Laurie Garrett, senior researcher for Global Health at the Council on Foreign Relations (CFR) in New York is the media consultant's nightmare: it cuts to the chase and talk bluntly. But then Garrett is, at its heart, a journalist, and has brought the policy wonk hat CFR for the past 4 years.
a Pulitzer prize winning journalist and bestselling author, lately, Garrett has devoted much of its attention on the swine flu pandemic. (Full disclosure: I work with it to organize a Science / CFR-sponsored panel discussion on the pandemic.) His relationship with the Obama White House administration on the bottom to give it a unique perspective about several political issues that have surfaced. She is also a member of the Network Modernizing Foreign Assistance, a focus group network, NGOs and religious organizations, which aims to strengthen US efforts in developing countries, and it interacts regularly with senior officials of the World Organisation Health (WHO) and other parts of the United Nations.
In an interview with Science Insider last week, Garrett has denounced the failure of the Obama administration to appoint a head for the little known Office of International Health Affairs in Department of Health and Human Services (HHS). This failure, it argues, has profound implications for the H1N1 pandemic and international relations in general. She particularly concerned that the Administration has not squarely addressed the issue of supply of H1N1 vaccines for the world, and urges the Government to see the central role the US could play to ensure that fairness prevails . And Garrett said she and many of her colleagues MFAN had a "fantastic level of hope on a scale that I would put above boiling on the election of Obama," which began to decline.
this is a condensed transcript of the interview, edited for clarity
. Q: What is your thinking on the H1N1 response of the Obama administration so far
LG .: the biggest problem is currently is in charge from the outside it seems that the Centers for Disease Control and Prevention is in charge, and certainly CDC is in the driver's seat for some pieces. the answer pandemic. But as we have known since at least 05, when the Bush administration began to try to understand what a preparedness plan for a pandemic should look like and what agencies should lead response, CDC is not the only player, and there are very important parts of the problem that had to be supported to the Food and Drug administration, the State Department, the National security Council, and very important, the Office of international health Affairs (OGHA) in HHS.
Q: There's nobody running the Office of International Health Affairs, is
L.G. There is an empty seat. There is no special advisor to HHS Secretary Kathleen Sebelius, no undersecretary in this role, no deputy secretary in this role, etc.
Q: So what is the consequence? What does not happen regarding the pandemic would happen if someone had this seat?
L.G. We meet a deep and dangerous 5 or 6 weeks. A number of international issues are of pressing concern. And it's not clear to me or to anyone else that I talk about in the government that our side should handle it all. In the Bush administration, Bill Steiger in OGHA coordinated, if not the key decisions in response to these problems. In the absence of a OGHA director, what do we do?
There is a very acute growing gap between about 12 rich countries and the world as regards access to medicines against the flu Tamiflu and Relenza and a potential H1N1 vaccine. It is very clear that two things conspire to exacerbate the problem. First, it is difficult to grow the seed stock for vaccine. All pharmaceutical companies report difficulties that will surely mean the availability date will be pushed back, and there will be limited supplies. Some of the companies said that we do not take more orders. Well guess what? The countries that got their orders in the world are rich. Where this leaves 4 to 5 billion human beings on the planet? This could be the great challenge of our time in terms of global equity and globalization, which could affect other international negotiations of the World Trade Organization to further discussions in the Doha Round, and even I would say Copenhagen climate change talks. Each has ramifications to the scientific community, and they are being affected by how poor and middle-income countries perceive the attitude of the rich world of the pandemic.
Q: There is no mandate of WHO to say. "Here is how much vaccine, how it will be distributed here" Someone could run the show? Do we need that?
L.G. The only way of equity and distribution may possibly occur given the shortages is whether the United States led the effort. We are the largest consumer of vaccine. We are only able to walk and say to all the key players, "Okay, we need to reach a conclusion here that will both increase supply, but also increase equity in the world. " This will have to mean a system of understanding of who should receive the vaccine. The United States needs 360 million doses? I do not think so. How do we really need? And what does the US do with the vaccine we do not use?
Q: There is obviously the question of adjuvants, boosters of the immune system that are not currently in use in the FDA approved vaccines against influenza. We could stretch vaccine greatly if we saw adjuvants as a public health responsibility.
L.G. We should use absolutely adjuvant. Without taboo. The attitude of the international community I hear is it is unethical. In terms of globalization, in terms of the whole future of relations between the emerging countries and the United States and the world rich in general, it is absolutely imperative that we use adjuvant.
Now, that brings in two sets of questions that have historical precedence. He do with the issues of liability and 1976 pigs vaccination campaign against influenza. The other is a large constituency of people who firmly believe that the builders were responsible for a multitude of health problems, including autism.
Q: There is another problem: individual benefit / risk against the public good. If you are using an adjuvant in favor of an individual if the vaccine would not work well without it is an equation risk / benefit. But if you use adjuvant to provide the vaccine to the world, which is quite an equation risk / benefit different. You force people to take risks that others have the product, as
LG :. We have a long history of accepting generous as Americans, citizens of the world, we take risks on behalf of needy people elsewhere. Who were the first and strongest responders to [Banda] tsunami Aceh? military forces of the United States. When looking at food crises around the world, citizens and the US government believe it is in our interest to move to the plate, even if it ends up costing the taxpayers money. Helping the world and see ourselves as embedded citizens in a global community are not a new phenomenon, nor is it that we should ignore. And President Obama has been very clear he wants an acceleration of our commitment to global health.
