public. They issued no advice on how to avoid the virus, no warning against contact with sick birds. There was no public guidance about how to recognize the disease if you caught it and what to do if you did. No effort was made to import and stockpile Tamiflu, which was considered the main remedy for the virus.
Nor was Prasert the only one with hard lab evidence of a flu epidemic out on the farm. Across town at Bangkok’s elite Chulalongkorn University, researchers had confirmed it was bird flu back in November and even determined that the virus was the H5N1 strain. Associate Professor Roongroje Thanawongnuwech, head of the university’s veterinary diagnostic laboratory, would later disclose that the virus had been found in samples taken from Suphan Buri province, about sixty miles northwest of the capital. His lab used a test called the RT- POLYMERASE chain reaction to reveal the virus’s makeup. Researchers compared their results with GenBank, a public database run by the U.S. National Institutes of Health containing tens of thousands of known genetic sequences, and discovered that the Thai virus was very similar to those previously isolated in Hong Kong and Vietnam. Roongroje later reported that these findings had been turned over to Thailand’s national livestock department. But again the public was not told.
Thai health officials and researchers were cowed. They were under intense pressure to keep mum. At stake were the country’s lucrative poultry business and its export markets, primarily in Europe and Japan. Hundreds of thousands of Thais were estimated to work on thirty thousand poultry farms and in related industries. While some infectious-disease specialists in the health ministry were anxious to sound the alarm, they were silenced by a powerful agriculture ministry whose primary aim was promoting farm interests.
“We were fighting with each other and not the virus,” admitted Dr. Kumnuan Ungchusak, a senior Thai health official, in a remarkably frank lecture delivered in May 2006 at a medical conference in Singapore. As the director of epidemiology in the ministry’s disease-control department, Kumnuan had been uniquely positioned to investigate the threat to human health that began emerging with the mass poultry deaths in November 2003. But he continued, “Nobody dared to speak that this was H5N1.” He urged his listeners from countries facing the epidemic—by that time the virus had spread to birds in more than fifty countries—not to repeat Thailand’s mistake in withholding information. “We should have declared this a couple of months before so we can save a lot of poultry and we can save a lot of lives.”
I was in the audience as Kumnuan recounted his experience and was surprised by his public candor. After he finished, I asked him privately to expand. Why wouldn’t anyone in the health ministry reveal the truth? “At the time,” he explained, “there would be a large impact on exports. There was a lot of reluctance to inform the public about it. This is a very bitter story.” But specifically, I pressed him, who gave the order to keep quiet? “I don’t want to pinpoint,” he demurred.
What Kumnuan remained reluctant to say was that the poultry sector’s pull had extended beyond the ranks of the agriculture ministry to the very top of the Thai government. The industry had influential advocates in the tight inner circle of Prime Minister Thaksin Shinawatra. A telecommunications tycoon turned politician, Thaksin had come to office in a landslide in 2001 vowing to turn around the struggling Thai economy by running it like a corporation. He had indeed succeeded in resuscitating the economy by 2003, achieving some of the highest growth rates in Asia and promising even faster growth in the year ahead. He had also demonstrated his impatience with those who got in the way of his economic juggernaut. Thaksin labeled himself the CEO-prime minister. His critics called him autocratic and vengeful.
In mid-January 2004, nearly a month after Prasert produced proof of a flu outbreak among Thai chickens, Deputy Agriculture Minister Newin Chidchob was still vowing it wasn’t so. “Irresponsible media and some groups of people are trying to spread this rumor,” he told reporters. “There is no bird flu here.” His assurances were endorsed three days later, on January 19, by David Byrne, the European Union’s health commissioner, who was visiting Bangkok on a previously scheduled trip. Part of his job was to protect European consumers, and, after a briefing from agriculture officials, he pronounced Thai chickens to be safe. “There’s absolutely no evidence of the existence of bird flu in Thailand,” Byrne said in remarks he would soon furiously retract.
