly alarmist, and that their decision during the week of April 27 to raise the pandemic flu threat to the penultimate level, Phase 5, "Pandemic Imminent," far outpaced the data that had accumulated and was unwarranted. Even worse was their official declaration of a pandemic, which illustrates that WHO's fundamental paradigm is flawed: A warning system based solely on how widely a virus has spread but that does not consider the nature of the illness it causes is prone to false positives; it would classify as "pandemics" not only seasonal flu but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis, for example. It makes the term almost meaningless.

The WHO's dubious decisions demonstrate that its officials are either too rigid or too incompetent to make needed adjustments in the warning system - perhaps both, because that's what we have come to expect from an organization that is scientifically challenged, self-important and unaccountable. WHO may be well equipped to perform and report worldwide surveillance - i.e., count numbers of cases and fatalities -- but its policy role should be drastically limited.

The decisions that need to be made are difficult, encompassing virology, medicine, and even economics and ethics. Should nations close borders and restrict domestic and international travel and trade? And given the relatively indolent spread and low virulence of the H1N1 virus, should we rush to prepare vast amounts of vaccine? And if so, what viral isolates should be included in the vaccine, and to whom should it be administered?

I have had the misfortune to work with UN officials for many years, most recently at the meetings of the task force on biotechnology-derived foods of the Codex Alimentarius Commission, a creature of the UN's WHO and Food and Agriculture Organization (FAO) that sets international food standards. The group established standards that were unscientific and excessively stringent and ensure that new, innovative foods will be so expensive to develop that they will remain largely unavailable to the poorest of the poor, who need them most. During a meeting of the task force, Jorgen Schlundt, the director of the WHO department concerned with food safety, zoonoses [diseases that spread from animals to humans] and food-borne diseases, repeatedly exhorted the group to add ethical concerns about biotech foods to the regulatory barriers that already impede their adoption. He was more like a witless Monty Python character than an official entrusted with serious international responsibilities - including issues pertaining to swine flu, avian flu, West Nile Virus and SARS .

But the UN's influence is no laughing matter. Its involvement in international public health policy is just one manifestation of the organization's even grander designs: The UN has become the regulator-wannabe for all manner of products and human activities, from desertification and biodiversity to the regulation of chemicals, uses of the ocean, and new genetic varieties of plants. The UN's regulatory policies, requirements and standards regularly defy scientific consensus and common sense: UN agencies' virtual ban on DDT for mosquito control and their stultifying regulation of agricultural biotechnology are lamentable examples. The result is a more precarious, more dangerous and less resilient world.


Henry I. Miller, a physician, molecular biologist, and former flu researcher, is a fellow at Stanford University's Hoover Institution.He headed the FDA's Office of Biotechnology from 1989 to 1993.
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8 Comments

What's in a word?
Pandemic!

The word strikes horror in the hearts of the ignorant. But all it means is that some infectious agent has been infecting people without restraint, around the world.

So far, the spread has been fairly innocuous. No more people are dying from it than have been dying from any other strain.. and we're used to seeing ordinary winter-onset flu arrive without being particularly concerned-- despite the fact that it kills some 36,000 Americans each year.

The obvious reason we need to keep an eye on this one is that (a) it's new. We don't have immunological defenses against it yet. (b) It has mutated once, to jump to a human host. And (c) once mutated, the genome is to some degree unstable. Further mutation could in fact make of this pandemic organism a worldwide plague.

Or, it might not. If we're feeling lucky we can ignore it.. unless and until it starts killing people in the tens of thousands.

Many of us are uncomfortable with that. So we see the sense in devoting a certain number of bucks toward tracking the spread of the infection and keeping close watch on the agent itself.

The other thing of course, is that I knew the good Doctor Miller couldn't keep himself from repeating this old lie of his:

"The UN's regulatory policies, requirements and standards regularly defy scientific consensus and common sense: UN agencies' virtual ban on DDT for mosquito control and their stultifying regulation of agricultural biotechnology are lamentable examples."

THERE IS NO virtual ban on DDT. And hasn't been for a good many years. I've posted the refutation several times here. You can look for it yourself by searching for "indoor residual spraying who".. to see what the World Health Organization says about the worth of IRS programs in malaria control.

DDT
No ban on DDT? No UN antagonism toward DDT? See http://www.reuters.com/article/environmentNews/idUSTRE54542W20090506, "U.N. seeks to ban DDT pesticide and still fight malaria," which contains this verbiage: "DDT is one of a 'Dirty Dozen' chemicals banned by a U.N. 2001 Convention after it was found to be a toxin that can suppress the immune system. It is infamous for threatening bird populations by thinning eggshells."

It goes on to note that there have been some exemptions for developing countries, but this does little to ameliorate the stigma associated with the use of this safe, effective, inexpensive chemical.

This doesn't sound like a ban to me
From the World Health Organization's Global Malaria Programme guide entitled "Indoor Residual Spraying":

"Indoor residual spraying (IRS) is one of the primary vector control interventions for reducing and interrupting malaria transmission. In recent years, however, it has received relatively little attention. Recent data re-confirms the efficacy and effectiveness of IRS in malaria control in countries where it was implemented well.

"Effective implementation of IRS with DDT or other recommended insecticides should be a central part of national malaria control strategies where this intervention is appropriate. [emphasis here]

"It is implemented with the objective of reducing malaria morbidity and mortality and accelerating progress towards global and national malaria targets. However, there are important considerations that must be taken into account when considering whether to introduce or scale up IRS. In particular, there must be sufficient capacity to deliver the intervention effectively, prevent unauthorized and un-recommended use of public health pesticides, and manage insecticide resistance. Intensified research efforts are needed, for example to develop new insecticides, long-acting formulations and improved application technologies.

