H5N1

Haiti cholera victims threaten to sue the UN

Via BBC News: Haiti cholera victims threaten to sue the UN. Excerpt:

Victims of Haiti's cholera epidemic have given the United Nations a 60-day deadline to start talks about billions of dollars worth of compensation or face legal action. 

The UN is accused of negligently allowing peacekeeping soldiers to pollute Haiti's water with cholera. 

A UN cholera expert agrees that this is "most likely" to be true. 

The UN rejected an earlier call for compensation and continues to insist it is immune from legal proceedings. 

The cholera epidemic began in Haiti near a camp for UN soldiers, where there were leaking sewage pipes. Some human waste was also dumped near a river outside the camp. 

>The camp housed UN soldiers from Nepal, where cholera is endemic. The UN's own cholera expert, Danielle Lantagne, has said that Haiti's outbreak is likely to have come from UN soldiers. 

The victims include relatives of the 8,000 people who have died and hundreds of thousands of people who have fallen sick. 

Lawyers for the victims say the UN is breaking international law. 

They say they will open legal proceedings in New York with claims totalling many billions of dollars if the UN does not start talks within 60 days. 

The lawyers say they will file claims for $100,000 (£64,000) for the families of those who have died and $50,000 (£32,000) for every one of the hundreds of thousands who have fallen sick.

H5N1 flu research sparks ethical and safety debate

Via South China Morning Post: H5N1 flu research sparks ethical and safety debate. Excerpt:

A team of top Chinese researchers has found that swapping a single gene of the H5N1 bird flu virus with one from H1N1 human flu makes it transmissible between guinea pigs, representing a jump from bird to mammals. 

However, their study has reignited an ethical debate over the merits of artificially creating potentially deadly new viruses. 

The team, led by Professor Chen Hualan from the Ministry of Agriculture's Harbin Veterinary Research Institute, produced 127 novel viruses in the laboratory. 

After testing them on mice and guinea pigs, the researchers found that four were both deadly and highly infectious, making them possible candidates for the next global pandemic outbreak. 

The publication of their paper on the website of the magazine Science on Thursday triggered heated debate in the scientific community on ethical and safety issues, including whether the viruses could escape from the lab or be used by terrorists. 

Flu researchers around the world had agreed a voluntary moratorium on H5N1 research under which transmission studies using ferrets were banned. It followed controversies over two other flu research projects by American and Dutch scientists. They also involved the deliberate manipulation of viruses to make them more dangerous, but the moratorium expired in January. 

Neither Chen nor the ministry could be reached for comment yesterday, but a co-author of the paper said their work environment was classified bio-safety level 3, which should be sufficient to prevent a leak. 

He said he did not know where the viruses were stored or how they were guarded. "I was only responsible for part of the project," he said. 

Professor Xue Yu, a biologist at Huazhong University of Science and Technology in Wuhan, said an accidental leak was possible at any laboratory, even those that were better guarded. "If the virus fell into the hands of terrorists, it would kill more people than a nuclear bomb," he said.

For that matter, if the virus fell into the hands of a government, it could kill a lot of people too; it's not as if terrorists are the only fools on the planet.

I don't share the moral angst of the people who object to such experimentation. Once nuclear fission was demonstrated in the late 1930s, physicists all over the world started talking about an atomic bomb. It was just a question of political will and engineering.

Similarly, once the genetic structure of the influenza virus was understood, building a more lethal one was inevitable. The Manhattan Project built the first American A-bomb because it was feared the Nazis were doing it too. And by understanding how H5N1 can move between mammals, we have a much better chance of dealing with it when it happens through a random mutation. A reliable vaccine should be easier and quicker to develop.

What about the chance of an accidental release? Well, it could happen. It could also happen with the nuclear waste we've been blithely accumulating over half a century. Some of it will continue to be a threat for many thousands of years, long after archeologists have renamed us the Paleo-Idiots.

