Recently in Science and Development Category

Erstwhile Panda Diplomacy?

In an article on China's panda diplomacy last week, the Financial Times included a photo of Japan's famed Ling Ling surrounded by flowers and bamboo shoots. Japan's beloved panda, a 16 year resident of Tokyo's Ueno Zoo, had died of kidney and heart failure and the debate in Japan surrounded how Ling Ling would be replaced. Various Japanese officials expressed reservations about Chinese President Yu's offer to replace the panda with two new ones, especially when the $1 million rental fee was revealed. ("Panda diplomacy loses charm amid Sino-Japanese mistrust", May 12th, Financial Times).

Critics advised the Japanese government not to trust the panda overtures in light of China's environmental problems, food-safety, natural resource claims, and anti-Japanese sentiment. Panda proponents on the other hand, like the head of the Ueno Zoo, pointed out the benefits and reasonableness of Yu's offer - as he put it to the Financial Times - "'It is not like renting videos"'.

Pandas (Ailuropoda melanoleuca) are an endangered species in the Ursidae family. So called panda diplomacy has been around since Chinese emperors were giving pandas to governments but China revived the practice by presenting President Nixon with two pandas. When China started charging rent for pandas a successful suit from the World Wildlife Fund demanded that US government payments be channeled to increasing panda populations in the wild.

The pandas' appeal to zoo visitors is unambiguous, profitable, and beneficial to the panda. But although the Chinese has long been supplying pandas to Japan, the current Japan/China dilemma lead some international press to wonder whether Ling Ling's death marked the end of a more optimistic era between the two countries.

Thumbs Up...Panda's Alive and Well

When the earthquake struck Sichuan province people were relieved to hear the news that the giant pandas were safe at China's Chengdu Research Base of Giant Panda Breeding. At another panda reserve even closer to the earthquake epicenter, the Wolong Nature Reserve, the plight of the pandas and nearby villagers was unknown for days. Those in the global panda community who had visited the center and spent time with the Wolong pandas and their caretakers became increasingly worried.

Finally bad and good news came. Some of the villages around the reserve did not fare well, homes were destroyed and people perished when the 7.9 temblor struck the mountainous region.

The pandas at the Wolong reserve were OK, despite the massive earthquake and ongoing "aftershocks" that surpassed the average Chicago "earthquake". A Chinese news article (china.org) reported that a group of American and British tourists stranded at the Wolong panda reserve when the earthquake hit were also safe after being helped by a resourceful local army, kind villagers, humor, television and traditional Tibetan dancing (the latter, actually seems like a standard for Chinese Panda tours advertised on the web).

Panda diplomacy seems alive and well.

On to Polar Bear Diplomacy?

The endangered pandas seem to have it lucky compared to polar bears (Ursus maritimus). Also in the Ursidae family, polar bears were recently designated by the US Fish and Wildlife service as "threatened". The agency lists a species as threatened if they're likely to become "endangered" and the melting Arctic makes this so. The new label was welcomed by some and criticized by others who thought the polar bear should be listed as "endangered". The LA Times reported this week that small towns like Churchill, Manitoba will see an influx of tourists because of the government's new polar bear status. Although Canada hasn't turned official attention to the polar bears, the U.S. designation will increase awareness.

Tiny Species Diplomacy?

Most threatened or endangered species (Urrr..so ignored) emerge not fuzzy, cute, or mammal -- to their peril. Many are not even large enough to see and these more discreet species will just disappear.

A report released by the Zoological Society of London (ZSL)called the Living Planet Index, produced by the ZSL, the World Wildlife Fund, and the Global Footprint Network, tracked 4,000 populations of 1,500 species over 35 years. The census found that by 2005 the populations had decreased by a third, a decline "unprecedented since the extinction of the dinosaurs".

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The Myanmar Effect

"'A Catastrophe Within A Catastrophe'". That's how French Foreign Minister Bernard Kouchner described the "junta's uncooperativeness", after Cyclone Nargis devastated the Burmese city of Rangoon and the Irrawaddy Delta last week. The political struggles between the obstinate Myanmar military junta and international aid groups and governments trying to help Burma dominate the news. The German paper Spiegel shows a map of areas submerged in the storm earlier this week. The Guardian spoke to Mark Canning, ambassador to Britain, who warned that "authoritative estimates of the numbers of dead and missing ranged between 63,000 and 100,000, and up to 1.9 million were now vulnerable to water-borne disease, hunger and lack of drinkable water. 'So you can do the maths and you will see how quickly this thing can get larger'".

The International Red Cross and other agencies report that there aid is getting through to people who need it --a statement that will encourage donors -- but if that is remotely true, the aid is stretched very thin. The junta has confiscated food and equipment from the UN World Food Programme, refused to grant visas to aid workers, and said that it will only accept cash and material aid, not labor. The Guardian quoted the US ambassador to Thailand, Eric John, who noted in a somewhat awkward analogy that food without distribution capabilities would be like "dropping a lot of orchestral instruments on the ground and expecting a symphony to come out of it."

Let Them Eat Rotting Rice

In Burma, equipment and tools are forever scarce, as are all other resources. The military junta takes food from villagers even on "good" days, that is, when the government is merely tyrannical, incompetent and brutal but not faced with the aftermath of a massive cyclone that has ripped through a mangrove-stripped delta of rice paddies, leaving in its path face-down floating bodies and individuals desperately searching the rubble for their kin. Given the everyday actions of the junta, it should be no surprise that the government confiscates international food sent for Nargis victims -- that's just what they do. Nor should it surprise us that the government isn't ashamed to dole out supplies with the names of generals written on boxes -- before news cameras -- in some twisted "propaganda exercise", as the International Herald Tribune called it.

The military junta's political shenanigans are to be expected.The rulers are by all accounts paranoid as well as brutal, tenaciously controlling the population via the only methods they know, violence and manipulation. The Free Burma Rangers ¹, a group profiled here by The Economist, lists the junta's habitual human violations, offenses that often target minority groups like the Karen. The group accuses the military of everything from stealing supplies to burning villagers out of their villages, to forcing unpaid villagers to clear land, build roads, and walk in front of bulldozers clearing land-mined areas.

Always wrangling to increase its power, the Myanmar military relentlessly pursues its goals, even as citizens are left struggling in the wake of the cyclone without water, food or medicine. The government insisted on holding a referendum to increase its power yesterday, and the military spent considerable effort coercing, forcing and bribing people to vote "yes". With mind blowing cynicism, the leaders had their pictures snapped with their fancy-dressed wives, casting their votes for what all outsiders call a "sham" election, while hundreds of thousands of "people with almost no clothes battl[e] it out to survive" -- as one Indian pilot reported on the situation after he flew an aid sortie and traveled through the Irrawaddy Delta.

China, Thailand and India have the most potential for nudging the junta towards accepting responsibility but it's unclear how much sway these governments hold. China has the closest economic ties to Burma apparently, but what incentive it has to mediate? It's own abuse of Tibetans and minorities and its interest in Burma's resources, not to mention its habit of not "interfering", leaves us skeptical. India reports sporadically about its stance on the situation, while Burma's neighbor Thailand, for its part, will send a diplomatic team to Myanmar. Thailand was obviously disturbed to see media films showing Thailand's aid boxes plastered over with labels indicating they were gifts from the junta's generals.

What the junta is actually giving in aid, the Associated Press reports is "minuscule rations of rice and oil", in some places one cup of rice per day per family. AP says many people are simply "clustered on roadsides hoping for handouts," and that desperate pleas -- "[t]he words "'Help us!'" [written] in chalk on the side of one home", are evidence of the level of despair.

Aid First?

Disasters such as Cyclone Nargis exaggerate and bring into stark relief dysfunctional politics. They also present a quandary for international communities. A few years ago, Acronym Required wrote about the Global Fund withdrawing its AIDS program in Burma due to difficulties working with the junta. At the time we commented on the conflicted ideas about providing aid to the repressed citizens of brutal regimes. The AIDS crisis in Burma is serious and any country's bad governance will make a public health or natural disaster recovery infinitely more dire. As we've often documented, politics can worsen the death toll of AIDS or avian flu pandemic, an earthquake, cyclone or tsunami.

The world has experienced enough natural disasters in the past couple of years to know the difficulty of getting help to stricken populations. In the U.S., the government was challenged to evacuate survivors swiftly enough and to deliver aid and essentials in a timely way after Hurricane Katrina. Rescue and supply delivery is increasingly daunting in remote locations of the world, like SE Asia where the tsunami victims were hard to reach, and during the Kashmir earthquake. And in these situations the affected countries welcomed aid. ²

The international community is forever torn because there is no good answer. Try to support the citizens in spite of the government? Or condemn and punish the government, which further increases the suffering of the people? The current situation in Burma intensifies the unforgiving choices of this dilemma.

Given the Myanmar junta's treatment of the country's people, its hard not to advocate political change. But that's problematic, since governments around the world acknowledge that the Burmese in the stricken areas are in dire need of the most basic necessities now, not "democracy".

