The excellent op-ed by Prof Lawrence Gostin*, “Fighting the Flu With One Hand Tied” in the May 1, 2009 edition of the Washington Post highlights the legal and financial limitations of two of the world’s key public health agencies- the World Health Organisation (WHO) and US Centers for Disease Control and Prevention (CDC).
In reference to the revised 2005 International Health Regulations and the experience with SARS, Prof Gostin points out:
…the frightening truth is that the WHO has no real power. It lacks an effective mechanism for monitoring and enforcing national reporting. Its recommendations to countries are expressly “non-binding.” Countries do not even have to share virus samples with it. Indeed, despite painful negotiations over the past two years, the agency has not been able to persuade Indonesia to share samples of avian influenza, threatening vaccine production and public health preparedness.
Professor Gostin also highlights the grim reality of how the world’s poor are also the most vulnerable to, and the least capable of coping with public health emergencies of international concern.
Perhaps more worrying is the lack of capacity in poor countries to detect and respond to emerging threats. This is of particular concern because influenza often emerges in Asia, where crowded cities and close proximity between animals and humans can breed infectious disease. Although Mexico is the likely center of the current outbreak, the genetic material in the swine flu virus is of Eurasian origin. Many poor countries lack adequate surveillance, early warning systems and modern laboratories; they also have negligible public health infrastructures. Although the revised International Health Regulations urge capacity building, Western governments have donated precious little funding, and the WHO has no mechanism or resources for expanding public health capacities within individual countries.
After shedding some light on CDC’s limited legal authority and resources to effectively respond to swine flu -influenza A (H1N1), Prof. Gostin concludes:
The WHO and the CDC are our frontline defense against infectious diseases that can rapidly mutate and travel across continents. It is easy to criticize these agencies and deprive them of resources. It is much harder, but necessary, to build strong public health agencies to do the vital work that we all rely on, especially in the face of an international public health emergency.
*Professor Gostin is a professor of global health law and faculty director at Georgetown University Law Center’s O’Neill Institute for National and Global Health Law, as well as a member of the World Health Organization International Health Regulations Roster of Experts and director of the WHO Collaborating Center on Health Law.