NEHA and the World Health Organization.

I had the meeting experience of my life in 1997, when I found a way to get into the G8 Summit that took place in Denver. That I somehow found a way to get into the same building with the eight most powerful human beings on the planet was, more than anything else, a story of perseverance, opportunism, creativity, and imagination. Suffice it to say that I hadn't been invited to begin with!

I had a similar experience a couple of months ago--though not quite on the same scale.

Family considerations took us to Geneva this summer. As we were planning our trip, I said to myself, "Geneva--why that's where WHO is." And then, as with the G8 Summit, starting first with a thought and then an intent, I had before long worked out not one but two meetings with WHO officials to add to our family trip! Both quickly proved to be exceptional meetings.

Since you, environmental health, and NEHA were on my mind throughout these visits, I thought I would use my column this month to summarize what those meeting discussions entailed.

One of my meetings was with Dr. Jamie Bartram--who has a leadership position over WHO's public health and environment program. We talked about a host of ways in which NEHA and WHO could work together on behalf of the environmental health cause. The issues and the highlights of our discussions can be briefly reported as follows:

* Volunteers -- We talked about how NEHA might serve as a vehicle through which NEHA members could possibly volunteer for WHO assignments.

* A WHO column in the Journal of Environmental Health -- We talked in promising ways about WHO authoring a column for the Journal of Environmental Health. Such a column would give WHO a direct communication pipeline to NEHA members to ensure that we are all kept uniquely informed on key worldwide environmental health issues and concerns. (I know of no other professional society that offers such a program.)

[ILLUSTRATION OMITTED]

* NEHA involvement in WHO policy setting -- We discussed ways in which NEHA could become an "NGO in official relations with WHO." In such a capacity, NEHA would enjoy a right of voice at the World Health Assembly. We also discussed ways in which NEHA (and, more specifically, our members) could become involved in WHO committees that write up guidance documents.

* WHO involvement at our Annual Educational Conference (AEC) -- I'm pleased to note that significance interest was expressed in speaking at the AEC. Such a presentation would give our attendees a special connection with the world perspective on many of the issues we work on daily.

[ILLUSTRATION OMITTED]

* Emerging issues -- It was interesting to get a sense from WHO on what it considers to be emerging issues. Some of the more interesting ones (to me at least) were the impact of nanotechnology, global climate change, energy, and new pathogens.

* Committee opportunities -- We also discussed how we could open up opportunities for NEHA members to actually sit on various WHO committees. What an experience that would be for interested members!

Beyond these specific items (and others), I asked Dr. Bartram: If he could speak directly to the NEHA membership, what would he say? Of course, I then pledged that I would carry his message to our membership--which I am now doing.

His message to you was poignant to say the least. First he explained that WHO is ramping up its efforts to focus on primary prevention. He emphasized that WHO believes at least 25 percent of all diseases can be prevented through achievable environmental control measures. If we are to progress in this direction, however, the environmental health profession is going to have to find a way to significantly enhance its standing, reputation, and influence. He believes that WHO's ambitions to reduce preventable disease will never succeed unless the environmental health profession is able to take on a much more significant role than it has today. To that end, he said that WHO is deeply interested in working with NEHA and NEHA-like organizations from around the world.

My other equally stimulating meeting was with Dr. Paul Gully. Dr. Gully is a senior advisor to the WHO director-general's special representative for avian influenza. He therefore works at the highest levels of WHO's worldwide avian-influenza program.

As with Dr. Bartram, I came loaded with questions. Some of those questions and Dr. Gully's responses can be summarized as follows:

* What is the clinically effective Tami-flu dosage? Is virus gene sequencing showing that the virus is mutating in ways of concern? Should we be stockpiling Tamiflu? Are the cluster cases in Indonesia a sign that a pandemic is becoming more likely? To these questions and many more like them, Dr. Gully kept coming back with the same message, which was "We really don't know." His point was that there have been so few cases (of humans infected with avian influenza) that meaningful clinical trials and studies haven't been possible. Hence, we just don't know in many instances.