The next day, as television cameras rolled, Prime Minister Thaksin and his cabinet ministers tucked into a luncheon feast of spicy chicken soup, minced chicken salad, chicken biryani, chicken teriyaki, and grilled, boiled, curried, and fried chicken, capped by a healthy serving of the Thai leader’s trademark bravado. “Come and join us. Are you scared?” the prime minister taunted reporters. With anxiety mounting among consumers, Thaksin’s response was to order up the repast and claim all was well. “It’s the best chicken in the world, Thai chicken,” he offered between bites. “It’s very good. It’s safe.”
But WHO already knew better. A week earlier, on January 14, the agency’s office in Bangkok had received a confidential tip from a government epidemiologist reporting that bird flu had been detected in a recent poultry outbreak and tests had determined it was an H5 virus. Though more analysis was needed, the scientific implication was that the strain was a novel H5N1. This troubling disclosure was forwarded to WHO headquarters in Geneva, where infectious-disease specialists asked the Bangkok office to get more specifics from the Thai government.
These inquiries were repeatedly spurned. WHO’s chief representative in Thailand and his staff were informed by their government counterparts that only the health minister could release details, and she remained tight-lipped. So over the coming days, the WHO team in Bangkok grew increasingly exasperated, venting frustration in e-mails and conversations with Geneva.
WHO had been on edge practically since the new year. Poultry outbreaks of bird flu had already been detected in South Korea, Vietnam, and Japan. Just a week earlier, Vietnam had confirmed human cases, stoking public fear of a flu pandemic for the first time since Hong Kong’s outbreak six years earlier. Could Thailand be the next front? It was crucial to know. Yet there was little the agency could do. It couldn’t force the Thai government to come clean. Nor could WHO itself go public unless the government cooperated.
As a United Nations agency, WHO was established by its member countries and, like other UN bodies, respects their national sovereignty. Though WHO has been growing increasingly assertive in recent years, pressuring governments on occasion to hunt for infectious diseases on their turf and disclose them when discovered, the agency still largely defers to local politics. Even when an outbreak becomes apparent, WHO cannot dispatch investigators to a country without a formal invitation. And even after they get on the ground, these teams are barred from the field until authorized by the country to proceed.
The agency’s critics fault it for becoming a prisoner of its politics. They accuse it of too often bowing before the dictates and deceits of its member countries, of placing a higher price on diplomatic nicety than on truth. But senior WHO officials, including some who have personally braved the world’s most horrible pathogens, scoff at the contention that they’re weak or cowardly. They counter that WHO is a creation of international politics and thus, by definition, a creature of one. Otherwise, they say, WHO and its mission could not exist at all.
Nor is WHO some kind of global health department with an army of doctors, nurses, ambulance drivers, and inspectors. It has no labs or hospitals of its own. The oldest disease-control program at WHO, even older than the agency itself, is its global monitoring effort for flu. The perils of pandemic combined with the economic and health impact of seasonal flu made this initiative an early priority. Yet even this program depends entirely on a network of outside labs—at latest count more than a hundred in eighty-plus countries—to track the evolution of flu viruses and help develop suitable tests, drugs, and vaccines.
Mostly, WHO supplements the efforts of individual governments, offering specialized expertise and scarce materiel like stockpiled vaccines for meningitis and yellow fever. To accomplish this, the agency relies on an extensive network of consultants from around the world, both public and private, to help investigate outbreaks, treat the sick, test samples, train local health staff, and deliver medicine, vaccines, and equipment.
These outside allies are people like Prasert, whose career was devoted to forging the institutions and disciplines of modern medical learning in Thailand that now make his country among the most advanced in the region. Yet there was always time for WHO. On a curriculum vitae stretching for several pages of publications and affiliations, Prasert prominently highlights his position as consultant to the World Health Organization. For over three decades, he served on various advisory committees for the agency, most notably the expert panel on viral diseases. He has run a WHO collaborating laboratory for AIDS research and edited an agency monograph on dengue fever.
In Geneva, senior agency officials describe their role in coordinating all this outside expertise by using words like