I guarantee you, if America does not greatly exercised citizenship in this global crisis, we will pay a price in a multitude of ways that many people are not even imagine right now.
Q: Do you think Obama should come out and publicly that the United States has decided that we will use the adjuvant to share as widely as possible the vaccine antigen we bought
LG: Before the President made a public statement to this effect, we need to see movement to fill the OGHA direction on an emergency basis. We need a much stronger decision tree regarding exactly who is responsible for the international response on behalf of the United States. We need some quick research on applications suitable adjuvants with vaccines against influenza.
Q: Have you heard anything from WHO in terms of its relations with the US government on this question? Did they say anything publicly that you know or do any backroom
LG: There is a very high level of anxiety to WHO from within, in the office of the Secretary General of United Nations, and several ministries of health around the world. There is a collective feeling that we reach a kind of time showdown.
Q: In the adjuvant
L.G. During fairness. Look this way. It's not just equity of access. It is crucial to survival. If you think a vaccine will make a difference, even in a relatively mild flu epidemic and save lives, then someone, somewhere made a conscious or unconscious decision that the life of an American is worth hundreds lives in a poor country.
Q: If we had the leadership to OGHA it would make a big difference on this issue
LG: If we had OGHA leadership right now, with real stature person in this work, it would be full time care of this person. WHO, through its Charter, is a membership organization of nations. But the body to vote is the World Health Assembly, effectively the legislative body of the WHO, it is the health ministers. When the Director-General Margaret Chan wants to talk to Nigeria, she talks to the Minister of Health or the designated spokesperson of this person. She does not speak to the Minister of Foreign Affairs or the Minister of Finance. For our country, which has traditionally served the WHO spoke to OGHA.
At some point during the Bush administration, OGHA has reached a level of power and unprecedented influence in its history and that this meant literally no other agency representative in all the US government could talk to global players in health without erasing that through OGHA. So we went from there a year, with this level of authority in this obscure office most Americans have never heard of, all the way to the office is empty.
Q: Do you think it has become too heavy before, if
L.G. While much of China was broken by a very aggressive bull.
Q :. You do not speak in the country of China
LG: [Laughter.]
Q: What are other examples of problems which affect OGHA make a difference
LG We have a risky situation involving over Indonesia. Indonesian Health Minister Dr. Siti Supari has insisted for years that it is not the duty of the country to share H5N1 virus samples of bird flu that emerged, and now she is added a host of other viruses to the list of things she did not share.
The position of Supari throughout was that bad business drugs will transform these viruses in vaccines and recharge both their products that poor countries from virus will never be able to pay rescue Products. What we see now is taking place with the vaccine against H1N1 scenario seems to validate his argument.
Q: What leadership OGHA could do in terms of Indonesia
LG: It is vital that we have the leadership at the moment to say: "Look, everyone, we are all in one world. The virus does not carry a passport. This virus will cross borders and we need a global solidarity. If it fails, all paris open. "
If we had a pandemic unfolding ratcheted that a couple of notches so that the virus has gone through a mutational cycle and become more virulent without sacrificing seemingly extraordinary ability to transmit between humans and quickly distributors in the United States would find that our N-95 masks, syringes, latex gloves, and protective equipment for first responders are manufactured abroad. Why India and China should let their manufacturers fill US orders for these products if their countries are denied access and can not afford vaccines and drugs for their own massive populations
Q: There is a other side that would raise skeptical this pandemic is not fatal is not the scenario you describe in danger of exaggerating the threat to the point where it is alarmist
LG:..?. the refutation is a evidence. We have never had a pandemic threat declared before 6. And you can argue until you're blue in the face whether it was justified or a smart decision, but it happened. What points to countries all over the world not only are we supposed to rev our watch and think about our response capacity in case of a pandemic, we are also supposed to have access to tools for our kits public health tools. Where is this stuff?
Q: Do you have a point of view inside why the Director OGHA has not yet been completed and if the candidates online
LG:. There are no candidates. There is no real priority set by person I can discern for this position filled.
Q: You spoke to people about it. What do they say?
L.G. The disappointment of Tom Daschle [who in February withdrew his name to serve as HHS secretary under Obama] behind everything in terms of appointment at HHS. There are still many empty seats. We do not have a director of the US Agency for International Development and seems to be largely due to the verification process. People left the task once they saw that the vetting test would be like. It is a leading candidate and the vetting is still not done.
Q:.? You said that you were beyond boiling when Obama arrived Are you still
L.G. I had a few cold showers. It is obvious to me that we have very different opinions within the government about what our commitments to global health and foreign aid should look like and how they should be structured and organized.
There is no place on the planet that is not disputed by the swine flu right now, scrambling to come up with resources and tools and plans. Yet each country is finding things difficult, and poor countries suffer the most. We must show that we have an idea of how to be a partner in this new global player in global health landscape.
The world recognizes, fortunately, that the H1N1 virus is currently a relatively mild virus, and we all have our fingers crossed that it will remain. But it is still the test case. God thank you that the test for the world is a relatively mild virus. God help us if just at that moment, we were dealing with H5N1 in transmissible form. Right now, what the world sees when a pandemic comes, the rich world takes everything and flees.
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