But we wouldn't even understand that long-term threat we post to our descendants if we had not studied radioactivity, and we won't understand the threat of H5N1 and its cousins if we don't study them.

H7N9 and "gain of function" H5N1 research

Via Reuters: Deadly new bird flu vindicates controversial research. Excerpt:

Scientists in the Dutch city of Rotterdam know precisely what it takes for a bird flu to mutate into a potential human pandemic strain - because they've created just such mutant viruses in the laboratory. 

So as they watch with some trepidation the emergence in China of a strain of bird flu previously unknown in humans, they also argue it vindicates their controversial decision to conduct these risky experiments despite fierce opposition.   

Above all else, what the world needs to know about this new strain of H7N9 bird flu is how likely it is to be able to spread efficiently among human populations. 

And according to Ab Osterhaus, a world leading flu researcher who is head of viroscience of the Erasmus Medical Center in the Netherlands, studies his team and another in the United States have been doing are the best way to find out. 

"At the moment we don't know whether we should go for a full-blown alert or whether we can sit back and say this is just a minor thing," Osterhaus told Reuters in a telephone interview. 

"(To answer that) we need to know what this virus needs to become transmissible." 

With 10 cases of the new H7N9 bird flu confirmed in people in China since Sunday, including four deaths, Beijing is mobilizing resources against the threat. 

Japan and Hong Kong said they had also stepped up vigilance against the virus, and Vietnam banned imports of Chinese poultry. 

MAKING A MONSTER? 

The scientific work that can answer key risk questions is known as "gain of function" or GOF research. Its aim is to identify combinations of genetic changes, or mutations, that allow an animal virus to jump to humans. 

By finding the mutations needed, researchers and ultimately health authorities are better prepared to assess how likely it is that a new virus could become dangerous and if so how soon they should begin developing drugs, vaccines and other scientific defenses.

H5N1 viral-engineering dangers will not go away

Via Nature News & Comment, a thoughtful opinion piece: H5N1 viral-engineering dangers will not go away. Excerpt (but read the whole thing):

Barely two months after a small group of influenza virologists lifted a moratorium on work to make the H5N1 avian flu virus as transmissible between humans as seasonal flu, researchers are at it again. 

Earlier this month, a Dutch scientist proposed similar experiments with other avian flu viruses, as well as the SARS coronavirus. And a fortnight ago, scientists in Germany and Switzerland reported how they had tweaked canine distemper virus to make it grow in human cells. 

The logic behind these kinds of experiments, collectively called gain-of-function (GOF) research, is to identify combinations of mutations that could allow an animal virus to jump to unprepared humans. By knowing the mutations, the thinking goes, we can better prepare and marshal our scientific defences against a possible threat. 

GOF research on avian flu provoked heated controversy, much of it covered by this journal. That controversy did not go away with the lifting of the moratorium. On the contrary, it continues to fester. Officials in Washington DC are putting the finishing touches to new guidelines for the review, regulation and oversight of this kind of research. 

The chill winds that we can anticipate blowing from policy-makers as a result could affect all of us who research viruses and their pathology. To avoid this, researchers in this field need to learn lessons from the past. 

Rather than use the avian flu moratorium to seek advice, listen and foster debate, many influenza scientists engaged in an academic exercise of self-justification. There was a single large open meeting, at the Royal Society in London, which engaged a wider audience, including bioethicists. The recent calling off of the moratorium by 40 flu researchers alone — not funders, governments or international bodies — says it all. The flu community simply hasn't understood that this is a hot-button issue that will not go away.

Branswell: Doctor stirs debate over mandatory flu shots

This has stirred up quite a fuss here today. I would have linked to the original CMAJ commentary, but it's behind a paywall. So here's Helen Branswell of The Canadian Press, in The Globe and Mail: Doctor stirs debate over mandatory flu shots. Excerpt:

Mandatory flu shots for health-care workers should be put on hold until there is a more effective influenza vaccine, a prominent infectious diseases specialist says. 