We possess the technology to produce a lot of information such as the gene sequences of the H5N1 strains. The problem, he explained, is that the technology is ahead of our ability to understand what it is telling us. Moreover, different labs report different results for the same virus. Accordingly, we don't always know what this information means and what is going on.

* What are your thoughts on the issue of rationing scarce resources? Dr. Gully noted that there are many ethical issues to be dealt with both within and between countries. Within countries, he explained, the public health profession isn't used to discussing issues like this, let alone working to gain the public's buy-in on decisions. He suggested that we are only beginning to understand that as this issue continues to play out, we are going to have to start engaging in a much more public dialogue about who gets the Tamiflu, the ventilators, the hospital beds, the vaccines, and so forth. If such a dialogue isn't conducted and the public first hears about these decisions once the crisis is on, public disorder could quickly result, further complicating an already difficult situation.

Between countries, he noted that several Pacific Rim nations have recently argued against sharing samples of the H5N1 virus with WHO and other world public health authorities. They point out that by sharing the virus, they are enabling the wealthier nations to develop vaccines to protect their people. This research that, ironically, the poorer countries will have made possible will end up being of no benefit to them. Therefore, before giving up this "property," these nations now want assurance that the wealthier nations will share their vaccines with them so that they can protect their peoples as well. An assurance of this sort could mean less vaccines for the wealthier nations.

* How capable is the worldwide public health system of dealing with a pandemic? Dr. Gully stressed that the pubic health infrastructure in many nations has been eroding for some time. With passion, he advocated for turning this potential crisis into an opportunity to upgrade our public health systems--environmental health included. Moreover, since so much of what we are doing to prepare for a pandemic is transferable to overall emergency preparedness, he suggested that whatever we can accomplish for pandemic flu can be used to ultimately benefit public health as a whole--even if no pandemic ever materializes.

* If our public health officials continue to tell the media that they have plans and not to worry, aren't we then creating a disincentive for the public to do much of anything on their own? After all, if the authorities have it covered, why should I waste my time and money getting prepared? Dr. Gully agreed, noting that there is a middle ground that we should be taking. It is good that the public develop a confidence that their public health officials know what they are doing and that they are working on this problem. We should also, however, be telling our citizens that they too have an important role to play and that every household also needs to be preparing, as local authorities can't do it all alone.

* What concerns do you have about the public health system properly preparing? Dr. Gully pointed out that public health is used to taking care of others--not itself. We are not used to planning for our "business." Yet if we are to do our jobs, we have to look at ourselves as a viable business and ensure that we have taken the steps that will enable us to continue our operation should something as bad as a serious pandemic or some similar emergency develop.

* If there are signs of a pandemic emerging, the WHO strategy is to "fireblanket" the area of concern with mass dosing of antivirals, quarantines, surveillance, health care, and so forth. To stop a pandemic from erupting, all this activity has to start within approximately 30 days of the initial case. Yet when the cluster in Indonesia occurred this past May, WHO was nowhere close to being able to implement its fireblanket strategy within this critical timeframe. Is the WHO strategy viable? Perhaps too much has been made of the WHO strategy, according to Dr. Gully. It is a plan--and a plan that will require the participation of the host country as well as of other parties. Stomping out an emerging pandemic before it erupts into a worldwide event is not something that WHO has ever stated it can do; rather, this notion is a representation that others have made of us and our efforts. We have to have a plan, and we have one. A plan like this is not a surefire guarantee, however, that WHO can prevent a pandemic from happening.

Drs. Bartram and Gully and NEHA are now in the process of following up on these meetings. Although our discussions were full of promise, we have taken only the first step in developing this special and important relationship. Should some of the ideas that we talked about take root, we will surely be reporting on them--especially those that involve international opportunities for NEHA members.

I learned from my experience with getting through the front door of the G8 Summit that where there is a will, there is often a way. For some time, our board of directors has expressed a growing interest in involving NEHA in some meaningful way on the international plane. The will is therefore there. NEHA members should know that we are now working on the ways.

Nelson Fabian, M.S.

[ILLUSTRATION OMITTED]