The Fatal Strain (39 page)

Troedsson was no influenza specialist. He was a Danish doctor who had previously been responsible for children’s health issues at WHO. But as the agency’s chief representative in Vietnam, Troedsson essentially held the rank of ambassador. Flanking him were six other foreigners, including senior figures from the United Nations, World Bank, and European Commission.

The Vietnamese side was led by Deputy Prime Minister Nguyen Tan Dung. Considered a reformer within Communist Party ranks, Dung would be promoted a year later to become his country’s youngest prime minister since Vietnam was reunified. He was joined at the table by the agriculture minister and his deputy, the deputy health minister, and five other top officials. Such audiences with senior dignitaries would often merit a few minutes on Vietnam’s nightly news and a mention in the morning papers. But this one was to be strictly confidential.

After opening formalities, Troedsson explained to Deputy Prime Minister Dung the significance of the recent lab findings. They indicated that bird flu infections in Vietnam were more common than previously thought.

“Vietnam could be on the verge of experiencing a nationwide epidemic, which could spread globally and cause a pandemic,” Troedsson continued. If an epidemic broke out, it could do serious harm to Vietnam’s economy and the health of its people. If went global, it could kill as many as 40 million people. So, he warned, WHO might have to elevate the pandemic alert level to either four or five if the test results were accurate. Several UN agencies stood ready to help Vietnam fight
the virus and prepare for a pandemic. But the troubling lab results had to be checked by international experts, he insisted. This was urgent.

Troedsson closed with a veiled threat. If the results could not be checked, WHO might have to raise the alert level as a “precautionary measure.”

Then, one by one, Troedsson’s colleagues tightened the vise. Jordan Ryan, the UN’s ranking official in the country, told the Vietnamese it was no longer question of
if
a pandemic was coming but
when
, and he urged Dung to do the right thing. Ryan’s counsel carried weight. A dozen UN agencies were active in Vietnam, engaged on multiple fronts, ranging from agriculture to childhood nutrition.

Next came Klaus Rohland, who ran the World Bank office in Vietnam. Over the years, Vietnam had received more than $5 billion in foreign aid for development, and the World Bank was in charge of coordinating that. Rohland told Dung that his country now faced a situation that could be “disastrous.” He strongly advised him to accept WHO’s offer of assistance.

Finally, Ambassador Markus Cornaro, head of the European Commission’s delegation in Hanoi, warned that foreign donors to Vietnam were counting on the government’s full cooperation. How the government responded to the “offer of international support” would indicate the degree of trust and cooperation between Hanoi and the donors, Cornaro told him.

The words were diplomatic, the threat unmistakable.

Dung listened intently to his visitors. Then he listened to presentations from his own health officials outlining the lab findings in greater detail.

When everyone else had finished, Dung vowed that Vietnam was concerned for the welfare of the whole world, not just itself, and wished to be proactive, neither complacent nor hasty. And so, Dung said, he would propose inviting an international team of experts to work with Vietnamese scientists in checking the recent lab findings and exploring the wider threat. The team could come immediately, but on the condition that the lab findings remained secret until the review was done.

It seemed WHO had gotten its way. But when Troedsson reported back by telephone an hour later, Stohr and his colleagues in Geneva doubted Vietnam’s intentions. Hanoi hadn’t said anything about actually turning over the original lab samples for independent testing, and nothing less would do.

“It’s a trap,” warned one senior official in Geneva.

Troedsson didn’t want to dally. The deputy prime minister had offered full cooperation and Troedsson took him at his word. What Troedsson didn’t say was that some of his staff in Hanoi believed time was already up and the pandemic was under way.

“It’s urgent here,” he pressed. “We want to have a team here next week. Klaus, don’t let us down on this one.”

When the conference call was over, Stohr and his colleagues in Geneva were agitated. “We didn’t get the message across to Vietnam,” Stohr grumbled.

But could they afford to continue bickering with the Vietnamese?

“We have to get a team in there as fast as possible,” urged Tom Grein, the veteran investigator who helped coordinate the global response to Vietnam’s early outbreaks a year before. “Six hours on the ground, ask for the samples.” If Vietnam balks, Grein added, “WHO has to have the guts to pull the team out.”

 

 

That week, Yan Li, the Canadian scientist at the center of the storm, sent an e-mail to many of those who had participated in the secret conference call the previous Friday. He said he agreed with their criticisms of his Western blot study and wanted to explain why he had proceeded with this technique.

Li said it would have been difficult to analyze the serum samples using a more reliable test because the Vietnamese didn’t have the proper lab safeguards. “Therefore, it would be better for us to first use the Western blot method for initial testing and provide on-site training to Vietnamese scientists to use this technique in their regular laboratory,” he said. “But the prerequisite was that all, or at least those serum samples initially screened positive by Western blot, be sent back to us so we can further test them.” Li’s own lab in Winnipeg could perform the verifying tests.

After the initial tests came back positive, Li wrote that he had repeatedly told officials from NIHE and WHO that “these were very preliminary results” that could reflect contaminated samples and would have to be retested using a more established method. “It was clear to us,” he said, “that the Western blot method was only for initial screening and training but not for the final decision-making test.”

Dr. Frank Plummer, scientific director general of the National Microbiology Laboratory in Canada where Li worked, later provided me with a similar account of the Canadian collaboration with the Vietnamese, adding that the results of the Western blot tests were supposed to have remained private. “This interim information was neither meant for distribution nor for decision making,” Plummer said. He called it unfortunate that the information was shared with officials, prompting public health concerns.

