Former Pakistani Prime Minister Benazir Bhutto, despite a bevy of bodyguards, was assassinated yesterday. Pakistan is a dangerous place, especially for pro-American politicians or those thought to be pro-Western officials. It’s something to think about when you read that WHO and the US reference laboratory NAMRU-3 each sent teams to the politically unstable and hostile-to-the-West northern regions of Pakistan to gather information about the recent cluster of bird flu cases. WHO’s team was in Peshawar, north of Islamabad. Here’s what Middle East expert Juan Cole said about Peshawar the other day:
Speaking of chaos, guerrillas bombed a mosque in northern Pakistan, killing 50 persons, on Saturday. Barnett Rubin explains this horrific event as part of a concerted plan by al-Qaeda and the neo-Taliban in Pakistan to cut off and surround the northern city of Peshawar. (Juan Cole, Informed Comment),
The “horrific event” referred to was the bombing a week ago at Charsadda (lots of sad details at the link inside the pull quote), just northeast of Peshawar. Both Peshawar and Charsadda are close to the Afghan border, an area that is a Taliban stronghold. There are reports that members of NAMRU-3 went outside of Peshawar to villages where some of the cases occurred, although I could not confirm this. Either way, this is a dangerous place and the bombing happened within a day or two of the visits.
WHO has offered an Update in which they support their belief there was limited human to human transmission in at least one case. Here’s the text:
The first case of human infection with H5N1 avian influenza has been confirmed in Pakistan. Laboratory tests conducted by the WHO H5 Reference Laboratory in Cairo, Egypt and WHO Collaborating Center for Reference and Research on Influenza, in London, United Kingdom have confirmed the presence of avian influenza virus strain A(H5N1) in samples collected from one case in an affected family. Additional laboratory analysis, including gene sequencing, is ongoing.
At the request of the Pakistan Government, a WHO team traveled to Pakistan to participate with national authorities in the ongoing investigations of several suspected cases of human H5N1 infections. The following conclusions have been made accordingly:
- The preliminary risk assessment found no evidence of sustained or community human to human transmission.
- All identified close contacts including the other members of the affected family and involved health care workers remain asymptomatic and have been removed from close medical observation.
The Ministry of Health in Pakistan has taken timely steps to investigate and contain this event including case isolation, contact tracing and monitoring, detailed epidemiological investigations, increasing the availability of personal protective equipment, dedicating hospital facilities for any new suspected cases, and other infection control measures. In addition, agricultural authorities, including the Ministry of Food, Agriculture and Livestock and FAO, have been active technical partners for the effective control of this limited outbreak. (WHO)
A story by Helen Branswell indicates that tests for H5N1 on the other cases initially thought to be positive have not been confirmed by reference laboratories but that follow-up testing for convalescent antibodies is being done to rule out false negatives. But apparently the fact tthat WHO and NAMRU3 have so far not able to confirm further instances of human to human transmission or even infection has angered some (for a particularly egregious example, see this comment). Such people are either so terrified that any attempt at reason is fruitless or so intent on justifying their own fear they are glad when the news is bad and angry when the pandemic they have so far warned must happen has not yet occurred.
Admittedly WHO has risked this kind of reaction by clumsy attempts to spin information in the past. But spinning isn’t covering up and it isn’t outright lying. People can disagree on interpreting the evidence but I have no reason to believe now or in the past evidence was altered or suppressed or that in this case they are releasing false information.
I mention this because I am frankly upset with irresponsible comments about WHO from people tapping away at their keyboards in the safety and security of their living rooms thousands of miles away from the action. If I a loved one of mine were traveling in these areas I would worry for their safety every second. I’ve been quite critical of WHO here (I hope fairly), but when they and other public health professionals risk their lives to gather urgent public health information, they most certainly get the benefit of the doubt from me.