Barbara Bush, who back in 2007 advised that the US would impose sanctions on the Myanmar military government if it did not moving toward democracy "within the next couple of days", used the publicity of last weeks' cyclone to reiterate her displeasure with the military junta. The move was widely criticized by 'those in the aid community who know better', since it could only increase the paranoia of the highly paranoid holed-up-in-the-middle-of-the-jungle junta. Yet is restraining from beating people over the head when they say "no" such a challenging notion that it's only available to those in the aid community? You'd think the emerging White House diplomat would carry some insight about this from her second grade teacher experience, or her experience listening to why the US denied aid from Cuba during Hurricane Katrina, or even because her diplomatic threats to Myanmar never motivated the junta to budge before. You'd think she'd deliver a more nuanced diplomatic entreaty. Now apparently, Mrs. Bush seems to have backed off and Secretary Rice is left to insist that Burma Aid Is About Saving Lives, Not About Politics.

Of course, the White House always sends mixed messages. While Mrs. Bush lectured Myanmar from the podium in the past few years and the Bush administration imposed sanctions, for instance by cutting off the bank accounts of the junta, companies like Chevron provide a lifeline to the regime . Chevron runs a gas line through the country that is reportedly aggressively guarded by the junta.

"Tear Down the Bamboo Curtain"

So wrote the Financial Times last fall, and The Australian today. As if the western nations could just summon some erstwhile off-duty troops to parachute into Myanmar, China's neighbor and ally, to take care of this troublesome situation. The press loves to chant a rallying cry for "freedom", and "democracy", and no doubt could not restrain itself from referencing what is now relived in popular dream-talk as Reagan's great coup: the tearing down of the wall. It's the business of news to engage fantasies and so these headlines are relentlessly fantastic.

Reporters ask questions like: "Could there be a silver lining to the cyclone's clouds?" Time magazine wrote hopefully, "for decades, outsiders have searched for a way to pry open Burma's secretive regime". As if this is some natural evolution of government, when actually China, Russia and a host of other countries prove that power may be more instinctively and securely amassed via non-democratic and brutish governance. And so, spooked but with aid pouring in, after 40 years, Myanmar hunkers down to give its citizens and the world, more of the same. Tons of high-energy biscuits energy bars can go a long way in a junta that was days ago 'reduced' to stealing rice from villagers.

The Myanmar junta is of course defiant in the face of the international democracy criers, defending its own deadly actions by saying that the US government's response to Katrina was also slow. Seeing the same shaky (optimistic?) parallel, a dean from the University of Vermont, in an editorial for the Daily Times of Pakistan, offered: "This may also be a time for alerting the world to the grave inequalities in the country, just as Katrina was a wake-up call for the world to see the plight of impoverished African-Americans in Louisiana." Ah, silver linings.

It's hard to imagine that there would be "sides" in the midst of such a disaster, or that politicians would take the opportunity to push political points of view, but of course they do, even in the enlightened western democracies. In the Financial Times yesterday, Christopher Caldwell from the Weekly Standard took the opportunity to reconstruct the events of the Katrina aftermath altogether, with the truth defying statement: "that the US failed in part because it was too constitutional, too deferential to the prerogatives of the state of Louisiana, is not something anyone remembers or cares about any more." ("Disasters and Dictatorships"). "Too constitutional" -- that's Orwellian.

While countries like the US and France now try to muffle their instinctive calls for democracy, other countries will take a different lesson from the cyclone and in the US commentators will frame the disaster for their own ends. If nothing else, attempts to shape and rewrite history are universal.

Hopefully, the Myanmar military junta, weakened to the point that is convinced that it will lose control by letting aid workers in, will come to its senses and realize that in it's own best interests to save some of its people.

In the meantime, to help with aid efforts, various groups are accepting donations for Burma. Google gave a million dollars in matching aid (updated 05-17) and Doctors Without Borders, Unicef , and many others.

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¹This group lists itself as a "multi-ethnic humanitarian service movement".

²With the exception of India which initially rejected international help after the tsunami.

Acronym Required has published several articles on Hurricane Katrina and FEMA and AIDS and Burma.

Public health requires perseverance. A mutation in a virus responsible for avian flu or in the parasite that causes malaria can instantly change the course of a disease -- who gets infected, where, and how. Many other changes, in politics, economics, leadership, geopolitical stability, funding, even weather can impact progress treating and preventing diseases. Technology also changes the course of disease, although promises of technology advances sometimes provide more sustained satisfaction than the actual technology fulfillments. In the fight against AIDS, for instance, [romises vaccines one-upped promises of retroviral treatment for all, which in turn supplanted promises of prevention through education and condoms. Ths means that progress on the ever devastating HIV/AIDS pandemics takes even more perseverance than many less lethal threats. It's morbid to think there may never be a silver bullet for the HIV/AIDS crisis, but at the least, many more strategies will be tested en route to stanching the devastation of the virus.

Despite global discouragement, there are always optimistic moments, like ten years ago when education and prevention through condom use and social marketing was the crux of HIV/AIDS fight. In September, 1998 Washington Post reported on the "remarkable success" of the new strategies.

Across the world, the paper said, HIV infection rates were decreasing. In places like the Dominican Republic, Brazil, and Uganda, and the Ivory Coast, and in Tanzania,, where a three year trial aimed at decreasing sexually transmitted diseases had "reduced HIV transmission by 40 percent". An administrator from the AIDS Control and Prevention (AIDSCAP), Brian Atwood, told the paper: "this agency has made a global contribution....over the years, we've learned so much about this..."

Learning about the risk of AIDS doesn't necessarily change sexual practices or result in long term success. The AIDSCAP program ran through the 1990's and despite the successes, suffered many obstacles. Any program can be derailed by staff turnover, stigma around disease, misunderstanding of disease etiology, uneven programming, funding shortages, interruptions, and politics.

Today in Tanzania infection rates are lower than places like South Africa, averaging at about 8%, but overall life expectancy has decreased by 8 years due to AIDS. While HIV infection in urban areas declined by 16.65% from 2000 to 2005, in rural areas infection rates have markedly increased. Other critical economic development measures have also regressed in Tanzania, for instance literacy rates dropped from 80% in 1980, to 60% today. In one survey of adults, 52% of women and 62.5% of men believed that a teacher who has "the AIDS virus but is not sick should be allowed to continue teaching."

Now, an experimental trial in Tanzania will attempt to attack this complex knot of problems underlying the HIV/AIDS epidemic with a market solution. The Financial Times wrote last weekend about a project in Tanzania that would pay people who practiced safe sex. The trial participants would take regular tests for sexually transmitted diseases like gonorrhea, and be paid about $45 if they remained disease free. The control arm of the trial would not be paid. All would be treated for any infections. Sexually transmitted diseases increase the risk of becoming HIV infected and Tanzania has long focused on this connection.

The project is sponsored by the World Bank, William and Flora Hewlett Foundation, the Population Reference Bureau and the Spanish Impact Evaluation Fund (affiliated with the World Bank). The Financial Times quoted Carol Medlin, a researcher on the project from the University of California, San Francisco, who said: "We hope this 'reverse prostitution' will make people think hard about the long-term consequences of their short-term behaviour."

The move is controversial -- can paying people for intrinsic choices motivate them? Can the complex set of problems underlying AIDS epidemics, involving everything from public health infrastructure, to politics, social norms, economics, and leadership, be resolved by motivating personal choices with money? In an accompanying editorial ("Cash for safe sex; Bribing Africans to be careful is bizarre - and worth a try"), the Financial Times suggested that the scope of the problem warrants such an attempt: "In the face of an appalling Aids epidemic, we should overcome our unease." Should we?

When Merck's AIDS vaccine candidate failed in clinical trials, the National Institute of Allergy and Infectious Diseases (NIAID), in the National Institutes of Health (NIH) called a summit. The drug candidate did not reduce HIV infections, in fact the adenovirus based vaccine seemed to increase the risk of infections.

The meeting of scientists on March 25th in Washington focussed on the future of HIV/AIDS research in light of the fallout of Merck vaccine trials. Scientists including Anthony Fauci, who heads the NIAID, agree that funding needs to be redirected towards a broader research agenda and ideas beyond drug development and vaccines. Science last week noted that the decision about whether to proceed with the large NIH clinical trial planned for its HIV vaccine is still pending. ("Review of Vaccine Failure Prompts a Return to Basics" DOI: 10.1126/science.320.5872.30)

Nature also reported on the summit last week, pointing out that these clinical AIDS trials went forward not necessarily based on the strength of the science -- one of the vaccine candidates had a unimpressive track record -- but because programs needed to "show the public that progress is being made, thereby justifying the millions of dollars from philanthropists and taxpayers". ("Broken Promises" doi:10.1038/452503a).

The Nature editorial offers analysis of this HIV-AIDS vaccine experience, noting that ambitious commitments made in a flush funding environment in the early part of this decade short-changed basic research. These choices to heavily fund drug development are regarded less forgivingly in light of the trial failures and the budget shortfalls of recent years, according to the journal. Nature warns other fields, for instance stem-cell research, autism, and Parkinson's disease, are repeating these same mistakes.

The business approach comes with a high stakes mentality and ample, vigorous marketing that can ratchet up expectations both within the organization, the field and the public arena. The business-oriented nature of many philanthropic organizations influences the focus on development and can distort public expectations. But investors can and do influence the direction of an entire field. When a field becomes dominated by a few foundations it can gather tremendous productive momentum, but it can also stampede so hard down a particular path with such strong momentum in a particular direction. If that direction proves to be less fruitful than hoped research cannot turn around on a dime.

Each high-funded disease has its own idiosyncratic pitfalls, but behind the good works and fine intentions of charities, but the science research rarely responds to pressure, unlike many entrepreneurial ventures. When scientists request research funding, the results don't always yield answers as quickly as businesses might hope -- research is the mythical man myth on steroids. Some people investing in biotech and international public health come from businesses very unlike public health with its vagaries of not only politics and human behavior, but biology.

