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WHO Tries to Focus on Bird Flu But Remains Vigilant Elsewhere
posted by admin on 19/09/06

"The WHO should not lose focus," said Chua Soi Lek, Malaysia's minister of health and one of the scores of senior officials attending a weeklong regional conference of the WHO here.

By NICHOLAS ZAMISKA
September 19, 2006

AUCKLAND, New Zealand -- The World Health Organization is struggling to maintain the public's focus on the risk of a bird-flu pandemic without letting a single -- and still largely hypothetical -- threat overshadow the rest of its ambitious public health agenda.

High on that agenda are diseases such as tuberculosis that, unlike bird flu, already infect millions of people each year.

"The WHO should not lose focus," said Chua Soi Lek, Malaysia's minister of health and one of the scores of senior officials attending a weeklong regional conference of the WHO here.

Dr. Chua said the WHO has overemphasized the threat from bird flu at the expense of other, more pressing diseases such as AIDS, TB and malaria, which he says "don't have any glamour anymore -- they're not sexy. I'm not saying avian flu is not important, but we should have a balance....I have colleagues who have reservations, but they don't want to say it because they don't want to offend the WHO."

Richard Nesbit, the WHO's acting regional director for the Western Pacific, told reporters that the risk of a bird-flu pandemic "continues unabated. After three years now, I'm sure many journalists and the public are starting to get tired of the same message" -- that a global outbreak could strike at any time -- "but we have an obligation to keep giving this message."

In January, mounting concern about a possible global outbreak of avian influenza, stoked in large part by experts at the WHO, prompted countries around the world to pledge about $1.9 billion for bird flu. Much of that funding has yet to materialize, partly because the pandemic for which it was earmarked hasn't shown strong signs of materializing either.

A study just published by the journal Emerging Infectious Diseases is one of several that are shedding light on why the H5N1 strain of avian influenza hasn't yet evolved into one that can spread rapidly among people. In the study, a group of about a dozen researchers focused on a single Cambodian village where a 28-year-old man had died of bird flu in March 2005, and tested 351 people from 93 households near the man's home to find out whether the virus may have been spreading undetected among people there.

None of the people showed signs of past infection, tamping down theories that the virus might have been spreading silently through human populations. Such a spread would greatly increase its opportunities to encounter a human influenza virus and potentially acquire the transmissibility of that common flu. That doesn't seem to be happening, at least in this case, with last year's strain.

"The likelihood of H5N1 to meet a human virus is much lower than we thought," Dr. Sirenda Vong, a researcher at the Institut Pasteur in Phnom Penh, Cambodia, and lead author of the study, said in a recent telephone interview.

Tuberculosis, too, has health authorities struggling to strike the right tone in calibrating their messages for the public. Earlier this year, researchers and health officials gathered in Atlanta for a meeting to discuss a deadly new strain of TB that appeared resistant to most, if not all, of the drugs used to fight the disease. Health experts at the meeting, including scientists from the U.S. Centers for Disease Control and Prevention, discussed whether to label the new strain "extreme" or "extensive," when describing its degree of drug resistance. Health officials had already dubbed a less deadly form of the disease "multidrug resistant."

The question hinged, in part, on how dire a warning to sound, with the CDC taking a slightly more cautious approach. "The U.S., the CDC, will definitely not call it extreme, because they say there is nothing beyond extreme," an international public health official said.

The flurry of dire bird-flu warnings from scientists and public health officials alike, combined with the fact that a pandemic hasn't yet occurred, has already prompted a subtle shift in the rhetoric. Yesterday at the conference here, for instance, a senior Australian health official told her counterparts from across Asia that the work that countries were doing to combat and prepare for avian influenza would pay dividends down the road -- with other diseases.

Anders Nordström, acting director general of the WHO, acknowledged on the sidelines of the conference here that the world is in a "down period" of bird-flu cases but said that countries need to remain vigilant. "We will have a pandemic," he said. "The question is when and how severe it will be."

Still, Dr. Nordström said the agency is trying to prevent diseases such as bird flu, which has killed fewer than 150 people since it re-emerged in Asia in 2003, from overshadowing the rest of the WHO's work, and is shifting the agency's emphasis somewhat toward more noncommunicable health problems, such as maternal health, diabetes and environmental problems. He pointed to the tenor of this week's meeting and planned budget increases as evidence that the shift is already happening.

"If you look in terms of the silent epidemics, in terms of women dying, maternal mortality...we haven't seen any progress," Dr. Nordström said. "And there one can be concerned about how do we use the WHO's capital. There has been a concern, and that is why we are changing the focus slightly."

Write to Nicholas Zamiska at nicholas.zamiska@wsj.com

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