ARTICLE - EPIDEMICS OF DENIAL MUST END

HAITI: EPIDEMICS OF DENIAL MUST END
(NewScientist) - By Debora MacKenzie

Haiti's cholera outbreak is a depressing reminder that the first victim of an epidemic is often the truth, says Debora MacKenzie.

AS HAITI'S deadly cholera epidemic spreads, it may seem irrelevant to ask where the disease came from. The World Health Organization certainly thinks it is, describing the question as "unimportant".

That could not be further from the truth. Haitians themselves care deeply about how their country got cholera. There is widespread suspicion that the disease was brought in by United Nations peacekeepers from Nepal, and that the UN is now covering it up. This suspicion has sparked riots that have killed people, both directly and by impeding medical efforts.

We should care too. Haiti's cholera tragedy - more than 1600 dead and 30,000 hospitalised as New Scientist went to press - tells us something important about our highly interconnected planet, and how we should - but still don't - govern it.

Cholera bacteria thrive on poverty and disruption, and Haiti has plenty of both. The country was free of cholera when the earthquake struck in January, but when the disease broke out in October it quickly took off.

When the news broke on 20 October, suspicion fell rapidly on 454 Nepalese UN peacekeepers based in the town of Mirebalais, 60 kilometres north of the capital Port-au-Prince. Haitian officials tested the river by the base two days later.

There were reasons to suspect these Nepalese. Cholera, which is carried by faeces-tainted water, is endemic in Nepal: there was an outbreak in Kathmandu, the country's capital, just before the peacekeepers flew in from there between 9 and 16 October. Their camp in Mirebalais dumped sewage straight into a stream that led to Haiti's main central river. The first cases were in Mirebalais and downstream, areas barely touched by the earthquake. What is more, the DNA in Haiti's cholera shows it was a single, recent introduction of a strain from south Asia, though we don't know if it is circulating in Nepal.

All of this is just circumstantial evidence, of course. The UN insists it is in the clear because the tests on water on or near the base did not find cholera, and none of the peacekeepers had symptoms.

Yet this doesn't clear the matter up. Many people with the strain now circulating in Haiti do not develop symptoms but shed bacteria in their faeces up to two weeks after infection. Nor are negative water tests conclusive: cholera researchers say the bacteria are hard to find in fast-flowing rivers. To settle the matter, the Nepalese soldiers themselves should have been tested, promptly.

A single positive swab from a soldier early in the outbreak would have strongly suggested they were the source. A negative result would not have entirely cleared them - tests can produce false negatives - but it may well have calmed public suspicion.

But no such tests were done. The Nepalese government claims the water samples alone prove that its troops are not the source. The UN Mission in Haiti even phoned me out of the blue to claim that tests cannot detect cholera in symptom-free people.

They can. That is an elementary scientific fact about cholera.

Why would the UN go to such trouble? I can only conclude that they are trying to protect themselves and their people. Many Haitians dislike the UN force; dozens of peacekeepers have been killed in violent clashes since the mission arrived in 2004 to stabilise the country in the face of political upheaval.

I asked Brian Concannon, head of human rights group Institute for Justice and Democracy in Haiti, who worked for the UN in Haiti in the 1990s, what he thought. He told me that most people in Haiti already blame the UN, and that an admission of guilt - if appropriate - might not have been as damaging as the UN assumes. "I can't see that it would have led to any greater anger." It might even have defused the situation, he says.

There are broader lessons to be learned. UN peacekeepers around the world are largely supplied by poor countries, and of the top 15 contributors, which supply 71 per cent of UN troops, 12 harbour cholera. If Haiti's cholera did indeed come from Nepal, it was a foreseeable accident.

More caution is called for.

Even more importantly, Haiti reminds us that the interconnectedness of our world allows pretty much any infectious disease to travel pretty much anywhere.

We've seen it with HIV, West Nile virus, malaria, chikungunya and many more. Yet the knee-jerk reaction of every authority responsible for starting an outbreak, or letting one spread, is denial. No one wants to be the bearer of disease - but denial doesn't work, and can make things worse.

The interconnectedness of the world means that any infectious disease can travel anywhere.

Remember BSE? Starting with the UK, government after government claimed that beef was safe, or that their cows didn't have it, and resisted tests that eventually showed otherwise. Their denials and stalling allowed the disease to be shipped worldwide. In 2004, China denied having H5N1 bird flu, even though scientists knew otherwise. The delay helped the virus spread across half the world. In 2003, denial in several countries worsened SARS.

You can understand why authorities deny responsibility for diseases: they think the truth will cause unrest. But as theUK's BSE inquiry concluded, cover-ups don't dampen public dismay - they deepen it.

The big lesson from Haiti is the same as with every new disease outbreak: do the tests, find out as much as possible, and tell the truth. What part of this is so hard to learn? Denial may seem safer, but with scientists increasingly able to track pathogens, and bystanders increasingly armed with cellphones and the internet, it isn't.

Accountability matters, vitally so in a networked world. It is too late now to do those tests in Haiti. It is not too late to learn why they should have been done.

Debora MacKenzie is New Scientist's Brussels correspondent