explanation, some WHO officials concluded that his remarks had contributed to his ouster.
A similar fate befell Naipospos, the country’s animal-health director. Commonly known as Dr. Tata, she was passionate and opinionated, with dark eyes that seemed both probing and vulnerable behind her thick glasses. She was a rare professional in the ranks of the agriculture ministry. She had earned a master’s degree from England, a doctorate in veterinary epidemiology from New Zealand, and widespread respect from disease experts at WHO and other international agencies. Naipospos first disclosed the government’s cover-up in an interview she gave me in early 2005 for the
Agriculture Minister Anton Apriyantono told me he dismissed Naipospos because he was not happy with her handling of bird flu and her working relationship with top ministry officials. This explanation outraged Naipospos. She countered that she had been sacrificed by the ministry not only because of her candor but because of party politics. With the minister’s upstart party trying to cast itself as a force for government reform, Apriyantono sought to tar her with the failures of his department, even accusing her of corruption. That charge was never pursued by prosecutors. And UN officials publicly criticized the government for ousting its most respected animal-health expert at the height of a crisis.
Naipospos alleged that bird flu had never been a priority in the agriculture ministry. Agriculture officials had not even tapped available emergency funds to pay for disease control. “I talked to the minister about it many times,” she recalled. “He said a disease outbreak is not a national emergency, not a disaster.”
Naipospos was ultimately vindicated when she was named to a new presidential commission established in 2006 to oversee the government’s avian flu policies. The body’s primary charge was to coordinate the efforts of rival ministries, in particular health and agriculture. But it, too, proved impotent. The commission received little support from the ministries, and even its own director was just a part-time appointee. Indonesia would continue to be singled out by senior UN officials for “the lack of a national strategy, the lack of political involvement.” Still, the avian flu commission made a small contribution to setting the record straight. In a press release three years after the disease erupted, the commission formally acknowledged that the virus had indeed first made landfall in Indonesia in the middle of 2003, many months before the government had admitted.
The trip that took Margaret Chan to Beijing’s Great Hall of the People was a delicate mission. Just three weeks before, in early November 2006, the former Hong Kong health director had been elected WHO’s new director general. She was to replace Lee Jong Wook, who had died suddenly after brain surgery. Chan’s election had been hotly contested, with the former Hong Kong public health director besting ten other candidates. China had sponsored Chan’s candidacy, lobbying hard for her, and saw the contest as a measure of the country’s growing clout on the world stage. When months of quiet pressure and diplomatic horse trading were finished, the Chinese government had lined up far more than enough votes, including crucial backing from the United States, and Chan became the first Chinese national ever to hold such a high post at a United Nations agency. Now she was visiting China’s monumental seat of government to personally thank President Hu Jintao. “I will remember the support given to me by the country in my heart forever,” Chan told him.
But she also had more sensitive matters to raise. Beijing had stopped supplying flu samples to WHO’s affiliated labs. No human specimens had been shared since the spring, and the most recent was from a year-old case. The newest samples from infected birds were also a year old. Flu viruses are notoriously mercurial, and China’s defiance of repeated international appeals was keeping WHO from staying abreast of the virus’s twists and turns. This was undercutting international scientific efforts to understand the behavior of this unusual virus and anticipate its further evolution. At stake was the timely development of vaccines and drugs tailored to the prevailing strains.
In the days after Chan was elected, reporters had pressed her on whether she would stand up to the Chinese government. One commentator in her hometown of Hong Kong even asked whether she’d be simply a “foot soldier for Beijing.” Chan insisted that her allegiance was to WHO. “First and foremost, now that I have been elected as director-general, I will no longer wear my nationality on my sleeve. I’ll leave it behind,” she replied. As she met with Hu, skeptics were watching for a sign of such independence.
Chan told the president it was vital for China to disclose its outbreaks and share samples. She urged him to speed up the process of providing specimens to WHO. She pressed the same points with Premier Wen Jiabao.
“The president and premier have a very good understanding of the potential impacts, on the health of the people, and also on the economy,” Chan told me later. “They understand the importance of being transparent.” In meetings with the leaders, she had made sure to praise China for strengthening its disease monitoring system since SARS. But she also reminded them that the country still had a hard time staying on top of emerging threats in the provinces. “China has a challenge, being a vast country,” Chan continued. “The importance is to make sure that policies go down to the lowest possible level so that the implementation is not impeded.”
That point was not new for either Hu or Wen. “They understand the challenge,” she put it to me. “But you know…” Her voice trailed off. It was a tacit acknowledgment of her own doubts about the potential for change.
After she exited the meeting in the Great Hall of the People and was asked by waiting reporters about the prospects for cooperation between China and her agency, Chan offered a diplomat’s assessment:
“We will have to look at the actual situations, but we all agree with it in principle.”
In one of Chan’s first speeches as the world’s top health official, she outlined in 2007 what she called an unwritten code of conduct requiring governments to tell the truth about infectious disease. “No nation has the right to conceal an outbreak within its territory,” she declared. Chan didn’t mention China by name. But Beijing’s handling of SARS had clearly been the most flagrant breach.
Now China was again a cause for concern. It wasn’t just that China was still failing to provide virus samples. People were continuing to get sick from bird flu, but Chinese authorities were not confirming any related outbreaks in the birds. Investigators were being robbed of crucial details about how people were contracting the virus.
In an e-mail to WHO headquarters in early 2006, one of the infectious-disease experts in the agency’s Beijing office noted a series of recent human cases that had all occurred in the absence of any reported poultry outbreaks. “What on earth is going on with the animals and the virus?” she wrote. The health ministry, though repeatedly pressed for an explanation, offered none. By the middle of 2007, cases in China had reached twenty-five, and only one could be explained by a related outbreak in poultry.
One possibility was that China’s hugely ambitious campaign to vaccinate its entire population of chickens, ducks, and geese was hiding outbreaks by keeping birds from getting sick, without fully disarming the virus. A second explanation, put to me by influenza researcher Robert Webster, was that the poultry might be receiving a kind of natural inoculation from another, less lethal flu strain that was prevalent among the birds. He suggested that exposure to this second strain, H9N2, might offer limited protection to poultry when infected by H5N1. The birds would carry the virus and spread it but not show symptoms.
Yet in some instances, birds were indeed dying and agriculture officials were not reporting the fact. China’s agriculture ministry has long denied details of livestock diseases, even to officials at China’s own health ministry, claiming that animals are none of their business. When the two ministries clash, as they have repeatedly since the 1990s, the agriculture ministry inevitably prevails. It is far more powerful and prestigious because China’s senior leaders place their top priority on development, and agriculture is a central part of that, according to Yanzhong Huang, a professor at Seton Hall University specializing in the politics of China’s public health system.
Huang explained that China’s mishandling of the SARS outbreak had transformed the country’s health sector. Chastened, China invested heavily in disease surveillance and laboratories and lifted the ban on disclosing infectious diseases, which had been considered state secrets. But these advances did not extend to the agriculture ministry, where the prevailing view was that any candid discussion of animal diseases would only undercut productivity.
Equally vexing is the divide between China’s central government and local officials. A week after China confirmed its first outbreaks in birds, Vice Premier Hui Liangyu admitted to WHO that the central government wasn’t sure what was transpiring in the provinces. For local officials, career advancement hinges on success in promoting economic development. Better to keep quiet about infectious diseases that could deter investment and scare off tourists. So it’s little surprise that Chinese local officials look unkindly on journalists and whistle blowers who publicize these outbreaks, even arresting and expelling them.
Qiao Songju was a simple farmer in Jiangsu, a coastal province just north of Shanghai, when the young man