In a commentary published in this week’s issue of the Canadian Medical Association Journal, Dr. Michael Gardam argues that making the vaccine mandatory could lead to legal challenges that may not be winnable, given the modest efficacy of the vaccine. 

Gardam, who is pro-vaccine and who gets a flu shot annually, is essentially arguing that this is not a hill worth dying for. 

“Any sort of policy decision where you’re going to make a vaccine mandatory is going to be an uphill battle, right? It’s going to be a real fight,” said Gardam, who is head of infection control at Toronto’s University Health Network. 

“And so you have to decide if you’re going to make that fight, is this vaccine worth it to make that fight? And I personally don’t think it is.” 

The commentary was swiftly rebutted by influenza vaccine proponents, who countered that it’s faulty logic to link the fact that the vaccine could be better with the question of whether mandatory flu shot policies for health-care workers are legitimate. 

“The premise of a relationship between those two things just doesn’t make sense,” said Dr. Allison McGeer, head of infection control at Toronto’s Mount Sinai Hospital and a vocal advocate for mandatory flu shot policies for health-care workers. 

“Yes, influenza vaccine is only 60 per cent effective. Yes, we very clearly need better influenza vaccines, because despite fairly widespread use of a vaccine that’s 60 per cent effective there’s still a lot of morbidity and mortality” – illness and death – “due to influenza. 

“The fact that we need a better vaccine does not mean that our current vaccines are not useful. We need better treatments for cancer too, but we’re not going to stop treating people for cancer because our treatments are not perfect.” 

The commentary and the heated discussion that will surely follow its publication flow from an evolving debate within infectious diseases circles over flu shots. 

One of the only tools available to combat influenza, flu vaccine used to be thought to be between 70 and 90 per cent effective at preventing illness in healthy adults, though less effective at protecting the elderly and young children. 

But in recent years, the efficacy estimate has taken a big step back, with the U.S. Centers for Disease Control and Prevention now suggesting the vaccine protects about 50 to 70 per cent of healthy adults who get a shot. 

Some infectious diseases experts have rallied to the vaccine’s defence, arguing that 50 to 70 per cent protection is still sizable. But others see support for the existing vaccines as undermining efforts to push the pharmaceutical industry toward finding ways to make better flu vaccines – products that last longer and protect against more strains of the always-changing virus.

Canada: Science world abuzz as virologist turns down Gairdner award

Via The Globe and Mail: Science world abuzz as virologist turns down Gairdner award. Excerpt:

When the latest winners of Canada’s most prestigious international science prize were named in Toronto, one question was buzzing in the background: Why would someone turn it down? 

Michael Houghton, who holds a $10-million Canada Excellence Research Chair in virology at the University of Alberta, had apparently surprised the Gairdner Foundation by being the first person to decline the prize in its 54-year history. 

Dr. Houghton, who was not at the ceremony on Wednesday, said he could not accept the Gairdner because two close collaborators were not being similarly recognized. Qui-Lim Choo and George Kuo worked with Dr. Houghton at Chiron Corporation, a California biotech company, when they identified and cloned the hepatitis C virus. The discovery has since led to screening tests that have reduced the risk of acquiring HCV through blood transfusion from one in three to about one in two million. 

Dr. Houghton has previously been recognized for this work and in 2000 accepted the Lasker award, the highest U.S.-based award in the life sciences. Neither Dr. Choo nor Dr. Kuo were named as co-winners on that occasion. However, Dr. Houghton maintains he did not apply a double standard in choosing not to accept the Canadian award, but rather did not want to relive the conflict he felt after accepting the Lasker. 

“I agonized over it,” Dr. Houghton said. “And I decided I didn’t want to do that again.”

Haiti: 8,057 cholera deaths as of March 4

MSPP has posted more cholera statistics on its Documentation page, taking us from February 26 to March 4. As usual Grande Anse isn't reporting, and the numbers are doubtful in other ways, but here they are:

Total cases as of March 4: 649,449

UN accused of cover up of Zimbabwe cholera

Thanks to Jonathan Katz for tweeting the link to a startling Al Jazeera report: UN accused of cover up Zimbabwe cholera.