In today's fast paced communications and computing climate, intense focus on "results" is inherent to our culture. Expectations carry over from the successful and extraordinarily speedy progress of the genome sequencing. Scientists and politicians built hopes during that time that drug development and an accelerated understanding of human disease would follow. It has, but did we expect more? TV drug advertising gives the impression that scientists are developing a pill for every insignificant hangnail, when many of these drugs aren't new, just the subjects of new marketing campaigns. Meanwhile tougher diseases and conditions remain elusive.

High profile funding can influence the research environment and lead to a very public dead end. In the larger picture, despite the wisdom that should be accruing from these experiences, politicians, technology leaders, and pundits sometimes wax-on about technology's potential to produce solutions not only for specific diseases but for extremely complicated social problems such as global warming and healthcare. But while science research may yield pharmaceuticals and oil extraction techniques but one cannot look to science or technology to solve the healthcare crisis in the United States. Science and technology contextualize these problems and are integral in our lives but despite heady declarations, they are not central to the solutions.

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Acronym Required has written previously about these subjects, AIDS and research directions, and vaccines. Here are a couple of our vaccine articles:

Vaccinations -- Why Worry?
Polio Vaccinations - The end of a scourge?
Group B Strep Vaccine Development
Vaccine Development For Infectious Diseases

Last year, as avian bird flu H5N1 skipped around the world decimating bird populations and fatally infecting clusters of humans, governments near and far felt increasingly threatened by the possibility of a influenza pandemic. Tension and mistrust increased among countries at a time when full cooperation among them was essential to public health.

Countries promised $1.9 billion to a United Nations avian flu program but had yet to fulfill their pledges. The World Health Organization (WHO) established a repository for virus information from member countries at the Influenza Sequence Database (ISD) at Los Alamos National Laboratory in New Mexico in 2004, but the agency had a spotty history trying to deal effectively with infectious disease and was accused of beholden to the "gang of fifteen" labs given access to the data. The World Organization for Animal Health (OIE) and the United Nations' Food and Agriculture Organization (FAO) also committed to sharing data, but like the WHO, answered to their member states and could do little to compel countries to share resources. Private labs, the CDC, and individual countries like Russia, and China, had all been withholding data and biological samples, sometimes because of poor international relations, concern about intellectual property rights, or concern about credit for their contributions.

In response to the fragmentation in the research community, scientists, politicians and public health officials fulminated, concerned that hording virus and sequence samples would hobble effective responses to outbreaks. In February of 2006, Italian influenza scientist Ilaria Capua called on fellow scientists to promptly deposit their sequence data into gene banks."'Most of us are paid to protect human and animal health,' she said, 'If publishing one more paper becomes more important, we have our priorities messed up.'" ( Science 3 March 2006: Vol. 311. no. 5765, p. 1224)

By August she and about 70 influenza research allies, along with international consultant Peter Bogner, announced the establishment of a new, more open and collaborative system. Capua, Bogner, David Lipman, Nancy Cox and the others submitted a letter to the journal Nature announcing the Global Initiative on Sharing Avian Influenza Data (GISAID), a more collaborative and egalitarian effort to collect and share data in the scientific community.

The project is now set up and expected to begin accepting sequence data. Last week Science wrote that the database will live at the Swiss Institute of Bioinformatics (SIB) in Geneva. According to the article, access to the database will be free to people who register and accept the terms of use. Those who submit data have 6 months to take submit patents and scientific publications before their data becomes publicly available.

Last summer, people welcomed the initial announcement of GISAID and had high hopes for the collaborative approach. Yet some scientists are reserving their opinions until they know the exact terms of the agreement, still undisclosed. Others are openly skeptical of Bogner's motives, and wonder out loud why a media privatization mogel who is better known in skiing and sailing circles would pursue such a venture. For his part, he says he understands the issues scientists have with data rights from working with musicians. According to collaborators he has infused energy and financial backing to the project, and according to Science, might help bring future corporate funding .

Will sharing data help the frayed international relations? Emily Fitri of the Jakarta Post wrote her perception of the country's untenable situation in an article this week. Its unclear how well this represents the government's position in the wake of its agreement with Baxter. In summary she thought Indonesia and poor countries should be incensed for being used as "petri-dishes". While Indonesia struggled with geographical and informational challenges to containing bird flu she said, wealthier countries take cultures to study and make vaccines without offering assurance that whatever resulting remedy will shared with the country for an affordable cost. Indonesia has a right to be angry she says:

"There is a local saying cacing pun marah ketika diinjak, literally translated as even a worm gets upset when stepped upon. This must seriously be pondered upon by those with greater power to review their initial righteous intentions of creating a better world."

Indonesia said earlier this week that it would share data as soon as it is promised affordable vaccines. Perhaps GISAID will help promote the cooperation that is needed but it seems like a daunting challenge. Whatever relations are in place before a pandemic will be further tested in a crisis. Russia is in the midst of trying to control recent H5N1 outbreaks among birds in 8 villages around Moscow. The Moscow Times reported on the situation this week:

"A sign reading "Quarantine" welcomed a steady stream of vehicles passing through the checkpoint. The vehicles slowed down to drive over disinfectant-soaked sawdust intended to clean their tires. The traffic policemen took turns standing out in the icy wind and stopping drivers, ordering some to open the trunks of their cars and show their documents in a temporary cabin nearby."

The country is trying to vaccinate all birds and control the outbreak. One could imagine this scenario anywhere in the world. Some Russians interviewed for the Moscow Times article said that the control methods were arbitrary and that drivers circumvented the blockades by driving through surrounding villages. Others said it was a lot of hoopla for nothing. One veterinary worker who the Moscow Times interviewed commented: "Two chickens die and all this blows up. It's ridiculous."

Scientists agree that international cooperation is necessary to prevent infection and develop vaccines, and in the case of contagious human infection, to contain the disease and distribute medicines. Hopefully GISAID's accomplishment in meeting its six on-line month goal will reinforce the hope it engendered last August and help promote cooperation that citizens of the world are dependent on -- granted, a tall order.

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We also wrote about Avian Flu in these articles: Avian Flu v. Everyday Plagues, "Hopes For Avian Flu Vaccine"; "Modeling Epidemics", and "Avian Flu in China- Increasing Resistance", "Avian Flu Updates", and Avian Flu Pandemic -- Officials Save The Date"

In late December, Northfield Laboratories announced the results of Phase III clinical trials of Polyheme, a hemoglobin based oxygen carrier (HBOC), that ended last summer. The Wall Street Journal reported the negative results in "'Preliminary' Findings Of PolyHeme Death Rate Suggest Approval Setback"(12/20/06). We learned that 712 trauma patients with trauma and significant blood loss enrolled in the study. 46 patients treated with Polyheme died, versus 35 control patients who died from standard treatment. 13.2% of the Polyheme patients died versus 9.6% of the patients of standard treatment. The standard for care is to give saline to the patient during transport only until donor blood is available at the hospital.

The response to the negative news was immediate. Quite a few people suddenly distanced themselves from Northfield Labs. West Virginia University hospitals, who enrolled in the Northfield study and is listed on the clinicaltrials.gov site, issued a press release saying that even though ambulances were carrying Polyheme,"The drug, PolyHeme, was never used on any patients in West Virginia, according to Dr. Lawrence Roberts, director of WVU's John Michael Moore Trauma Center". (italics ours) The doctor defended the choice to participate in the study while dismissing the product: ''The data looks like the patients that got Polyheme had worse outcomes. That implies this stuff is no good and you can't use it."

Investors, brokers and some financial reporters, who had once rabidly attacked reporters and sites that brought up patient safety concerns, started echoing "I told you so" headlines back and forth to each other. The stock sunk from $17 to $4. Northfield Labs' CEO, Steven Gould presented to an investor teleconference last month and the WSJ noted his eternal optimism, saying he was

"'encouraged' and 'optimistic' that the company's blood substitute soon will become the first approved by the U.S. Food and Drug Administration to revive hemorrhaging patients." [WSJBurton, Thomas "Blood Substitutes Face Long Odds History, Scientific Concern Hamstring Sector" February 13, 2007].

None of this bodes well for patients. The negative results potentially impacted past patients who probably did not receive optimal care for their situation. Doctors, emergency workers and the military as well as future patients would benefit from a new product that delivers oxygen, survives storage and transport, and doesn't require blood matching.

In this clinical trial Polyheme's success is judged according to a simple but slightly unusual criteria. The goal was to show that the product "superior" to, "not inferior" to, or "inferior" to the standard treatment. The future of the product depends on how many people survived the Polyheme group as opposed to the control group. Northfield is now striving to get the FDA to label the Polyheme "not inferior".

The CEO called the shaky results "preliminary". He said that some of the data had errors because of "protocol violators", that is patients who were enrolled who for one reason or another should have been excluded. When these patients' data was removed from the analysis he said, then the results of the study looked better and would fair more favorably in an FDA review. True enough, the protocol violators died more frequently. Of the 126-patient "protocol violator" group that Northfield seeks to exclude, according to an analysis on Thestreet.com, by Adam Feuerstein, there was a large difference in death rate of patients getting Polyheme (17/70 or 23%), versus the controls (7/56 or 12.5%). However, since the trial was originally structured for patients with significant blood loss and trauma. Feurestein points out:

Northfield designed an ambulance trauma trial for Polyheme because it wanted to see how the blood substitute performed in the real world, where all kinds of patients are bleeding to death from all sorts of accidents. After the fact, when the results aren't to its liking, the company can't go back and argue that Polyheme works, but only when conditions are perfect.

