World Health

Henry Niman we hardly knew ye. We loved your mash-up with swine flu updates, but the MSM has got you beat in slickness with its fancy designers.  The NY Times now has a map up, as does the Washington Post. I think the Times map gets the data into my veins more efficiently, but suspect the Post map might be updated more regularly. Prove me wrong Times.

UPDATE: I forgot to mention Google's Flu Trends, through which they've discovered that certain search activities are good indicators of flu activity.  They've got an "experimental" trend map up for Mexico.

Jeffrey Horowitz, writing for The Atlantic's new food channel, gives a great rundown of the ultra-Orthodox Israeli Deputy Health Minister's refusal to call a swine a swine.   The Minister, Yakov Litzman, has said, while chomping on freedom fries, that Israel will call swine flu "Mexican flu" because, of course, pigs aren't kosher (boy would he hate Corby).   

Who cares what they call it...beside the fact that it's generally ridiculous, the virus is now transmitted by humans not swine, and that crazed stances like these lead to pork shops being "firebombed out of certain neighborhoods"? Horowitz makes the argument that the general refusal to acknowledge a porcine presence in Israel makes for unregulated hog farming practices, the exact kind that are now being questioned at Smithfield Foods in Mexico. He concludes:

By refusing to recognize the source of the problem and regulate irresponsible farm practices in Israel, future swine viruses could emerge from Israel, and could wind up bearing an Israeli moniker--a much more humiliating prospect.

UPDATE: Israel's not the only one that's got beef meat-related issues with the name of the disease.  The other objector: the U.S. pork industry.

(image from flickr user David Blaine under a Creative Commons license)

The World Health Organization is getting a lot of attention these days,   and rightfully so. The organization is an independent body of the United Nations system responsible “for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.”  Its 193 member states form the WHO's governing body, called the “World Health Assembly” that meets every May. The WHO’s director general is Dr. Margaret Chan of Hong Kong/China/Canada.

The last time the WHO got this much play in the press was amidst the 2003 SARs outbreak, which affected people from Hong Kong to Toronto.  Back then, the WHO was largely forced to improvise its way through the crisis--and did so successfully. The experience, however, lead member states to devise a more formal regulatory framework for dealing with similar situations in the future.  So, in 2005, the World Health Organization passed a sweeping set of reforms called the 2005 International Health Regulations, which set mandatory procedures by which member states and the WHO would respond to sudden international public health emergencies. The Swine Flu outbreak is the first major test of the new system.  

Julie Fischer, head of the Henry L. Stimson Center’s Global Health Security program, offered a quick assessment (via email) of how the newly empowered WHO is responding to the crisis.

Thus far,  the system seems to be working as planned.  The only immediately apparent concern is what appears to have been an unnecessary delay in intraregional communications among the U.S., Mexico, and Canada, which reflects both bilateral/trilateral communications issues but also calls into question whether [Pan-American Health Organization], the regional WHO office, served its role adequately.  That would not be an issue of WHO reform, but more of staffing and function.

So, it would seem that formal frameworks for international cooperation are a net plus when it comes to responding to these types of emergencies.

Photo from Flickr user tukatuka.

The tendency of old(er) media to lash out at new(er) media apparently involves passing the buck on the worst of old(er) media's excesses. Happy to push the canard that bloggers and Twitterers are merely unrestrained and unsubstantiated gossipers, CNN has either not been reading its own headlines or has an uncanny ability to swallow irony.

Some observers say Twitter -- a micro-blogging site where users post 140-character messages -- has become a hotbed of unnecessary hype and misinformation about the outbreak, which is thought to have claimed more than 100 lives in Mexico.

"Swine flu" is currently first on CNN's list of "hot topics." This is fair enough, because it's a major topic and a cause for concern, and therefore worthy of media attention.  But CNN takes it decidedly over the top.  Perhaps following the Time magazine model of cool and rational stories on potential nuclear annihilation, the CNN page devoted to the entirely necessary and carefully measured information about swine flu includes sober headlines like the following:

• Mexico City at epicenter of growing swine flu fears 
• Stricken teen describes illness, recovery
• Pandemic: What would happen next?
• Gupta: Swine flu affecting people in prime
• Deadliest pandemics of the 20th century
• Officials plan for worst case

Naturally, and without a trace of irony, CNN urges you to follow Dr. Sanjay Gupta on Twitter.