"Along with producing IRS manuals and guidelines, the World Health Organization (WHO) will support countries to collect and analyse data, towards determining potential effectiveness and feasibility of IRS in the national context, and with planning and implementing
the intervention. WHO requests countries to report on coverage and impact as IRS is implemented or scaled up." etc.

http://malaria.who.int/docs/IRS-position.pdf

Elsewhere on the WHO site you can find country by country case reports on programs where they've encouraged DDT use in this program for a number of years. The only country I can recall where there were reasons mitigating against an IRS program was Sri Lanka. I think it may have been an immunity issue.

The WHO does stand against programs of broadcast use of DDT in the open air.. for the obvious reasons. It's a broad spectrum killer that does not target mosquitos, and it persists in the environment for a long enough time to be a danger to valuable bird and insect life. It should never be sprayed in volume out in the open. Ever.

The flip side of the argument
This article, I think, gives a level headed synopsis of the UN's position on IRS spraying with DDT, as of 2006:

http://www.medicalnewstoday.com/articles/52010.php

It does have this to say:

"Environmentalist groups, such as Pesticide Action Network North America (PANNA) and Greenpeace have criticized WHO's decision to encourage the use of DDT. AFM's correspondence to Greenpeace on this issue has so far neither been answered, nor even acknowledged. The opposition to DDT is largely based on misplaced fears that IRS is harmful to the environment or that DDT is harmful to man, despite decades of evidence to the contrary (DDT harmed the environment when used in massive amounts in farming, there is no real evidence of harm to either humans or environment from public health use of DDT).

"Environmentalist opposition to IRS in the past in part led to the WHO discouraging its use and forced some countries to abandon their IRS programs, costing lives among some of the world's most vulnerable communities. Unlike PANNA and Greenpeace, several respected environmentalist organizations, such as The Sierra Club and the Endangered Wildlife Trust of Southern Africa support the WHO's position on IRS and DDT."

So in fact there is some truth to the old canard that environmental groups have resisted sensible use of DDT. And that such resistance does seem likely to have cost lives.

So where do we go from here? That depends on the public health programs in the individual countries. Based on the Mexican experiment, where new malarial infections were reduced by 63% via non-IRS methods, it would seem that these methods would make an excellent addition to, not replacement of, IRS programs already in place.

And I would suggest that as public health agencies out in the third world advance in sophistication, this is the likely direction in which prophylaxis is to develop. To the extent that the UN or any organization still opposes sensible use of DDT, pending further discoveries of harm in low doses you would have to say they were greatly mistaken.

So I think on that, we can both agree.

From the UN News Centre
New UN report spotlights successes in fighting malaria

18 September 2008 – Greater access to bed nets and medicines has helped bring sharp progress in tackling malaria, a disease that claims 1 million lives every year, according to a report released today by the United Nations World Health Organization (WHO). “Progress in malaria control has accelerated dramatically since 2006, especially in the wake of the UN Secretary-General’s call for universal malaria control coverage by the end of 2010,” WHO Director General Margaret Chan said on the report’s release.

The “WHO’s World Malaria Report 2008,” which covers the period between 2004 and 2006, found that during that period the amount of access to malaria control interventions, especially bed nets in Africa, skyrocketed.

The percentage of children protected by insecticide-treated nets climbed from 3 per cent in 2001 to 23 per cent in 2006 in 18 African countries. The procurement of anti-malarial medicines has also surged, while about 100 million people worldwide are now protected by indoor spraying of insecticide.

The WHO report noted that malaria deaths have fallen in several countries, including Cambodia and Thailand, with a few in Africa – Eritrea, Rwanda and São Tomé and Príncipe – slashing them by half.

“We know that malaria control interventions work and that we can make rapid progress towards ending malaria deaths,” said Ray Chambers, the Secretary-General’s Special Envoy for Malaria. “Now is the time to expand those results to all of Africa and the rest of the world.”

Small children remain most likely by far to die of the disease – about 3,000 children every day – and the global malaria burden is still enormous, especially in Africa.

Access to WHO-recommended artemisinin-based combination therapy (ACT) – whose production surged from 4 million treatment doses in 2004 to over 100 million in 2006 – is only reaching 3 per cent of needy children in Africa. Also, some 650 million children on that continent are still not protected by bed nets.

http://www.un.org/apps/news/story.asp?NewsID=28107&Cr=malaria&Cr1

So.. are they for it? Or against it?

Like the Global Warming scam, UN is primarily interested in scaring people.
It's easier to lead a population that is paniced.

By that definition, there have been hundreds of pandemics in the last 100 years.
Why has the UN not called any until now?

Certainly not hundreds
The Wikipedia article lists these pandemics as having occurred in the last hundred years:

Two episodes of cholera (in the early 1900s and in the 1960s);

Three episodes of flu (the 1918 flu, the Asian flu and the Hong Kong flu);

Ongoing battle with tuberculosis and the various strains of malaria;

And AIDS.

http://en.wikipedia.org/wiki/Pandemic

That's not very many. If you want to nit pick and divide these episodes more finely, you might get a dozen pandemics over that period.

Here's the definition commonly used: "..an epidemic of infectious disease that is that is spreading through human populations across a large region; for instance a continent , or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic. Further, flu pandemics exclude seasonal flu. Throughout history there have been a number of pandemics, such as 2009 flu pandemic pandemic and the HIV. More recent pandemics include the tuberculosis and smallpox pandemic."

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