Bird Flu: Science and Policy

[DewDiligence]

Research Raises Questions About China's Bird-Flu Approach

http://online.wsj.com/article/SB115100160949387761.html

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Letter Suggests First Case
Of Human Infection Came
Two Years Earlier Than Said

By NICHOLAS ZAMISKA
June 23, 2006

HONG KONG -- Research suggesting China had its first human case of virulent bird flu two years earlier than it has said raises questions about the spread of the disease and the accuracy -- and possibly openness -- of the Chinese government in dealing with it.

A letter published by eight Chinese scientists in Thursday's New England Journal of Medicine reports on a study of a 24-year-old Chinese man originally believed to have died of severe acute respiratory syndrome in late 2003. The study found that the man hadn't died of SARS, which had been spreading in the region earlier that year, but of a particularly deadly strain of bird flu.

Adding more mystery to the matter, one of the scientists, Cao Wuchun of the State Key Laboratory of Pathogens and Biosecurity in Beijing, sent a stream of emails to the journal just before publication seeking to withdraw the letter, according to Karen Pedersen, a spokeswoman for the publication.

"We returned [the emails] with a message from the editors telling them that it was too late to withdraw since the issue had already been printed," Ms. Pedersen says. "We asked them for an explanation, and we asked them if they would like to retract the letter. We have not yet received a response."

China has said it discovered its first human case of bird flu late last year. If the scientists who submitted the letter are right, it could change health authorities' understanding of the path that bird flu has taken since it re-emerged in late 2003, and of the number of human cases China has seen. International health officials have long suspected that the actual death toll from bird flu in China might be higher than stated.

Some have voiced suspicions that the government might be covering up cases, while others point to the immense challenge of tracking the disease in such a large country with limited resources. With bird flu resurfacing in the region just after SARS had petered out, confusion between the two wouldn't have been extraordinary.

The Chinese government is extremely sensitive to perceptions that it isn't fully cooperating with global health authorities in the fight against bird flu, which since its re-emergence has infected more than 200 people, killing more than half of them. Scientists fear that if the virus -- which passes occasionally from birds to people and, still more rarely, from person to person -- mutates to one that can be spread rapidly among humans, a pandemic could ensue, possibly taking millions or tens of millions of lives.

In working to ward off such an event, groups such as the World Health Organization have pressed Beijing to share data on the disease's incidence within China's borders. Many have praised the government for showing far greater cooperation than it did in the fight against SARS, when it concealed the outbreak of that disease, which caused a world-wide scare before it ebbed after taking about 800 lives.

The Chinese Ministry of Health said it was caught off guard by the scientists' letter. "We just found out this morning," an official with the ministry in Beijing said Thursday afternoon, adding that his office was first alerted to the case when reporters from Hong Kong began calling with questions, which then prompted officials at the ministry to begin an investigation.

The World Heath Organization sent a letter Thursday to the ministry requesting more information about the previously unreported case, according to Roy Wadia, a spokesman for the health agency in Beijing. He said the ministry has told the WHO that it is investigating the matter and will reply.

It isn't clear why Dr. Cao might have attempted to take back the letter at the eleventh hour. The letter made no mention of this being China's first human bird-flu case, focusing instead on a detailed discussion of the virus's genetic makeup.

Qin E'de, a researcher at the State Key Laboratory in Beijing and one of the eight authors of the letter, declined to comment when reached by telephone at his office. Zhu Qingyu and Dr. Cao, of the same laboratory, as well as Yu Jun at the Beijing Genomics Institute, weren't at the office Thursday, according to colleagues. The four other researchers who signed the letter also were unavailable for comment.

The journal sent an email to reporters on Wednesday, signed by editor-in-chief Jeffrey M. Drazen, informing them that it had received the request to withdraw the letter from publication. "We do not yet have an explanation from the authors," Dr. Drazen wrote.
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