Earlier today I posted about this Miami Herald report: Zika virus: Florida health department does not report all local Zika infections, leaves out all residents of other states and countries. It argues that Florida Governor Rick Scott and other state officials have stopped providing detailed information on what they're learning about Zika infections, kept quiet about some Zika hot zones, and failed to mention cases in non-residents.
I confess it didn't come as a shock. No government wants to be transparent and honest about disease outbreaks; it would only lead to a sharp decline in tourism and investment. Poor and backward countries like Guinea are smart enough not to create health-ministry websites in the first place, which saved the Guineans a lot of political grief during the Ebola outbreak. (Liberia's health website has been offline for months.)
Similarly, Haiti's Ministry of Public Health and Population has a user-hostile website that is a marvel of poor navigability, with ancient reports the only reward for stubborn users.
Back when H5N1 in both birds and humans was an embarrassment to the Indonesian government, the then health minister, Siti Fadilah Supari, found a pretext to stop supplying WHO with case reports it was legally obliged to provide under the International Health Regulations. WHO just had to put up with it.
This inspired me in 2008 to create the Supari Prize, awarded from time to time to the politician "who most flamboyantly endorses a deeply unsanitary policy. The prize itself is a sack of hammers, tastefully tied with a length of IV tubing and garlands of red tape."
Eight long years later, it occurs to me that the prize ought to be handed to every health bureaucrat and politician on the planet as he or she takes office, including the Director General of WHO...because sooner or later, faced with a choice between supporting public health and supporting those who fund them, those bureaucrats and politicians will always protect their funders.
WHO learned its lesson after the SARS outbreak, when its then Director General, Gro Harlem Brundtland, issued a travel advisory about Toronto. The Liberal government of the day, under Jean Chretien, was deeply unhappy. The advisory cost Toronto millions, not to mention the fee for a free Rolling Stones concert to let the world know Toronto was open for business again. Since then, WHO has usually taken pains, when reporting on some ghastly new outbreak, to say "Don't worry, you can still go there!"
Similarly, the US CDC stumbled over the Ebola cases in Dallas, which made the whole American healthcare system look pretty sloppy: two young nurses caught Ebola, and one actually flew while reporting a fever. The other is still suing her employer.
All of this reminds me of Henrik Ibsen's 1882 play An Enemy of the People, which I read in college well over 50 years ago. Ibsen describes a small Norwegian town that relies heavily on tourists coming to "take the waters" in its baths. The local doctor finds that the baths have been contaminated by runoff from a nearby tannery, and is determined to announce this publicly. Otherwise, visitors will get sick or even die. All hell predictably breaks out, and the poor doctor becomes an enemy of the people he is trying to help.
Nothing has really changed in the 134 years since the curtain first went up on that play. Zika is only the latest trial for our long-suffering politicians, whether in Brasilia or Miami or Port-Au-Prince, and they seem hard-wired to respond in one of two modes: silence, or cheery assertion that everything is under control. Cheery assertions are easier when annoying facts go unreported, as Rick Scott evidently believes.
The only response I can think of is for reporters to do their jobs, if need be by collaring doctors and nurses and getting them to tell what they know (as Cuba's dissident journalists did in covering their country's cholera outbreak). Reporters also need to push and push and push against the politicians and their bureaucrats, and to remind them that the cover-up is always politically more trouble than what they're trying to cover up.
In the long run, however, we really are going to need health agencies with "drop dead" money...that is, the resources permitting them to tell their political masters to drop dead if they ask for a cover-up.
The lack of such resources has led to the CDC running out of money to fight Zika because Congress would rather squabble over funding Planned Parenthood. It's also led to the abject failure of the UN to admit its responsibility for Haiti's cholera, because doing so would require it to put money it doesn't have into restitution for millions of Haitians.
And it's led to countless humanitarian disasters, from South Sudan to Aleppo to the Hungarian border to the Central African Republic, because the business plans of the High Commissioner for Refugees, and OCHA, and FAO are essentially to stick out their begging bowls and hope some of those Supari Prizewinners deign to throw a couple of pennies their way. No pennies? No help.
The only agency with enough drop-dead money to speak truth to the prizewinners is MSF, and my respect for it (and its international president, Canada's Dr. Joanne Liu) has only grown. But even it will have only limited effectiveness until WHO, CDC, and other major health agencies are also independently wealthy enough to blow the whistle on their wretched political masters.
