A rchive Date
[ 25-04-2003 ]
Category
[ International Relations ]
sub-Categoy
[ Canada ]
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[http://cnews.canoe.ca/CNEWS/Canada/2003/04/21/69984-cp.html
WHO admits to breakdown in communication; Lastman bristles on U.S. TV
By HELEN BRANSWELL
Fri, April 25, 2003
TORONTO (CP) - The reputation of the World Health Organization took a drubbing in Canada on Thursday, as government officials and medical experts challenged the lack of science behind the decision to issue a SARS-related travel advisory against Toronto.
The organization itself admitted to a series of embarrassing missteps in its handling of the situation.
The WHO decision to urge people around the world to avoid travel to Toronto for at least three weeks left Canada at odds with an organization that views this country as its "strongest friend."
A WHO official erroneously implied the travel advisory could last considerably longer than the three weeks first suggested. And another admitted the WHO's assertion that it had given Health Canada 24 hours' notice of the pending advisory may not have been "absolutely right."
"There was a breakdown in communications. I think that's obvious," communications director Dick Thompson said in an interview from Geneva, adding that a message had been conveyed, but "something was lost in the intensity by the time it arrived at Health Canada."
"I think that we're willing to acknowledge that there was some kind of mistake, that they didn't receive the message. I don't know how that happened. And I think we're ready to accept some blame here. That's for sure."
Toronto Mayor Mel Lastman wasn't as conciliatory toward the WHO in an appearance on CNN late Thursday.
"They don't know what they're talking about. I don't know who this group is, I never heard of them before. I'd never seen them before," he said.
"Who did they talk to? They've never even been to Toronto. They're located somewhere in Geneva," a blustering Lastman said of the WHO advisory that said travellers should stay clear of the city hit by SARS.
Meanwhile, leaders of the team that has worked round the clock for six weeks to contain Toronto's SARS outbreak for the past six weeks felt a similar admission ought to be made in terms of the decision to issue the travel advisory itself.
They took part in a conference call Thursday with Health Canada officials and counterparts at the WHO. At the end, they barely attempted to contain their contempt for the way the organization made its decision or the facts upon which it was grounded.
"It was disappointing that they didn't provide to us rational arguments as to why we should have a travel ban in this country," said Dr. Donald Low, one of Canada's leading infectious disease experts and a vocal critic of the decision.
"And when we argued about the theoretical reasons, they weren't able to stand by them. . . . None of the arguments that they have hold water."
Dr. James Young, Ontario's commissioner of public security, said representatives from the team were ready to fly to Geneva to put the facts to the organization if the WHO would agree to meet with them.
"Hopefully we can inform them and science will win the day. But I'm not sure that they fully appreciated the seriousness of the decision they had made," Young said.
"They talked about it in rather cavalier terms. ... 'Well, it's just a travel advisory.' It's a lot more than that and we tried to impress upon them the seriousness of this label."
Furthermore, they insisted, the move comes at a time when there are promising signs that Toronto's outbreak - the largest outside of Southeast Asia - is being wrestled under control.
There hasn't been a new case found in the community - in other words, outside of health-care workers and the workers' close contacts - in 19 days. That's almost two incubation periods. The WHO appeared to be unaware of that fact, Low noted.
Sixteen people have died in the Toronto area since the outbreak began.
The province's caseload dropped for the first time Thursday, with the total probable and suspect cases listed as 257, down 10 from Wednesday. The reduction reflected the fact that some people who were thought to have SARS were ruled out.
And there were fewer active cases in hospitals - 89 - than recovered and released cases (132), the officials said.
"I don't think there is a crisis anymore," said Low, microbiologist-in-chief at Toronto's Mount Sinai Hospital. "We're seeing an incredible decrease in the curve."
"We're on the right track in Toronto and why they would do this without talking to us is beyond me."
The WHO said the decision to warn people against travel to a SARS hot-zone - and the global SARS outbreak is the first time the organization has issued such advisories - is based on three things. The first is the size of the outbreak, the second is the issue of spread into the community.
Third is whether the country is exporting cases to other parts of the world - something the WHO insists Canada has done on several occasions and something Canadian officials suggest has happened once, perhaps twice, but is still no reason to, as Low puts it "shut down a city."
Low mused there may be political undertones to the decision, suggesting it might have been done to appease China, where travel advisories cover Hong Kong, Beijing, and the provinces of Guangdong and Shanxi.
"I think they're looking for another scapegoat. And I think we're the scapegoat."
Thompson vehemently denied that allegation.
"Boy, I'll tell you, that couldn't be more wrong. The reason is WHO doesn't have a stronger friend than Canada," he said forcefully.
"I believe that 100 per cent. That there's absolutely no relationship with China in that.... And that's why this is really anguishing. It's why this is so difficult."
Not difficult enough, Canadian officials might argue, given the lack of clarity in the WHO's pronouncements.
Thompson was forced to refute the suggestion - made earlier in the day at a media briefing by Dr. Julie Hall, co-ordinator of operations for the global outbreak alert and response network - that the travel advisory would stay in effect for some time longer than three weeks.
The travel advisories the WHO has issued to combat the global spread of SARS will only be lifted three weeks after the country or city involved stops reporting or exporting new cases of the disease, Hall said Thursday morning.
"In terms of most of the criteria we're looking at, we are saying that if there are no new cases or no exported cases three weeks after the last reported case, then at that point the travel advisory would change and be downgraded," Hall said.
"She's wrong then," Thompson admitted in a phone call Thursday afternoon. "I think that she's not as close to that aspect (of the advisory) as other people."
"This won't budge for three weeks - two incubation periods," he said, adding that after that period, changes on the ground could result in the advisory being lifted.
"Three weeks down the line we look at that data and say 'Voila. Things are much better. We can remove this recommendation.' "
The confusion over the length of the travel advisory - which threatens to decimate the city's restaurant, hotel and convention industries - further frustrated an already annoyed Dr. Paul Gully, Health Canada's senior director general of population and public health. And that was before Thompson waded in to correct Hall's mistake.
"Let's say the communications from WHO have not been particularly clear at all times," Gully said.
"I think he's right," Thompson admitted glumly.
Ask to explain the series of missteps, Thompson borrowed an analogy from a higher up:
"My boss uses a phrase: We're building a boat and sailing it too.
"You know, we're running against a clock. We've got a window of opportunity to control these outbreaks, to get this thing contained. So everybody's going very fast, they're working very hard."
Low and his colleagues, however, were singularly unimpressed with the WHO's handling of the situation.
"It's very disappointing that the organization that we look to to set standards, this is how they make decisions? That to me is very disappointing."
 World Fact Book (CIA)]
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