Laurie Garrett

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Why we need a new and improved World Health Organization | 

The World Health Organization is in a sorry state these days, by most accounts. It seems to have lost its rudder and is reportedly plagued by a lumbering, highly politicized and fractured membership who can hardly get together on anything.

Yet many say the WHO remains critical to our future well-being — if only because the world needs some kind of publicly accountable organization to guide strategy and provide intelligence in our ongoing fight against disease.

Writing in Nature, Laurie Garrett at the Council on Foreign Relations and Tikki Pang, a former policy director at WHO, argue the case for reforming and improving the 64-year-old agency:

The World Health Organization (WHO) is facing an unprecedented crisis that threatens its position as the premier international health agency. To ensure its leading role, it must rethink its internal governance and revamp its financing mechanisms.

It’s a good overview of what’s wrong with the WHO and what these two think needs to change. I asked Laurie to further explain why we need the WHO. Now that global health is almost an industry until itself, do we really need this creaky old UN agency?

In an email, she replied:

We desperately need a functioning WHO. Here’s a list of issues that plague us right now, and a viable, breathing WHO should solve. No other global entity can (or will):

-          Drug resistance, specifically NDM-1 plasmid control. If we don’t act globally and aggressively 100% of antibiotics will be useless with the decade.

-          Global drug safety and integrity

-          Pandemic influenza, especially the risk of man-made H5N1 (bird flu).

-          Health systems metrics – global measurement standards that donors will back.

-          Drug-resistant malaria, specifically artmesinin resistance. We are in a race for time, and need far more aggressive global policies FAST or malaria becomes incurable.

Five reasons not to panic about the bird flu experiments | 

Flickr, hugovk

News analysis

The scientific community is in serious kerfuffle right now about whether or not to publish the details of certain bird flu virus experiments.

Angry words are flying back and forth between experts – much like the proverbial behavior of chickens with their heads cut off.

One commentator for Scientific American has even suggested banning all such research.

It’s all a bit much, and probably not good for science or for our global health. I would like to offer five reasons not to panic, but first the background:

The fear among some experts is that terrorists could repeat the experiments, in which genetically altered bird flu viruses, H5N1, were made more easy to transmit in mammals, presumably also in humans.

Based on this, the National Science Advisory Board for Biosecurity has suggested censoring some of the research — redacting key portions of it. A few weeks ago, the scientific community agreed to a temporary moratorium on this research while the issues got hashed out.

There are persuasive arguments on both sides of this debate weighing the goal of reducing risk vs. the need for open exchange of knowledge.

But in some ways it’s not a fair fight. Continue reading

BBC looks at “secretive” and powerful Gates Foundation | 

News analysis

Tom Paulson

Bill and Melinda Gates speak at Malaria Forum, with moderator ABC News' Richard Besser

The BBC has done an extensive (40 min) report on the Bill & Melinda Gates Foundation titled “Fortress Bill.” It is available for six more days online and will be rebroadcast on Sunday, Jan. 8.

The BBC introduces the Gates Foundation as the world’s largest philanthropy aimed at helping the poor:

“Yet it remains an often secretive and hard to penetrate organization, which arouses suspicion on some sectors of the aid community.”

My friend and colleague Laurie Garrett, with the Council on Foreign Relations, is interviewed by the BBC and notes that the influence of private philanthropy in global health and development is on the increase — which means policy is often set behind closed doors by a select group of people:

“What we think is global health, how we define this mission, is increasingly decided by a relatively small number of Americans living in Seattle, Washington.”

The dominance of the Gates Foundation has led to a bias toward scientific, technological and private-sector solutions, says Garrett. Science and technological improvements are needed, she says, but this focus ends up crowding out all of the other — social, political and economic — changes necessary to defeat the diseases of poverty. Continue reading

To publish and perish? Scientists create scary new flu bug | 

Flickr, Y

The U.S. government is opposing full publication by scientists of their methods used to create a mutant form of bird influenza based on the fear it could be used by terrorists to launch a deadly pandemic.

As reasonable as this may sound, many see the government’s position as unworkable and inappropriate.

