Letters to the Editor

• Pages: 2-3

Page 2

The SARS story

Congratulations on a first-rate global governance issue (December 2007). In "Governing Global health," David Bloom highlights the experience with severe acute respiratory syndrome (SARS) and reports how "concerted action . . . quickly brought it under control," and "agencies put aside their competing interests and coordinated their efforts through the rapid establishment of global epidemiological, clinical, and laboratory networks." this is true, but it necessarily misses out on detail.

There is a difference between establishing networks and having them actually work. While there was an early sharing of SARS experience and concerted action, only the laboratory network worked optimally, immediately sharing specimens and so discovering the cause of SARS and establishing essential tests. In the epidemiological and climate field, good networks were formed. But the World health Organization's (WhO) global epidemiological data set was never adequately populated, and the clinical network found it hard to develop a consensus on treatment and could not agree on trials. It was the early sharing of experience by the affected centers under the WhO's leadership as to how the virus was spreading and what control methods worked that was most important-along with the happy coincidence that SARS was controllable by rigorously applying traditional public health and infection control methods.

Will the world do better with the next SARS and the coming pandemic? Fortunately, the new International health Regulations provide an agreed legal basis for this kind of work, and many more countries have established emergency procedures and centers. But at least one country has refused to share human bird flu specimens. Also, with international and national players now more involved than in 2003, the technical systems are inevitably more political. If this means that specimens, data, or experience will not be shared because of political considerations, the outcome could be crippling.

As F&D documents, the number of global health players is growing and includes the "health 8": the Gates Foundation, the GAVI Alliance, the Global Fund, UNAIDS, UNFPA, UNICEF, the World Bank, and the WhO. But to whom are they accountable? Any global governance reform should presumably include an effective global body that determines overall health policies and...