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World health organization more power { May 18 2003 } Original Source Link: (May no longer be active)
http://www.washingtonpost.com/wp-dyn/articles/A4151-2003May17.htmlhttp://www.washingtonpost.com/wp-dyn/articles/A4151-2003May17.html
SARS Prompts WHO to Seek More Power to Fight Disease
Proposals Include Visits to Nations Threatened by an Epidemic
By Rob Stein
Washington Post Staff Writer
Sunday, May 18, 2003; Page A10
The World Health Organization, anxious to repair weaknesses exposed by the global struggle to contain the SARS epidemic, is seeking strong, new powers to fight future international threats.
The U.N. agency wants nations to report a far greater array of dangers than currently required and is seeking the authority to act even when governments will not admit they are facing a health crisis. In part, WHO is seeking the ability to send teams to investigate independently whether countermeasures are adequate.
"These are major changes in the way WHO works," said David L. Heymann, executive director of WHO's communicable diseases program. "The way we work now is passive. This would now be active."
Although Heymann acknowledged that the measures could raise alarms about the potential for infringing on national sovereignty, he argued that the changes are crucial to protect against the growing danger of potentially devastating pandemics, either occurring naturally or because of bioterrorism.
The proposal would mark the first major revision in more than three decades of the regulations that established the responsibilities of WHO and its member states to combat global health menaces. The current regulations date to an era when yellow fever, cholera and the plague were the infectious diseases of greatest concern, making the rules antiquated in an age when a mysterious new germ can circle the globe within days, Heymann and other experts said.
The revisions will be considered by the World Health Assembly, WHO's governing body, during a 10-day annual meeting that begins tomorrow in Geneva. The assembly will also consider a measure that would specifically require nations to report cases of severe acute respiratory syndrome promptly, and in detail, and to take steps to contain the new lung infection.
The Bush administration, which has been wary about giving the United Nations greater authority, was reviewing the proposal late last week and had not made its position public. William Pierce, spokesman for the Department of Health and Human Services, said the administration is concerned that the measures "not go too far. It's a balance we're trying to achieve. You want to be very clear about what you should do in these cases, but at the same time you don't want to create undue panic or take undue actions."
WHO has no power to directly punish a recalcitrant nation and would not gain any with the changes. But nations would now be obligated by international law to be more responsive, and the SARS epidemic demonstrated that the agency can focus international pressure to gain compliance and that its alerts and travel advisories can have a devastating economic impact.
WHO officials are hoping that the alarm and momentum generated by the SARS crisis will enable them to speed up the revisions of what are known officially as the International Health Regulations. Changes have been in the works for years, but they were not supposed to be completed until 2005.
"These regulations have been the only treaty-based international law that governs what you can and should do to protect populations from diseases and, at the same time, protect trade, traffic and travel from unwarranted limitation," said Ann Marie Kimball, a professor of public health at the University of Washington at Seattle.
Kimball and other health experts say the regulations, which have not been changed significantly since 1969, are overdue for updating.
"There have been a lot of emergent infections. We are encroaching on parts of the world where we haven't lived before. We are changing the way we process our food. As a result, you're seeing new infections emerge," she said.
The diseases that nations must now report -- cholera, yellow fever and the plague -- "with the possible exception of cholera, are not really what you're worried about anymore," Kimball said. "If you leave a body of internationally agreed regulations that limited, it becomes irrelevant."
The proposal would create a more general requirement that nations report any "public health emergency of international concern," which could include an environmental disaster.
To guide nations in deciding what circumstances would qualify, the Karolinska Institute in Sweden has created and tested a "decision tree," Heymann said.
"Picture an organizational chart, a flow chart. There are a series of questions. Is the event serious? Yes or no. Is it unexpected? If so, is there a significant risk of international spread? If yes, then under the regulations it should be reported," he said.
Another change would widen the type of evidence WHO could use to identify potential threats. Currently, WHO can act only on information from a member nation's ministry of health, a requirement that can bog down its response. The Chinese government, for example, did not confirm the SARS epidemic until months after it began, which gave the disease an opening to spread around the world.
Under the change, WHO could react to an array of other sources of information, including news stories, reports from nongovernmental organizations such as Doctors Without Borders and the Red Cross, and WHO-affiliated scientific laboratories.
"We hope this will help us sort out the rumor from the nonrumor and help countries in the end not be penalized by false information out there," Heymann said.
The proposal would also give WHO authority to verify that nations are taking effective measures, including possibly on-the-ground inspections by WHO teams.
"What we need to know is if . . . the control measures that are going on are in line with what we need to prevent the spread internationally," Heymann said.
"Now we make recommendations, but we don't validate the results."
Heymann acknowledged that "this may be a contentious point" for some countries. "It's giving up a little bit of their sovereignty," he said.
Kimball agreed, but she added: "It's important to understand that there are some things that are internationally pertinent. I think what you saw with SARS was that there was a lot of respect for sovereignty, and in some ways it cost us."
The changes would also set up a formal system for issuing international health alerts. When WHO became convinced that SARS posed a worldwide threat, the only way to notify all countries was to hold a news conference.
"We need rapid communications 24 hours a day with all governments," Heymann said. "What we need is to have the names of people in each country who we can go to beforehand to tell them what is coming."
Barry R. Bloom, dean of the Harvard School of Public Health, said the changes are needed, but that unless countries have clear incentives, fear of economic repercussions will likely make many nations hesitant to report outbreaks.
"There is no way to make them do it, and there's not much in it for them. If they can keep it quiet as long as possible, they can protect their economies," Bloom said.
But Bruce Plotkin, a Seattle lawyer who has advised WHO, said updating the regulations could make nations more likely to comply because the agency would be able to devise reasonable responses, heading off unnecessary and destructive trade or travel restrictions.
"This has the big advantage of getting the WHO involved immediately to help stop whatever is happening, and it permits WHO to then be in a position of notifying the world of what the real risk is and what an appropriate, justified public health response is," he said.
© 2003 The Washington Post Company
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