Actually, Northfield also chose this particular patient cohort because previous trials of Polyheme (similar to other HBOCs) failed when the products were applied in routine surgery and non-trauma situations. These trials ended badly for patients, so the companies turned their attention to critical care scenarios where donor blood wasn't an option. Since we're at war (perpetually, now), there's a huge potential military market for these products which coincides with the uptick in FDA interest. But will the FDA will allow Northfield to meet the trial's patient quota with "protocol violators", then in retrospect exclude those patients? Some financial analysts like Feuerstein are doubtful. The FDA's actions will also be followed with interest by those in drug development, and those concerned with patient safety and clinical trials.

Northgate's Phase III trial attracted initial controversy because it necessarily waived patient consent in order to study severely injured trauma patients. The trial involved giving a blood substitute in lieu of saline during transport, and for 12 hours after the injury once donor blood was available. Doctors and people involved with patient ethics questioned whether communities were being educated adequately about the trials. People also probed why participating doctors and medical centers seemed unknowing about previous failures with the blood substitutes. Fortunately for Northfield, all of this controversy only heated up three years into the trial. Northfield stopped enrolling patients just a few weeks after a story about patient consent aired on 20/20.

However the next trial for an HBOC will be conducted differently. The FDA recently denied the company Biopure, Northfield's neck and neck competitor for over 20 years, latitude to conduct a Phase III trial with its competing product Hemopure. Instead it will conduct a Phase II trial with fewer patients and the use of Hemopure will only be allowed until donor blood is available.

Despite years of work and promises, some people doubt the HBOC's viability, due to decades of failures in clinical trials. The WSJ quoted a former medical director of Biopure Corp. in Cambridge, Massachusetts, a company that makes one of Polyheme's competing products Hemopure, who said that the '"totality of the data' on this class of products is that 'so much harm has been shown, without benefit, that the field should be stopped.'"

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Acronym Required previously wrote about Polyheme and Hemopure in Polyheme© and The Newest Plastic Bracelet. We looked at the history of the products, focusing on on Northfield and Biopure, in Polyheme& Hemopure: Life Savers? Products to Die For?

South Africa's Wealth/Health Paradox

South Africa, where approximately 1 in 9 people are afflicted with AIDS, has a paradoxical economic development profile. It is considered an upper middle income country based on its healthy Gross Domestic Product (GDP). The World Bank ranked South Africa's GDP 27th of 177 countries in 2005, putting it in about the 85th percentile for GDP. The International Marketing Council of South Africa, with the slogan "South Africa, Alive With Possibility", describes the country as the "economic powerhouse of Africa".

Yet about 800 people a day die from AIDS in this country. Life expectancy in South Africa has decreased by four years and deaths from AIDS continue to decimate populations of young women under age 35 and men in their 30's and 40's, people who are in their prime and who -- from an economic perspective -- are in the most productive years of their life.

Now more bad news. An alarming study from Statistics South Africa's shows yet another dramatic increase in deaths from AIDS in South Africa. The report analyzed death rates from unnatural and natural causes and found that the death rate from communicable diseases of South African women aged 30-45 had increased by about three times, from 500 per 100,000 to 1500 per 100,000 in the time period between 1997 and 2004. Male deaths from communicable diseases had also increased and had even doubled in some areas. Some of this bad news was predicted. Since there is a lag between infection and full blown AIDS, it was assumed that the death rates would not decrease until 2008. However the figures are still stunning - as they were last year, and the year before...

The expectations of economists and politicians was that post-apartheid Africa would rebound and that the health of South Africans would improve. Indeed according to economic measures Africa is doing better and foreign investment has skyrocketed. But even compared to Russia, where life expectancy decreased as a result of political upheaval and economic downturn, the current patterns in South Africa indicate a dire state of affairs. For scientists and doctors, the increases in deaths are distressing since there are few signs that action is being taken to stem the epidemic.

South Africa AIDS Policies

Public health officials, scientists and doctors are taking South Africa to task for its AIDS policy, and rightly so. Historically, the government has denied that the HIV virus caused AIDS, and it has been slow to implement treatment programs for AIDS afflicted patients. Despite pleading from world leaders, South Africa's AIDS policy remains one of obfuscation and denial. Health minister Dr Tshabalala-Msimang often insists that nutrition will beat AIDS, and regularly pushes garlic, beets and lemon, and African potatoes as effective cures.

Patient treatment via antiretrovirals now costs less that $130 dollars a year. South Africa's health policies are out of step with the modernity and prosperity that it claims.

The country was condemned at the AIDS conference in Montreal this year for displaying a basket of this produce in its booth, initially without antiretroviral drugs. Earlier this year it banned two Non-governmental organizations (NGO's) from a UN AIDS conference because they were particularly critical of its policies.

In the most recent international public plea for policy change, a group of 81 doctors wrote a letter to President Mbeki asking the president to replace the ineffectual health minister. In response to the recent letter, the health minister complained that the international community was undermining the country's efforts. She has long defended her nutrition advice as "the truth", and allegedly doesn't mind her moniker- Dr. Beetroot".

In response to the outcry, the president has assigned a new committee to oversee the AIDS program, according to an associated press article (South Africa Scales Back Health Minister's AIDS Role). But the health minister denies that she has been demoted, and in typical sidestepping form, a government spokesperson, Themba Maseko, said: we need to shift the focus from saying the problem is the minister of health".

Effective AIDS Policies

AIDS programs succeed in countries because many deliberate actions. It is imperative that there is strong leadership to combat AIDS at the very, very top levels of a government. If the problem is not with the minister of health then it is with the president.

People have said that effective AIDS policies will be pushed to the fore by governments who realize that deaths impede economic progress. It's hard to imagine that South Africa, where 1 in 9 people on average are affected by the deadly disease and only a small fraction receive drugs has not come to terms with this economic reality. How the government can still claim that beetroot is as effective as antiretrovirals is as Stephen Lewis said: "obtuse, dilatory and negligent."

Once it seemed intuitive that a higher GDP could be linked to greater general welfare of the country's citizens. Economists now recognize that GDP doesn't always correlate with overall broader measures of prosperity. South Africa is a telling example of this phenomenon.

The United Nations' Human Development Index (HDI) rates quality of life factors such as education, the status of women, morbidity, and mortality. South Africa's comes in at 121sh out of 178 countries. This puts it in about the 33rd percentile of all countries, in the company of many countries who have far fewer resources. Therefore in terms of HDI, as opposed to GDP, South Africa's is in the same band of countries that its pro-business groups lord over with their "economic powerhouse" status.

In this "post-apartheid" era, we would not expect this chasm between the HDI (where it lies in the 33rd percentile) and GDP (where it is the 85th percentile). We would not expect the travesty of preventable AIDS deaths. We only wish that such a sorry state of affairs would convince those at the top levels of the government that only an active AIDS program will assure that South Africa is "alive with possibility".

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Acronym Required previously wrote about AIDS in Not in Paradise Anymore - AIDS in Africa - Reason for Optimism?" - in response to a David Brooks column and optimistic prognosis for the AIDS epidemic in South Africa. We also wrote about AIDS in Zimbawe, in Burma, as well as in other articles.

PLoS Medicine published an article in their Policy Forum this month, provocatively titled "Do We Need to Put Society First? The Potential for Tragedy in Antimicrobial Resistance" by KR Foster and H Grundmann. The article positions global antibiotic resistance as a proverbial "tragedy of the commons". The authors suggest that global accessibility of antimicrobials results in widespread antibiotic resistance and that although various parties try to curb the overuse of antibiotics by patients, "current policies may only partly solve the problem". Indeed, these efforts:

"do not address the conundrum at the heart of antimicrobial resistance: the solution may ultimately require us to put society before the individual. That is, halting the rise of resistance may only be achievable if some patients go untreated. We defend this uncomfortable conclusion using the logic of the well-known social dilemma "the tragedy of the commons."

This conclusion comes in the first paragraph. It's only dwarfed by the photo juxtaposed to the right of an oozing sore on the dark knee of a person inflicted with methicillin resistant Staphylococcus aureus (MRSA). As if an afterthought, the next sentence reads: "More data on the societal costs of resistance are required to evaluate the potential for a tragedy of antimicrobial resistance and the moral dilemma that it would present." One would have hoped that the "more data" part would come before the publishing part but perhaps tenuous commentary is the purpose of PLoS's "Policy Forum".

Though the topic sentence may affront, the theme of the article is more or less drug allocation and management, a vital concern to national and international drug and health programs. The proposal PLoS publishes may seem draconian but it is not foreign. Drugs are routinely made unavailable to various populations inadvertently or by design. Various drugs for infectious (and other) diseases are priced above what many patients can pay, and patents or trade regimes limit drugs' usefulness in order to maximize profit. The identification of subsets of people who will receive Tamiflu (whether it works of not), if and when bird flu becomes epidemic, and the hoarding of the drug is a obvious, recent example of drug rationing.

Drug production, allocation, distribution, and management are well discussed and argued in public health, policy, and economics circles. Antibiotic resistance is certainly on the rise and problematic. But is the "tragedy of the commons" a useful metaphor to analyze the problem?