UPDATE: CNN also tweets -- what medium could be better? -- as breaking news that "The federal government declares a public health emergency, as the number of cases of swine flu in the U.S. rises to 20."

cross-posted on Boondoggle

(image from flickr user merfam under a Creative Commons license)

Apropos to Boonstra's post below, Faculty chair of the University of Chicago Center for Health Administration Studies Harold Pollack  writes in to say an episode like Swine Flu underscores the necessity of the WHO and other international public health forums. Says Pollack:

The United States and Mexico (and many other countries as well) share common agricultural ecosystems and have tremendous human migration and commercial flows that provide conduits for diseases to spread. By providing a reservoir of information and expertise, along with the structures to provide a coordinated response, WHO allows a vastly more effective response than could be mounted by any single country, certainly including the U.S.  Even when judged by the exclusive metric of American population health, these organizations are a bargain at twice the price.

Anne Applebaum's column is not all friendly toward the World Health Organization (WHO), but she very much gets that, facing something like the threat of swine flu, it is exactly what we need.

The Geneva-based WHO is the organization we all turn to at times like this, and rightly so: With more than 60 years' experience, and real achievements under its belt -- it led the successful campaign to eliminate smallpox in the 1970s -- the WHO may well be the only international organization that we cannot live without. When infectious diseases are spread rapidly across borders, WHO is expected to coordinate the scientific response of national public health officials, from France to Malaysia, as well as the global information campaign needed to explain it. No national government can do the same. [emphasis mine]

Most of Applebaum's complaints about WHO have to do with what she calls particular UN culture and politics. Some of her critiques are legitimate, and aspects of the WHO, as with other UN agencies and the global body itself, should be reformed and improved. But the best way to do so is not to cut off UN appendages; rather, member states need to work together to improve, fund, and support them. In her last paragraph, it's good to see that Applebaum gets that, too.

The truth is that we tend to treat the really important U.N. institutions the way we treat the local water utility: Most of the time we don't care who runs it or how well -- but in an emergency, we expect a superhuman response. Now, just as we might really be on the brink of an emergency, it is worth reminding ourselves that if we want the WHO to be there when we need it, the organization must be constantly monitored and fully funded. U.N. member governments should make absolutely sure it stays focused: after all, only the WHO is equipped to carry out the international monitoring of the spread of a new infectious disease. Let's cross our fingers and hope that this time, they haven't been distracted by something else. [emphasis mine]

Mashup master Henry Niman has created a Google map tagged with all reports of swine flu.  Siberia, it looks like you're safe for now.

• Pink markers are suspect
• Purple markers are confirmed
• Deaths lack a dot in marker
• Yellow markers are negative

h/t Lifehacker

Kenneth Anderson thinks not:

Among the interviews I participated in as one of the experts on the Gingrich-Mitchell UN reform commission back in 2005 was one with a senior WHO official.  I asked him - this was not long after SARS in Hong Kong - whether he thought it would be helpful if the WHO were able to have a mandate from the Security Council treating pandemics or epidemics that might be a serious concern (like SARS or swine flu) as something susceptible to Security Council orders that mandated implementation of recommendations of WHO.  Shouldn’t WHO be able to appeal to the Security Council or the political bodies of the UN in order to be able to have the greatest legitimacy to order forcible measures to prevent the spread of a serious epidemic disease? 

His look was one of utter consternation and horror, and he asked me please not to propose such an idea under any circumstances.  (And I’m not proposing that here, because I think he’s right.)  

In his view, the success that WHO had with SARS, in getting Hong Kong and China generally to go along with what were, from a political standpoint, draconian and costly measures, was entirely a function of the whole crisis not being politicized.  (Update: I mean here once past the refusal of authorities in China even to recognize what was happening - which, certainly, can be understood as far more important than what happened next.)  Of course, in one sense it was political - shutting down HK internally and cutting it off via the airports to the rest of the world - but these measures were proposed and undertaken by reasonably non-political technocrats on an issue that involved, on the one hand, purely medical issues but which also required very difficult and, because of all the contingencies, never fully provable, estimations of cost and benefit from various public health measures.  How long HK and China would have sustained such measures is unknown.  But whatever that period of time was, in this functionary’s view, the legitimacy needed to sustain these policies - costly in direct and indirect terms - was of a kind dependent on it being seen as apolitical in some important sense.  Not all senses, obviously - economic costs weighed against public health unknowns being political always - but not in the sense of the Security Council trying to make it into a matter of international peace and security.

Read the whole post.