To some at WHO, Li’s defense rang hollow. They’d heard something similar from the Canadians before, two years earlier, to be precise. That’s when a baffling respiratory outbreak had raced through a nursing home in the suburbs southeast of Vancouver, Canada, and Li’s lab had weighed in with an alarming and ultimately misleading diagnosis.

In the first week of July 2003, scores of elderly residents at the 144-bed Kinsmen Place Lodge in Surrey, British Columbia, started coming down with the sniffles. So did dozens more of the staff. By August about a hundred residents and at least forty-five staff members had developed what looked like a summer cold. Seven residents had died during that period, not an unusually high number for the home. But pneumonia was implicated in three of the deaths, and that was worrisome. Initial tests at several Canadian labs failed to identify the cause of the outbreak. Then, Plummer announced to the media that his scientists had discovered it was SARS.

The revelation rattled Canada. The country was still on edge after the global SARS epidemic earlier in the year. Toronto, Canada’s premier city, had experienced the largest outbreak outside Asia and 250 people had fallen sick. Forty-four had died. Li and his colleagues at the National Microbiology Lab had been deeply involved in researching that epidemic.

The new cases at Kinsmen Place Lodge certainly didn’t look like the same SARS. Most were mild and nearly everyone recovered. But Li’s lab was now reporting that its genetic analysis had revealed an almost perfect match with SARS. Separate tests conducted by the lab on samples from the nursing home had also found antibodies to the SARS
Coronavirus
. The virus could be returning in a new, unpredictable form. WHO urgently dispatched a SARS expert from Geneva to investigate.

In suburban Surrey, the six-story brick nursing home was placed under quarantine. Ill patients were put into isolation. A sign on the front door greeted visitors: STOP. RESPIRATORY OUTBREAK. STRONGLY RECOMMENDED YOU DO NOT ENTER THE BUILDING. For days, residents could only wave through the windows to relatives on the sidewalk below. At Surrey Memorial Hospital, nineteen health-care workers who had contact with a patient from the nursing home were restricted to home quarantine. Then another nursing home in western Canada reported a similar outbreak.

As time passed, however, tests at other labs, including CDC Atlanta, failed to turn up SARS in the samples. Instead they isolated another
Coronavirus
called OC43, known to cause common colds. Both WHO and Canadian officials ruled out a new SARS outbreak, and the quarantines were lifted. The misdiagnosis by the National Microbiology Lab was ultimately blamed on a combination of contaminated lab samples and overly sensitive tests that generated false positives. The lab’s reputation took a drubbing.

Li later told the
Wall Street Journal
that his lab’s results had only been preliminary and were faxed out to the public without his permission.

So as a crack team of investigators secretly set out for Hanoi in June 2005, they suspected that Li’s Western blot results on the samples from northern Vietnam were flawed also. That thought offered a measure of comfort. But there were still those disturbing results from the separate PCR tests conducted by the Vietnamese, and the Vietnamese had a good track record.

Maria Cheng was in China when she took the call asking her to head for Hanoi. Her colleagues in Geneva told her that something was going on in Vietnam but they weren’t sure what. They were more nervous than she’d ever seen them. “They were really scared about what was going on. They thought the pandemic was starting,” she recalled.

Cheng was a bright, young Canadian journalist who had written from Asia for several publications before WHO hired her in the middle of the SARS epidemic to help handle the flood of press calls. She impressed her seniors in Geneva and, after that crisis faded, stayed on, expanding her communications portfolio to include bird flu, polio, and other diseases, splitting her time between headquarters and the field. She was an old hand at flu by the middle of 2005. Yet she didn’t realize how serious the situation might be in Vietnam until Dr. Julie Hall, an influenza expert in WHO’s Beijing office, sat her down.

“If there is a pandemic and you get infected, you’re stuck there,” Hall told her. “Are you really going to do this?”

Cheng said yes.

The Beijing staff showed her how to properly wear a mask fitted to the contours of her face and sent her off.

“It was freaky,” she recounted.

The Vietnamese government had decided, after all, to cooperate with the special mission and provide the required lab samples. By coincidence, Prime Minister Phan Van Khai was due that same week to make the first trip ever to the United States by a top Vietnamese Communist leader, and this was no time to pick a fight. In an interview with the
Washington Post
on the eve of his trip, Khai signaled his government’s good intentions. “Due to the limited capacity and conditions in scientific research facilities, therefore, we are working closely with the international community,” he said. “A sample has been provided for international experts and foreign countries to carry out joint research.”

In Geneva, Margaret Chan was planning for the worst. Just days earlier, she had been brought in as WHO’s new director of communicable diseases and special representative for pandemic flu. She
instructed Stohr to draw up a new list of experts who could advise the director general, Dr. Lee, about whether to sound a pandemic alert once the special team reported back. She recognized this would be as much a political determination as a scientific one.

“They should be from different backgrounds,” she told Stohr. “We need policymakers or advisors to ministries of health, not pure scientists.”

Chan was also concerned that news of the mission would leak. She called Hitoshi Oshitani in the regional office, and they agreed that the agency would say as little as necessary.

In Vietnam, Maria Cheng would have the unenviable task of trying to keep the press in the dark without actually lying to them. It would be hard to miss the foreign scientists that began descending on Hanoi on Monday, June 20. The elite team included Masato Tashiro, the chief virologist from Japan’s NIID; Angus Nicoll, an epidemiologist who was then head of communicable diseases for the British Health Protection Agency; and Oshitani. Also joining the mission was Nancy Cox, the CDC Atlanta’s influenza chief, who would finally get to make sure that the questionable lab findings were properly verified.