Tragedy or Dismal Science?

Garret Hardin's 1968 essay, "The Tragedy of Commons" (available online at Science: Vol. 162. no. 3859, pp. 1243 - 1248 and here), describes how resources in the public domain tend to get overused and depleted. According to Hardin's views which stem from neoclassical economics, private ownership offers individual owners incentive to conserve a resource so as not to detract from its future value. "Common" resources by comparison, offer no such incentive. Therefore individuals tend to overuse "commons" because they only recognize the immediate value of what 'to their mind' seems like an endless resource, whereas any loss of value due to depletion is shared by many other individuals. There are greater individual rewards from taking then conserving.

Hardin's essay popularized a general phenomena described by Aristotle and others in simplified terms that are easy to grasp. It's most frequently applied to environmental problems: fisheries, water resources and pollution. It adequately describes these situations where at least at one time, individuals arguably had access to open resources. The parable's simplicity, popularity and malleability, make it easy to apply to other problems such as internet useage, university education or even - to dubious effect - asbestos litigation¹. "What we have here is a failure to cooperate", the asbestos article starts, citing a line from "Cool Hand Luke". The author contemplates how to restrain "asbestos plaintiffs,...[who are] arguably 'overgrazing' the accessible financial assets...",. The recompense is 'the commons' and the plaintiffs, 'the commoners'.

While the simple "commons" metaphor is useful, it can also be used for dubious intention to effectively blame individuals for complex societal problems, to erode individual rights, or to promote legislation that privatizes natural resources (even when it is clear that privatization does not necessarily solve common resource problems).

The PLoS authors chose to use the tragedy of the commons parable for the problem of antibiotic resistance based on an article about the Spanish national health care program: "Baquero and Campos recently argued that this dilemma mirrors what Hardin termed "the tragedy of the commons". It's clear from reading that article, however, that the Spanish authors write specifically about the public health program in Spain where doctors prescribe drugs to patients based on a national formulary. Baquero and Campos outline incentives that could be used for the pharmaceutical companies, doctors, and patients to curb excessive prescription use in the Spanish system.

The PLoS authors seem to discount the authors' solutions while liberally extending the metaphor in a vague way to global public health and antimicrobial resistance: "Protecting the antimicrobial commons, and hence the collective best interest, may require society sometimes to act against an individual patient's best interests.

The integration of antibiotic resistance and economics and public health via a framework borrowed from the 1960's isn't an easiest feat. Hardin himself warned in an article in Science (vol. 280: May 1, 1998):

"A final word about interdisciplinary work -- do not underestimate its difficulties. The more specialties we try to stitch together, the greater are our opportunities to make mistakes -- and the more numerous are our willing critics."

Though Hardin's original essay gained tremendous popularity, it also attracted criticism both for its methods and subject matter. The original essay addressed the overpopulation "problem". Hardin proposed that the "right to breed" could never be resolved or managed by government and the implications were disastrous. However, history doesn't support the catastrophe he predicted. Population growth was controlled via individual family planning. Virtually all developing countries' populations decreased with development that resulted in better public health, female education and increased wealth. But the "problem" still has it's staunch supporters in Malthusian circles, and Hardin recently said (1998) (Science:162): "The reality that underlies all the necessary curtailments is always the same -- population growth."

The failure of Hardin's predictions about population growth doesn't rule out use of the "commons" framework. It has been applied to great effect for conceptualizing environmental problems. But any model, no matter how popular, needs to be measured against the historical record and applied only with care to contemporary problems.

The authors claim: " Hardin's tragedy of the commons has proved to be a powerful analogy for understanding the problem of protecting the benefit we all receive from public goods". We argue that it is not the best analogy. As privatization has become the norm the concept of a "common" resource has become almost anachronistic. In the case of antibiotic resistance, it is neither powerful nor an applicable. There are more powerful models that provide better framework to analyze the problem.

Antibiotics are Private Goods

Different disciplines have different vocabularies for the same phenomena that are equally valid, but in the case of public goods economists can do better then the simple "commons" parable. Economists define "public" goods and distinguish them from from "private" goods. A public "good" benefits society and can counteract a "bad". The definition is refined by considering concepts of "excludability" and "rivalry". Lighthouses are the prototypical public good, with non-excludability and non-rivalry, as is national defense. No one can be excluded from using a lighthouse or public defense, and one person's use does not hamper another persons use. For a non-rivalrous good the marginal cost of consumption is zero -- it doesn't impose on society. Non-excludability of a resource, whether it's a light from a lighthouse, national defense, or a broadcast on public airways, is a requirement for a "public good", as is non-rivalry.

Economists further refine these ideas by distinguishing between pure and impure public goods, and pure and impure private goods. A lecture in a public auditorium is an impure public good. Although many people can listen, each person who listens limits the future number of other people who can listen in the space and is in this way rivalrous. Ocean fisheries are similiarly impure public goods, because they are rivalrous, although they people for centuries imagined the oceans a limitless resource.

Club goods such as health clubs and churches are excludable. All private goods, like clothing and haircuts are both excludeable and rivalrous. Such services and manufactured consumer products are considered pure private goods. Medicines are considered private goods, however private medicines can be distributed by public programs - but they're still private goods. Exceptions include world wide polio vaccination program, which could be considered a public good.

This framework is not perfect for determining whether a good is public or private. Close examination of such a complex problem is still difficult, but the framework makes it easier to discern whether a problem has more public features or private. Perhaps in a case of nationalized medicine like Spain, antibiotics are not purely private or public, however from a global perspective, antibiotics are private goods. Antibiotic resistance is a global problem.

Antibiotics are sometimes extremely scarce and sometimes abundant. In rural areas throughout the world people die of simple infections that could be cured by antibiotics. In other places like some cities in Asia, antibiotics are priced at steep discounts and used with utter abandon in combination with various other traditional and allopathic medicines. But in both cases private industry determines the scarcity or glut.

An article written by Steve Stecklow and the late Daniel Pearl, from the Wall Street Journal, August 16, 2001, available here at essential.org, illustrates the extent to which privatization determines the supply of antibiotics. The article describes the influence of various players in the pharmaceutical industry in India. It details some of the profit incentives of pharmacies (which often stand in for doctors in India). The pharmacists relationships with pharmaceutical companies become arguably more important than the individual patient. The incentives of the pharmacists influences drug sales and in turn effect the use and misuse of drugs:

"Mr. Patil [a pharmacist] also didn't disguise his motivation for recommending certain brands. 'The ultimate decision is based on what the margins are," he said. For fevers, he usually recommended a generic version of the antibiotic Ciprofloxacin; a recent incentive deal from an Indian manufacturer offered him a 250% profit margin and a chance to win a motorcycle..."

Pharmaceutical companies refuse to develop drugs for markets that can't afford to pay, and pharmaceutical companies supply drugs cheaply when there are surpluses. There are ethical quandries with this model as it stands, but pharmaceutical companies are acting as rational for-profit entities.

Antibiotic resistance could be considered a global public "bad". It hasn't always been seen this way. Doctors in the U.S. have been cognizant of antibiotic resistance for decades and have counseled American patients about conservative use of antibiotics. But they ignored or were ignorant to egregious misuse of antibiotics overseas and for the most part failed to conceive how this might effect the US. Antibiotics are not a global public good because they are privately developed, manufactured, sold and managed according to the profit motives of pharmaceutical companies. Pharmaceutical companies influence politicians to pass laws favoring the sale of drugs. Lawmaker participation is as instrumental to the problem as the prescribing habits of doctors.

This is not a simple dynamic between some individual herders and a pasture. Antibiotics are not a free resource open for public consumption, but a private product sold to consumers by pharmaceutical companies for profit. Yet surprisingly, the word "pharmaceutical" does not appear in the PLoS article. Neither do the words "industry", "company", or "business". The word "drugs appears twice:

• 1) "Most worryingly, some bacterial strains are resistant to multiple classes of drugs"
• 2) "...development of new drugs...comes at considerable economic cost."

It's telling that pharmaceutical companies remain unidentified in the article as playing a role. It's their market! It's also telling that "economic cost" makes the potential solution of research and development of new antibiotics unpalatable to the authors, even when they compare it to the "moral dilemma" of not treating patients.

The authors run through many possible solutions to the problems -- curbing prescriptions for viral infections, limiting antibiotic use in agriculture, government incentives for drug development. But they seem to toss these valid solutions aside because they don't fit the text of Hardin's original 1968 essay. Indeed the authors note at the beginning of their essay:

"What is most important for our discussion, however, is Hardin's key insight that a tragedy of the commons lacks a technical solution, which he defined as 'one that requires a change only in the techniques of the natural sciences, demanding little or nothing in the way of change in human values or ideas of morality.'"

Since their article hinges on Hardin's assertion that there is no "technical solution", it's as though they fixate on an answer that seems most likely to satisfy the 1968 article; the one that most emphatically challenges notions of "human values or ideas of morality." While they recognize all the misuses of antimicrobials in exhaustive lists in their essay and they also seem to recognize the international disparities in prescription guidelines, they toss these key issues aside in favor of their histrionic proposal that we: "face up to the reality of a tragedy of antimicrobial resistance".

It seems that to these authors, contemplating the loss of individual life is less horrifying than contemplating a change in the paradigm of how antimicrobials are distributed. Similarly, when the U.S. government contemplates climate change, it dismisses any proposal that might alter the economic incentives for the entrenched fossil fuel industries. Have privatization and sustaining business profits become subsumed as "human values", and taken precedence over other "human values" that we used to claim such as individual lives and liberty?