As Nature magazine and GlobalPost report, some say the researchers should not be allowed to publish their findings because such knowledge would be dangerous in the wrong hands.

On Friday, a compromise position was floated — a three-month hold on publishing while the scientific community figures out how to balance the fundamental need for free and open exchange of ideas with the desire to minimize the potential risk of misuse of scientific information to do harm.

The mutant strain of flu variant H5N1 was created as part of ongoing research to prepare for a major pandemic. As Nature reports:

The mutant strains were not born out of a reckless desire to push the boundaries of high-risk science, but to gain a better understanding of the potential for avian H5N1 to mutate into a form that can spread easily in humans through coughing or sneezing.

That seems prudent enough, but some outside the scientific community are raising the alarm over plans to publish the findings in scientific journals. As The Independent reported:

A deadly strain of bird flu with the potential to infect and kill millions of people has been created in a laboratory by European scientists – who now want to publish full details of how they did it.

The discovery has prompted fears within the US Government that the knowledge will fall into the hands of terrorists wanting to use it as a bio-weapon of mass destruction.

There is reason for caution and precautions have already being taken, beginning with the standard laboratory containment measures. But this is also perhaps evidence why we need to better educate people — apparently including many folks in positions of great power — on statistics and relative risk. Continue reading

The coming of Contagion: A different kind of killer virus movie? | 

Okay, there’s another movie coming out about a killer virus that spreads across the planet — usually wiping out most of the extras and leaving only a few select movie stars.

This one is Contagion, by Steven Soderbergh, due out in a few days.

I have to admit I do love these kind of movies, even if they are usually ridiculous and often rife with all sorts of scientific and medical errors.

Also, it kind of irks me that few get as excited about the real massive killers out there right now like AIDS, TB and malaria. And that something like this kind of thing happens every year — it’s called flu season — and nobody gets that excited or terrified about that either.

But a friend and science-writing colleague, Laurie Garrett, assures me that this time it’s going to be different. Garrett, one of the top public health and pandemic journalists out there, worked with the filmmakers on Contagion. This is what she has to say, from her blog, about being asked to consult for the movie project:

I was worried. Hollywood and television have long portrayed contagious diseases in roughly the same way as they’ve treated vampires, zombies, space aliens and radiation: Terrifying entities incomprehensibly visited upon innocent humans with catastrophic outcomes for the entire species. Depictions of scientists haven’t been much better. If something truly evil happens in a Hollywood creation odds are it’s executed by a serial killer, scientist, or scientist-that-is-a-serial-killer. The only consistently “good” Hollywood scientists are those that work in police forensics labs.

Despite her misgivings, Garrett agreed to work as a consultant to the filmmakers for Contagion. She says it is definitely based on an extraordinarily virulent bug that spreads fast. But the science is solid, she says, and there are some valuable lessons contained in the drama. Garrett says:

I have worked on the movie as one of its two key science consultants, trying to ensure that this time Hollywood would get it right. Judging by the final cut, which I viewed in a Manhattan VIP screening room in early July alongside Hollywood icon Mike Nichols, “Contagion” will be the first blockbuster Hollywood motion picture to accurately portray what is likely to happen if the world is slammed by a pandemic involving a highly virulent organism.

I put a lot of stock in Garrett’s perspective on these sorts of things. I am looking forward to seeing the movie, no matter what. But I can’t help but remain skeptical about whether or not it can be both blockbuster entertaining without exaggerating the threat. I’ll reserve judgment until I see it, of course.

A film reviewer for the LA Times said Contagion “takes science seriously.” That sounds good, until you think about it. Sounds kinda like someone saying they take reality seriously. Anyway, we’ll see.

One thing that the film could accomplish is make people a bit more aware of just how connected we all are on this planet, microbially speaking. As this story in USA Today said, all of the crew came away from Contagion washing their hands more and covering their mouths when they coughed.

That’s not a bad lesson to learn. Next, I hope Hollywood can figure out how to inspire us to be just as freaked about those dying in poor countries from boring diseases, poverty and injustice — even when they can’t spread it here.