A United Nations investigation has reached a damning verdict on its own humanitarian operation, accusing it of "managerial ineptitude, high handed conduct and bad faith." 

The findings refer to its operations during a Cholera outbreak in Zimbabwe that started in 2008 and claimed more than 4,000 lives. 

The UN dispute tribunal in Nairobi, Kenya, in effect found that UN bosses did not want to upset the government of Robert Mugabe, and did not act on warnings by a senior member of its staff. One hundred thousand people caught the disease. 

Months before the outbreak of the cholera epidemic in 2008, which coincided with a time of heightened political tensions in Zimbabwe, Georges Tadonki, the then head of the UN humanitarian office in Zimbabwe, warned his superiors of the severe risks, but no action was taken. 

Tadonki claims that he was fired in January 2009, partly because he sounded the alarm about the cholera crisis. 

“Mr Tadonke pressed the issue, and this tribunal has heard that he was hounded out of his job, and his lawyers said he suffered a nervous breakdown as a result,” Al Jazeera’s Diplomatic Editor James Bays said.

“What the UN also said is that there should be disciplinary action against four very senior UN officials, including the former humanitarian chief of the UN, John Holmes,” Al Jazeera’s Bays added. 

“Now, all those four officials are no longer in their posts, so it is not clear what kind of action can be taken against them.”

Never mind the four officials. At some point, the whole World Health Organization, from Dr. Margaret Chan on down, will have to review its policies in the light of simple medical ethics. You're supposed to heal sick people, not use them as a springboard for your own bureaucratic career.

How the UN caused Haiti's cholera crisis—and won't be held responsible

Via The Atlantic.com, Armin Rosen writes a long, informative, and infuriating analysis: How the U.N. caused Haiti's Cholera crisis -- and Won't Be Held Responsible. By all means read the whole article, and follow the links. Rosen's conclusion:

It is unreasonable to expect any organization to submit to more legal exposure than is required under existing law, and in the Haitian case, the U.N. had a procedural means of simply making the complaints go away. 

One might hope that the U.N., which was founded to "reaffirm faith...in the dignity and worth of the human person," would be less mercenary in its concerns. After all, no multinational corporations host conferences on "Strengthening the Rule of Law," and none act as a steward for and enforcer of scores of multilateral treaties. Idealism is hardwired into the structure and purpose of the U.N., which is still the world's most respected venue for mediating international conflicts, and for forging cooperative solutions to weighty, global problems. The U.N. undoubtedly benefits from its legal immunity -- and since immunity is the price of a functioning international system, so does the world at large. 

But when an organization dedicated to the rule of law is itself immune from legal accountability, it can't help but cheapen its larger mission, as well as the quality of its work. As Flaherty notes in his paper, no U.N. personnel were seriously disciplined for their role in the U.N.'s Oil for Food Scandal, in which U.N. diplomats received kickbacks from the regime of Saddam Hussein in exchange for allowing him to use a U.N. program to circumvent international sanctions. Lubbers was eventually forced out of the U.N., but only after a media outcry -- and without the U.N. paying any compensation to his victim. 

And it is still the U.N.'s position that it was not responsible for the cholera outbreak in Haiti and owes nothing to the epidemic's victims. 

The U.N. has a troubling recent history of behaving as if it is above the law, perhaps because it is. The epidemic reveals how far even the most well-intentioned organizations can drift when they aren't subject to a hard external check, and how badly the U.N. is in need of mechanisms that will force it to do better.

See also this Facebook post by Ezili Danto—one of very few responses by Haitians I've seen so far.

Haiti: A massacre of negligence

Further to Jonathan Katz's powerful article, a collection of photographs on Slate.com: A Massacre of Negligence: Photos from the United Nations fiasco. These are photos from the early days of the cholera outbreak in October and November 2010. They are not for the squeamish.