Brave Policy Decisions

It is difficult to take seriously proposals that omit important pieces of the problems they claim to consider and discard solutions that they claim to seek. An obvious snag in the logic of the PLoS author's solution, leaving selected patients untreated, becomes clear when imagining the difficulty of imposing such a broad solution successfully, given their assertion that none of the other smaller scale government solutions they considered seemed to suffice.

The biggest problem with applying the metaphor of the "tragedy of commons" to antimicrobial resistance is that it's too vague and amorphous an analogy. There are more cogent and analytical frameworks for contemplating the problem of antibiotic resistance, and by comparison, the "tragedy of the commons" only invites criticism. At best it seems like cultural shorthand that stands in lazily for a more clear-eyed, rigorous, nuanced delineation of a problem.

Such an analysis might question the contention that individuals are best served by international patent regimes that strong arm countries into limiting development of essential medicines -- a view that the authors endorse. This patent protection purportedly motivates pharmaceutical companies to develop new drugs. But if this were true, than why continue excusing companies from not developing drugs because of "economic cost"? If this "...careful use of patents", did indeed encourage drug development, than why would the profit reinvestment need to be further augmented by "government investment" -- especially when governments already provide the means for basic research upon which most drugs are developed?

We could also question how individuals could possibly be culpable for antibiotic resistance: "every herdsman knows that putting too many cows upon a pasture will eventually destroy it by overgrazing. Who "knows" more? The patient in India who walks into the pharmacy as in the WSJ article, hoping to cure their illness? Or the pharmaceutical company that sells them the drugs? Furthermore, does the right of a company to spare "economic cost", trump the right of an individual to spare his own life with medicine that he pays for either with money or taxes he pays to support national healthcare?

While the authors readily acknowledge many features of the antibiotic resistance dilemma, they do no service in forwarding the notion that individuals should bear the brunt of inefficient antibiotics distribution. For years pharmaceutical companies have propagated antibiotic resistance with greedy business practices like dumping pharmaceuticals into markets where their cheap price practically guarantees overuse. Whether the individual is an MRSA patient in a London hospital, an AIDS patient with an opportunistic infection in South Africa or India, or a child with strep throat in the U.S., the individuals with infectious diseases are not plundering the drug supply, nor are they responsible for the problem of antibiotic resistance.

The authors conclude that "difficult choices" are in store that may "require brave policy decisions". If governments enacted policies that sacrificed individual treatment via antibiotics would this really be "brave"? This seems routine, business as usual. However, what if governments chose instead to contemplate aspects of the current for-profit paradigm of pharmaceutical companies, the issue that the article published by PLoS; "Do We Need to Put Society First? The Potential for Tragedy in Antimicrobial Resistance", tries to ignore? Wouldn't that be "brave"?

¹ Francis McGovern; "The Tragedy of The Asbestos Commons", Dec. 2002; Virginia Law Review Vol 88, No. 8.

The tsunami has a long lasting human toll; less recognized is the toll on natural resources. In Aceh, Indonesia, building progress for temporary housing has stalled because of a shortage of wood, according to a Financial Times article last week. Reconstruction depends on lumber sourced from foreign countries, instead of using domestic trees from Gunung Leuser National Park, where illegal logging is already threatening the ecology of the rainforest.

There are 67,000 people still living in tents and apparently "only 800 of the planned 20,000", temporary homes are finished in Aceh. The tsunami destroyed hundreds of thousands of across Southeast Asia, and estimated 120,000 on Aceh needed to be rebuilt.

Following the disaster there was quite a lot of media coverage focused on the outpouring of support for rebuilding. For those that lost track of the reconstruction progress in Indonesia, awash as we were with Katrina and the aftermath of the earthquake in Kashmir, reports about the slow pace might be a surprise. Weren't there hundreds of proposals for sustainable, affordable, geographically appropriate housing?

At one time, it seemed like arrangements for temporary shelter would emerge from the many proposals highlighted in the media. There is the Harvard/MIT "Sri Lankan house", that is economical as well as "built with local materials and engineered to withstand a tsunami". There are the Architecture for Humanities' structures, designed specifically for use in India and Sri Lanka. There is World Vision's project of 139 houses that they not ed in a press release were "lauded as 'best practice' in post-tsunami rebuilding". There were several more low-cost options featured on NPR including houses framed with cheap, flexible, strong bamboo. There was also press about architectureal wunderkind Daniel Libeskind, who worked pro bono to rebuild a town in Sri Lanka. It seemed like a plethora of architecturally innovative ideas from universities and architects for sustainable projects and innovative solutions.

Yet despite the apparent potential for success, a persistent source of consternation has been the materials with which the houses will be built. There was concern that the environmentally important forests of Aceh would be destroyed in the rebuilding. Concrete used in many places is not a sound seismic choice. Steel and tin, which were actually used for temporary shelters in the Andaman and Nicobar Islands, make oven-like structures that are inappropriate for the climate.

Solutions poured in, but it seems that wood was chosen, despite what seems to be availability of alternative resources. Conservation International wrote how they had successfully advocated for the use of foreign wood rather then Indonesian trees. British Columbia wooed Indonesia with their ideas of wooden prefabricated homes, cut from Canadian forests, shipped to Aceh, then trucked to villages and assembled. By May of 2005, donations had been offered from US, Australia, Belgium, Finland, Sweden, New Zealand, Germany, and Denmark. But FT writes that getting timber from places like Canada has been problematic because of shifting environmental standards and the "inexperience of many aid agencies in sourcing large amounts of wood.", but "a UK-based timber broker was expected in coming weeks."

This wouldn't be a surprise for some citizens of the areas hit. Six months after the crisis, many areas had already tired of the slow, spurious progress. In India the Habitat for Humanity proposed a certain model of house for Tamil Nadu. Prompted for a reaction when shown "the little cardboard house model", a lady of Killai commented:

"People have been here before talking about houses; now they are gone. You are here now, but how do I know you will come again?"

In addition to the challenges of sourcing timber from far flung places such as Canada and Sweden, organizations must also get clearance from the bureacratic government. Many NGO's seem to have neat press-ready plans to show, but scaling those and coordinating all the agencies to meet the epic challenge of the massive reconstruction effort of the tsunami has been a rough road.

It seems as though the challenge of affordable, sturdy emergency housing has been solved many times through innovative teams of architects, at universities and via the dedication of non-profits and lots of generous support. Not only is thatnot the case, the problem has been historically unresolvable. An article in Slate last year described the issue:

"Architects in the past have proposed a variety of ingenious shelters, including prefabs, inflatables, geodesic dome kits, sprayed polyurethane igloos, and temporary housing made of cardboard tubes and plastic beer crates. As Davis [the author refers to Ian Davis, who wrote the book Shelter After Disaster (1978)], points out, not only are these often untested 'universal' solutions generally prohibitively expensive, their exotic forms are usually ill-suited to local conditions. That may be why such shelters, when they have been deployed, have frequently been rejected by users, and why historically the most common temporary shelter is the tent. Emergency housing sounds compelling, but it almost never works."

Housing is not the only rebuilding issue. Aid organzizations are overseeing the rebuilding of thousands of boats that were also destroyed in the tsunami. There are issues with the size and technology of the boats being built; many are smaller than the larger trawlers they are replacing, which may lead to over-fishing in shallow waters. The boats are also apparently made of unseasoned wood, because of the timber shortage, which is far less seaworthy the seasoned wood. Though many of the problems are expected given the scope of the disaster, life nevertheless remains on hold for thousands of Indonesians on Aceh still living in "rotting" tents while agents track down millions of cubic feet of lumber half a world away.

We arrived in Bankok, Thailand on the 26th of December at about 12:00AM last year and when we awoke in the morning people were standing around TVs trying to make sense of news about the tsunami. It was clear from the TV images that the waves were monstrous and destructive, but it was initially hard to fathom how many people were involved. Thais in Bankok desperately tried to reach their relatives in the South. As more footage of waves crashing through beach towns came through and people ominously failed to contact their families, the tension grew. We logged on to CNN and there the only news of the tsunami was a story about one American who was possibly lost on one of the islands¹. The family had mined some FBI connections to track their son and publicly pleaded to the president to mobilize efforts to help find him on the island of Phi Phi. They enlisted a senator in their search, who commented on her limited ability to help:

"What's really frustrating is this is the 21st century and you would think there would be some kind of communications . . . some kind of direct link from someone on the ground in [Phi Phi]"

Unbeknownst to the senator, the communication gap that frustrated her wasn't a 21st century technology glitch that inspires crankiness in all of us but the fundamental effect of an abrupt 20 metre vertical displacement of the ocean floor. The geology of the 9.15 earthquake and resulting tsunami in the Indian Ocean is difficult to imagine -- even if you were there in Thailand, India, or Sri Lanka. The further away you were from South East Asia the longer it took to realize what was going on, based on the steady stream of e-mails we got weeks after the initial earthquake. Some of it was the political process. President Bush was on vacation and took days to say anything.

Aside from distance and politics, the fact is that the communications infrastructure was literally wiped out, making communications logistics not so obviously impossible. Even watching natural disaster extravaganzas like "Deep Impact" or "The Day After Tommorrow", would hardly prepare one for the destruction. The fault slippage generated by the earthquake covered an area of 1300 by 100 kilometers. The energy released by the earthquake was estimated to be the equivalent of about 475 megatons of TNT -- 23,000 Nagasaki atomic bombs. The earth wobbled on its axis.

