[Ip-health] IHT: At WHO, a chief cut from Hong Kong cloth

[Sheila.SHETTLE@geneva.msf.org]

International Herald Tribune=0D
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At WHO, a chief cut from Hong Kong cloth=0D
By Elisabeth Rosenthal=0D
Friday, January 5, 2007=0D
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NEW YORK=0D
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She was nominated by the People's Republic of China to be chief of the=0D
World Health Organization and has been repeatedly dubbed "the Chinese=0D
candidate." But there is little in terms of style or history that links Dr.=
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Margaret Chan, who this week took office as the agency's new director=0D
general, to the country she still calls "mainland China."=0D
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Raised in the British colony of Hong Kong and trained as a doctor in=0D
Canada, Chan was Hong Kong's chief public health official from 1994 to=0D
2003, an extraordinary decade that spanned not only the territory's return=
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to China, but also two public health crises: the first outbreak of H5N1=0D
avian influenza, or bird flu, in 1997, and the 2003 epidemic of severe=0D
acute respiratory syndrome, or SARS, which killed 800 people worldwide,=0D
nearly a third of them in Hong Kong.=0D
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Weathering each crisis with a direct, outspoken approach, Chan proved to be=
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more of a no-nonsense British civil servant than a Chinese Communist Party=
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bureaucrat.=0D
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Throughout her tenure, Chan was best known for her differences with Chinese=
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officials over how to handle health issues =E2=80=94 from counterfeit medic=
ines to=0D
infectious diseases. During the SARS and bird flu outbreaks, the Hong Kong=
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government published painstaking daily updates on illness and death, while=
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China =E2=80=94 the place that many scientists believe both viruses origina=
ted =E2=80=94=0D
worked hard to cover up the problems, allowing the diseases to spread.=0D
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At home in Cantonese and English, Chan admits that her Mandarin =E2=80=94 t=
he=0D
official language in China =E2=80=94 is slightly ragged. And Chinese offici=
als must=0D
cringe a bit when she refers to "mainland China," a term regarded as=0D
something of an aberration in Beijing, where language is chosen carefully=
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to avoid lending credence to the concept of a separate, independent Taiwan.=
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At Beijing's urging, the WHO has repeatedly voted to reject Taiwan's=0D
requests to attend the organization's yearly meeting as an observer. In a=
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press conference Thursday, Chan said that this would not change, but that=
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Taiwanese scientists would be able to attend WHO meetings as technical=0D
experts, in accordance with a policy established in 2005.=0D
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Chan, 59, said that she was surprised when officials in Beijing called last=
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fall to tell her they wanted to nominate her to lead the United Nation's=0D
health agency.=0D
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Before she accepted, "I said, 'I really need to understand why China wants=
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to nominate me,'" said Chan, a chatty woman who wore a fashionable black=0D
pantsuit at a recent interview near the United Nations.=0D
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Subsequent discussions convinced her that China was ready to become a more=
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active and open participant in global health matters. "I said: 'Good, all=
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right, if you're really interested I'm happy to take on this challenge. But=
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don't think I'm going to let you off the hook.'"=0D
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Still, during the highly politicized campaign for WHO leadership last year,=
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many experts objected that Chan lacked the clout and experience for the job=
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=E2=80=94 and to stand up to China. Since then, some detractors have soften=
ed these=0D
views.=0D
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Chan's new position could quickly put her at odds with Beijing.=0D
International scientists complain that China is still playing down its bird=
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flu problem and has been slow to share virus samples that would allow them=
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to develop better vaccines.=0D
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"It is a huge step moving from managing a health department of a British=0D
colony to managing a global health system, but I'm less worried about that=
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now," said Dr. Richard Horton, editor of The Lancet, a medical journal, who=
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had previously questioned Chan's qualifications.=0D
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"In her speeches so far, she's sent strong signals about her intentions =E2=
=80=94=0D
to focus on Africa and women. And I think that should be applauded."=0D
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Some doctors who worked with Chan when she was in Hong Kong, who spoke on=
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the condition of anonymity, regard her vault to power as unwise, even=0D
surreal, "like making a colonel head of the armed forces."=0D
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Chan knows that she faces enormous challenges. Last year, WHO announced=0D
that it would take a more active role in ensuring that expensive medicines=
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were available to poor people in the developing world. With the rapid=0D
spread of bird flu, the agency has become the de facto coordinator for=0D
preparedness against pandemics.=0D
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Chan, who has been WHO's chief communicable disease official for the past=
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two years, will have to show "much stronger engagement" in confronting drug=
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companies in patent disputes so that poor people can get medicines for HIV=
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and malaria, said Tido Von Schoen Angerer, of Doctors Without Borders'=0D
Campaign for Essential Medicines.=0D
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To promote women's health, she will have to champion improved access to=0D
contraception and abortion, said Horton, moves that are opposed by the U.S.=
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government.=0D
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Chan says that she believes in "coming together rather than confrontation"=
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and hopes that her "access" in Beijing will help to improve collaboration=
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on bird flu, for example.=0D
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But she insists she will not compromise on things like the need to share=0D
viral samples and will fight, if required.=0D
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Born in Hong Kong in 1947, Chan had planned on becoming a teacher. Instead,=
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she followed the man she would later marry, David Chan, to medical school=
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in Canada. "I gave up my teaching career to study medicine with him," she=
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said. "Now he says it's his turn to retire early to join me in Geneva."=0D
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Returning home, she rose steadily through the bureaucratic ranks of the=0D
Hong Kong health department, becoming director in 1994. Despite pressure=0D
from Beijing, she banned imports of substandard foods and medicines from=0D
across the border in China. "I also banned ice cream from the U.S.," she=0D
says, with a smile.=0D
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But bird flu and SARS were Chan's trial by fire, catapulting her into the=
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international limelight. On December 29, 1997, to combat the first=0D
recognized outbreak of H5N1 avian influenza in people =E2=80=94 four had di=
ed in=0D
Hong Kong =E2=80=94 Chan ordered all 1.2 million chickens and ducks in the =
city=0D
killed and closed down live poultry markets. That draconian strategy has=0D
become a model for controlling the disease in outbreaks taking place=0D
elsewhere.=0D
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After the SARS outbreak in 2003, a Hong Kong legislative panel concluded=0D
that Chan had failed to respond quickly enough, ignoring rumors that the=0D
deadly pneumonia was killing people in neighboring Guangdong Province.=0D
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But many experts say that the real culprits were the Chinese officials who=
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refused to share data. Chan told the panel that the Guangdong health=0D
department had failed to respond to her numerous inquiries, regarding=0D
infectious disease as a state secret.=0D
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Once SARS was confirmed in Hong Kong, Chan organized daily briefings,=0D
displaying a candidness that displeased some Chinese officials, who were=0D
convinced that the term SARS had been created by the World Health=0D
Organization "to discredit Hong Kong," she said. (The Chinese territory is=
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officially known as the Hong Kong Special Administrative Region, or Hong=0D
Kong SAR.)=0D
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"The leadership in mainland China has moved a long way since then," she=0D
said. "Hong Kong demanded transparency. They know what kind of person I=0D
am."=0D
=0D
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+++++++++++++++++++++=0D
Sheila Shettle=0D
Senior Communications Officer=0D
M=C3=A9decins Sans Fronti=C3=A8res=0D
Campaign for Access to Essential Medicines=0D
Rue de Lausanne 78=0D
1211 Geneva, Switzerland=0D
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