Waves generated from a large earthquake travel very quickly across the open ocean with speeds up to 500-1000 kph. They are short waves (one or two metres) on the ocean that then slow down when they approach land. There, the wave -- which is technically not so much of a wave, but rather a wall -- gains height. The resulting walls of water are extraordinarily powerful. Predicting their landfall is trickier then it may seem.

The Sumatra earthquake was initially measured as a 8.1-8.5 earthquake, then later revised upward to 9.15 using the moment magnitude scale rather than the seismogram amplitude (Ms) measurement. The difference between the size of the actual earthquake and the smaller initial measurement affected the tsunami predictions.

Cries for a tsunami warning system could be interpreted to indicate that this will solve the problem. It's true that before the tsunami there was a warning system implemented in the Pacific ocean but nothing in place for the Indian ocean where tsunamis were considered a rarer event. Warning systems are now being devised. The newest one is being designed by German researchers, who, relative to the Americans and Japanese, are newcomers to the field. The German system employs buoys that monitor surface conditions and relay this information along with sea bed information via satellite to a receiving station. Two of these buoys were installed in November. Tidal gauges will also eventually be engineered to monitor the data. These are part of the Global Sea Level Observing System (GLOSS) used in climate change studies. They are being upgraded to measure sea level information that will be useful to monitor tsunamis. There are also traditional communication systems based on seismic data that are now improved to forward warnings after earthquakes to countries vulnerable to tsunamis.

The improvements cannot come quickly enough. Der Spiegel reports that the stress of the Australian Plate beneath the continental shelf is higher then ever and the two recent earthquakes seem to have increased the tension since they only affected a small length of the border between the plates. But the 21st century communications system the senator laments may well be illusory.

We know that a warning system will never stop a hurricane or a tsunami. The warnings will help those who are capable and willing to heed them. Similiarly, during the rescue, technology will certainly improve the odds for many, though not all. But will it perform to the specs we expect? As with our all disaster, the response is as likely to depend on our neighbors as the technology -- on island or off; to whit, our neighbors judgement, instincts, and dare we say "emotional intelligence" will abet our survival or peril. These are the qualities in humans that sometimes seem disconcertingly unchanged since we all hunched over those first sticks trying to get sparks to fly. Sure there are enough heros, geniuses, and cats rescued from trees these days to buoy our spirits during the evening headline news. But in catastrophes, the weaknesses as well as the strengths of our fellow humans are evident, and as important as the "technological communications" systems. We will be as dependent on the chain of humans relaying the messages as we are on the physical limitations of technology -- even if the next tsunami leaves the infrastructure linked.

There were remarkable heroes in the tsunami last year. Some of the survivors stories are extraordinarily well told in the recent New York Times article "The Day the Sea Came", by Barry Bearak, which describes the turmoil and human toll of the event through the eyes of a few survivors. Many more stories we will never know, as those heroes perished with hundreds of thousands of others. If only technology could have saved them.

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¹The news must have gotten more in sync with the reality in time because CNN recently won the an award for best coverage for its stories on the tsunami.

Bats have a mixed reputation. Aside from their roles and fame in fact and fiction as vampires, they pollinate plants and have a voracious appetite for insects. Apparently little brown bats can eat 1,200 mosquitoes per hour. On the other hand humans fearfully associate bats with rabies virus, and occasionally with histoplasmosis, a respiratory infection transmitted via the fungus Histoplasma capsulatum - found in bat guano. But Bat Conservation International (BCI) battles their bad reputation, and points out that bats are only responsible for 1 death per year in the United States and rabies is found in only 6 of 45 species continental U.S. bat species, whereas dogs - "man's best friend" - are responsible for more fatal maulings of humans every year.

However bats are increasingly found to harbor fatal viruses. Bats are natural reservoirs for the Nipah and Hendra viruses. Bats have been linked to West Nile Virus. They have also recently been found to be the natural reservoir of the coronovirus that causes severe acute respiratory syndrome (SARS). Researchers found that bats were immune to symptoms of SARS and were the natural reservoir for the virus, whereas civets, the animal suspected of being the reservoir, whose populations were culled by about 10,000 in China in 2004, is only a carrier of the disease. The coronavirus was found in three species of horseshoe bats - a fruit bat.(Li et al, Science vol.310 pp. 676).

Bats have long been linked to human cases of Marburg and Ebola viruses, primarily because they're routinely found in places where humans contracted the viruses, a barn in one case, a field in another case... Since the 1970's, following almost every Ebola virus outbreak, scientists combed the surrounding areas for the source of the virus -- collected thousands of vertebrates and arthropods and tested them for the virus or antibodies to the virus. Most of these studies came to a dead-end -- no virus was found, no immune reaction detected in the specimens. Scientists also tried to infect cells and animals with the virus to no avail until earlier this year when they managed to infect a couple of bats. But the infection of the bats was not reproducible and the researchers did not have confidence in their data. (Pourrut et al.; Microbes and Infection, Vol. 7, pp 1005-1014)

They pursued that line of research though, and scientists reported last week that three species of fruit bats in Africa carried asymptomatic Ebola virus (Nature 438, 575-576). Researchers tested over a thousand small animals captured from around Ebola sites, assayed serum samples for antibodies to the virus, and spleen and liver samples for viral RNA and RT-PCR nucleotide sequences. Some bats were found to be Immunoglobin-G positive and others screened positive for nucleotide sequence analogy of Ebola viral RNA, however no bats were positive for both. Viral RNA could not be isolated. The authors discuss their results in their article. The fact that they found Ebola in the fruit bats helps solve a piece of the Ebola puzzle, but there are more unsolved questions. For instance, how do the bat's immune systems protect them from viruses and how do spillover events between species trigger the ever transient emergence of Ebola and other viruses?

Although we don't understand a lot about bat immunology we do know something about their community ecology. Bats often eat on the fly. They eat fruits and insects but extract the juice and sugars and leave insect carcasses and partially eaten fruits for animals and humans. As humans habitats increasingly overlap with bat habitats, chance interactions or disease spillover through other species like pigs or civets becomes more common. The link of the lethal viruses to bats is likely a harbinger of future infectious disease challenges.

The number of pathogens is arguably increasing with changing environmental, ecological and human factors, and many emerging viruses have lethal pathology including severe neurological symptoms. Over half of emerging infectious diseases come from animals (zoonotic), so understanding how the diseases are transmitted between species is critical to controlling them. It is increasingly important for understanding pathogens to probe anthropogenic affects on ecosystems and reconsider our relentless forays into nature and pension for development.

Ebola and other zoonotic pathogens have company among a growing number of emerging and re-emerging diseases. Bats are increasingly found to be the reservoir for viruses that are fatal to humans. While "zoonotic" is strictly a biological term indicating the source of a pathogen, to anthrocentric thinking the term has the rhetorical effect of indicting the reservoir animal. This does not bode well for bats. Animals suspected of harbouring disease are culled as the first line of defense for humans. But if humans encroach on an ecosystem, change it to suit their short-term needs, and at the same time disrupt it to the extent that new species take hold and previously established species are forced to adapt - or by chance become natural reservoirs to emerging pathogens like Ebola...isn't the virus the result of human activity? Isn't its zoonotic "source" a circumstance precipitated by the arrival of humans? Perhaps hard to say, but so far bats seem to conserve themselves through their immunity to the virus. Humans might be better served if thinking in conservation and environmental ecology was as deep as it is in vaccine development and animal control measures.

Only a few years ago, in 2002-2003, China dealt with outbreaks of Severe Acute Respiratory Syndrome (SARS) in a famously secretive manner that hampered international public health agencies as they tried to analyze and control the disease. Since then, China has made efforts to improve the swiftness and openness of its public health reporting. Yet outbreaks of the H5N1 avian flu strain occurred in China earlier this year and again the international public health community criticized China for not cooperating with international public health goals. They publicly suspected that China had wantonly authorized widespread use of the antiviral drug Amantine to innoculate chickens.

In the wake of SARS, China took pains to address its international public health image. The country invested millions of dollars to build an epidemic reporting system. The move to vaccinate its 14 billion domestic fowl against against H5N1 is somewhat controversial, nevertheless China is marching through the Herculean task. China itself is most self-congratulatory about these efforts, but it has also drawn recognition from public health organizations like the World Health Organization (WHO).

Despite progress, there are continual reports of information bottlenecks. There is persistent world-wide suspicion about the country's reported numbers because of China's historical lack of candor. Combined with increasing edginess on the part of health officials about an H5N1 pandemic, the atmosphere is ripe for rumors and panic. Last week Japanese virologist Masato Tashiro reportedly told a German newspaper that China had far more deaths from H5N1 than it led the world to believe. China defended its accounting vigorously and Tashiro has since denied his original accusation, insisting that he referred only to China's general issues with accurate reporting. At the heart of the unresolved questions, fears and suspicions, lie the real challenges to accurate reporting. Among these are geographic logistical challenges, disparate government agency agendas, and incorrect international perceptions of state power in China.

Real logistical barriers to collecting statistics are sometimes blithely ignored. New York Times wrote in, "Experts Doubt Bird Flu Tallies From China and Elsewhere", about discrepancies between Chinese officials' epidemic statistics, that seem far less then foreign expectations. It was an interesting article, but noted that "news on outbreaks has sometimes been slow to emerge from provinces and to the state media. Vietnam, in contrast, posts a daily 4 p.m. update on the Internet, detailing human and animal infections." It didn't weigh that China is about 9.5 million square miles, whereas Vietnam is 329,560 square miles, and that China's population is 1,306,313,812 people whereas Vietnam's is 85,535,576.

On top of very real logistical barriers to consistent reporting, observers see a striking lack of cooperation between government agencies. China Digital Times translated the October and November issues of Caijing Magazine recently, which reported that prior to 2003 veterinary epidemics were state secrets. China lifted this rule but there is uneven progress towards openness. The Public Health Ministry makes genuine efforts to appease foreign requests for information, however the Ministry or Agriculture is insistent that certain details of planning for an epidemic are "not public". Problematically, a subsidiary of the Ministry of Agriculture is reportedly the only organization that is authorized to research the avian flu virus. The lack of communication between agencies apparently figured in the obfuscation of pertinent information about the alarming number of human deaths in the outbreak of Streptoccocus suis in swine earlier this year according to Caijing. A WHO official investigating the S. suis epidemic shared this view -- that China's "human health side" was cooperative, whereas "veterinary" information was not forthcoming. (Science Vol. 309. pp 1308-9).

China's public health system is part of a maze of political and economic ambitions at the national and local levels. We often perceive China to be a centralized top-down authority, but the reality is that local politics and decentralized control often determine the outcomes of state policies. As economists and businessmen know, at different levels - provinces, districts, villages - officials have different approaches and capabilities for their duties. These individuals (as anywhere) are often motivated by personal ambitions that propel behavior that's not necessarily in national or international interests. Reporting is one certainly a critical aspect of public health; who's getting sick, where and how determine medical action. The AIDS epidemic is an example of devastation wrought when a disease gathers momentum because countries deny epidemics among their citizens. In China especially, infectious disease reporting depends both on the complicated and unpredictable social organization of individuals from the bottom up, and trust that key facts will survive the labyrinth of bureaucracy and political motivations.

Epidemics gain a foothold when public health is inadequate. China's health care was once centralized and rural health cooperatives and barefoot doctors provided insurance and care to people isolated in the country. This effective though sometimes idealized system was dismantled by the government in the 1980's. Health care was privatized, barefoot doctors abandoned their traditional practices to sell pills, and the cooperatives were disbanded. Medicine became expensive and decentralized, with resources concentrated in the cities and many individuals left without access to health care. Care facilities vary widely and different areas lack cohesive policies. Depending on where someone is located, if they are sick with flu, they may not be able to access a doctor who would recognize their symptoms.

China can try to rectify its public reporting system, but this on its own would be a superficial solution to problems within the current public health system. Nor does it address issues stemming from a political system habituated to secrecy, fiefdoms, and protecting local semblances of order. Its quite likely that the reports of an isolated case of a sick duck here or there covered up larger outbreaks of H5N1. While H5N1 was a "state secret" veterinary epidemic up to 2003, it had years to gain a foothold as a virus, and perhaps there are other diseases that are also threats. H5N1 is not the only infectious disease threat, in China or elsewhere.

The world's public health now relies in part, incongruously, on cohesive individual actions from the bottom up all over the globe. Today all eyes are on China. The world depends on a different type of China, but while the country seems to be moving towards transparency, change is slow. And its not only China, effective international public health care, which includes reporting, national and international cooperation, and sound politics (the position seems unfilled), all influence the outcomes of infectious diseases. Increasingly isolated country protocols affect global public health.

Josefina Coloma and Eva Harris write in "Open-Access Science: A Necessity for Global Public Health", that all aspects of science, including research, publishing and licensing need to be made more accessible to scientists in developing countries. They argue that many of medicine's most pressing challenges persist in developing countries, yet scientists and doctors in those countries are often excluded by the less-than-international research and development processes that they depend on to address their unique medical challenges. The authors note that in every area doctors and researchers in developing countries compete unfavorably with those who have access to the collegial science environment that favors success within an ethnocentric 'western' paradigm. To address this inequity they urge that:

"...the whole spectrum of scientific endeavor should be as open access as possible, from training in laboratory and epidemiological techniques, proposal writing, and manuscript-writing skills to open-access publishing and socially responsible intellectual property policies."

In the familiar book from 1997, A Demon Haunted World, Carl Sagan dismisses ghosts and monsters and fairies and demons. He bemoans the state of science literacy.

It's a common theme. In 1883, in an article in Science, "From Superstition to Humbug" (41: 637-639) an anonymous author wrote that the natives of India "exalt[ed]" English commanders "as more than human beings". In a tone that would resonate with many anthropologists of the day, the author comments on such "savage" inclinations:

"a benighted and superstitious populance, astonished by exhibitions of power...should, for a time, turn from its own hazy gods to new and visible wonder-workers"

Unfortunately, the article goes on to say, concepts of science are similiarly treated as some supernatural power, distorted and distended by so called civilized charlatans and naifs:

"It is curious to see how those, who a generation or two ago, would have been believers in witchcraft and all things 'supernatural' are now turning to be caught in the toils of scientific charlatanry..."

The newest topic that this 19th century author is concerned with is electricity:

"It is not with any intelligent reference to these exceedingly minute [physiological] currents...a man speaks...offers to rub a weak or disabled arm because he is 'strong and full of electricity, you know'. The fact is, we don't know, and we wish the man would explain..."

He fears the subject is corrupted by media and the public:

"It should be observed, however, that the kind of half-knowledge of this subject [physics] which is frequently obtained from newspapers and even from public lectures and popular scientific books, is the very pabulum of such errors and humbugs as we have described...It is the advance from pure superstition, in which men did not reason at all, to humbug, in which they reason from false or insufficient premises to wrong conclusions...Take, for instance, the modern master of that ancient black art of divination by rods..."

The author notes hopefully -- as we ever are -- more fuel for the notion of our flawed psychology, that physics education will improve and students will learn truth from fiction via better classroom teaching techniques:

"The tendency of the times, however, is toward the objective and experimental in teaching; and it is probable that the next few years will see considerable changes in the methods of general instruction in physics."

Over a century later, we are amazed at the constancy of human nature through distracting flashes of scientific progress -- whether the appearance of progress is a sleight of hand we don't know -- but witches, ghosts and appartitions and superstitions are alive, well, and always entertaining. CNN reports on witchcraft class deductions allowed by Dutch Law. According to the story on CNN a letter from Finance Minister Joop Wijn wrote of the decision, "Under the circustances, the cost of a course to become a witch qualifies as school fees."

The teacher of witchcraft Margarita Rongen's noted to one disbelieving lawmaker: "If he would come her and try the divination rod and see how important it is to find things..."

The Committee on Science, Engineering, and Public Policy (COSEPUP), comprised of members from the National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine suggests some tactics to advance the lagging science prowess of the U.S. Their recommendations are published here in PDF or paperback form, titled "Rising Above The Gathering Storm: Energizing and Employing American for a Brighter Economic Future."

The National Academies press release for the study lists some of the actions they propose to stem what the committee views as decreased interest and competance in the U.S. for science and math. There are clear indicators of the nation's flagging abilities, they say:

• "For the cost of one chemist or one engineer in the United States, a company can hire about five chemists in China or 11 engineers in India".
• "Last year chemical companies shuttered 70 facilities in the United States and have tagged 40 more for closure. Of 120 chemical plants being built around the world with price tags of $1 billion or more, one is in the United States and 50 are in China".
• "U.S. 12th-graders recently performed below the international average for 21 countries on a test of general knowledge in mathematics and science".
• "In 1999 only 41 percent of U.S. eighth-graders had a math teacher who had majored in mathematics at the undergraduate or graduate level or studied the subject for teacher certification -- a figure that was considerably lower than the international average of 71 percent".
• "Last year more than 600,000 engineers graduated from institutions of higher education in China. In India, the figure was 350,000. In America, it was about 70,000".
• "In 2001 U.S. industry spent more on tort litigation than on research and development".

The press release summarizes the recommendations of the report:

• "[T]he creation of a merit-based scholarship program to attract 10,000 exceptional students to math and science teaching careers each year. Four-year scholarships, worth up to $20,000 annually, should be designed to help some of the nation's top students obtain bachelor's degrees in physical or life sciences, engineering, or mathematics -- with concurrent certification as K-12 math and science teachers. After graduation, they would be required to work for at least five years in public schools..."
• "Policy-makers should increase the national investment in basic research by 10 percent each year over the next seven years."
• "Each year, policy-makers should provide 25,000 new, competitive four-year undergraduate scholarships and 5,000 new graduate fellowships to U.S. citizens enrolled in physical science, life science, engineering, and mathematics programs at U.S. colleges and universities."
• "Policy-makers should provide a one-year automatic visa extension that allows international students to remain in the United States to seek employment if they have received doctorates or the equivalent in science, technology, engineering, mathematics, or other fields of national need from qualified U.S. institutions."
• "Ensure that the United States is the premier place in the world for innovation. This can be accomplished by actions such as modernizing the U.S. patent system, realigning tax policies to encourage innovation, and ensuring affordable broadband Internet access, the report says."

The report outlines clear steps for improvement. Some are controversial, for instance there are international development issues to promoting a policy of siphoning off the most promising students from foreign countries, nevertheless, for the most part these seem straight forward. However, importantly, there is no sense of buy-in from many politicians. Thomas Friedman's <