TB Case Highlights WHO Guideline Weaknesses

RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. Good morning, I'm Renee Montagne.

STEVE INSKEEP, host:

And I'm Steve Inskeep.

We have one answer this morning to the question of how a man got on a transatlantic flight even though he had a dangerous form of tuberculosis. That question will be posed at a Senate hearing today which focuses on a man who traveled to Europe for his wedding, then came back through Canada.

In a separate examination, the World Health Organization found the international guidelines for health emergencies did not fail. The United States just never got around to using them.

NPR's Brenda Wilson reports.

BRENDA WILSON: The World Health Organization says that systems at the top for controlling major health threats were all go, but no one got the word from the bottom. In a teleconference from Geneva, Dr. Mario Raviglione, the director of WHO's T.B. Control Program, says there's a 24-hour alert and response system with someone available at all times to respond to a country facing a health emergency. But on all levels, Dr. Raviglione says, there needs to be more clarity about who issues the orders not to leave.

Dr. MARIO RAVIGLIONE (Director of T.B. Control Program, WHO): In the era of technological computerization, it should not be difficult to issue, let's say, a no-fly order or a no-leave-the-country order in a computerized way that it pops up in every computer at the police stations at the borders, wherever the border is, whether it is in the airport or a normal border - at the road or by the train, et cetera.

WILSON: And Raviglione says the WHO guidelines on tuberculosis in air travel are very clear, that a person with multi-drug resistant tuberculosis should not travel on commercial airlines unless they have been declared uninfectious.

Dr. RAVIGLIONE: If you come to know that the person says, well, I want to leave, then people are informed and read the guidelines, it would be absolutely imperative to say, no, you cannot leave, I'm sorry.

WILSON: WHO officials say the low levels of bacteria may have led local health authorities to give the patient, Andrew Speaker, confusing information about whether or not he was infectious.

Patrick Libbey, the executive director of the National Association of County and City Health Officials, says state law usually gives local health officials the authority and responsibility to manage cases of infectious disease, including patients who may be a threat to others.

Mr. PATRICK LIBBEY (National Association of County and City Health Officials): You inform them of the condition. You try and do that in language that's clearly understandable. And you have the authority to order them to restrict their travel, to restrict their movement, or in this case, what we're talking about basically is an isolation. And you do that typically with an expectation of voluntary compliance.

WILSON: In some states a court order may be required to restrict the patient's movements.

Mr. LIBBEY: I think at times it's as much about being clear in the communication as it is about the specific legal basis on which the action is taken.

WILSON: What is not clear to most observers, including Libbey, is exactly what Mr. Speaker was told. The patient has said he didn't understand that he couldn't travel. In public health the lines of authority are not always clear. If left up to local health authorities, Larry Gostin, a professor of Global Health Law at Georgetown University, says, there is no uniform standard way of proceeding.

Professor LARRY GOSTIN (Georgetown University): As we learned with Katrina, there's very little communication among agencies. There is a lack of coordination between federal, state and local agencies. And this case just simply demonstrated that there wasn't one person who was in command of all the facts, was able to take the kind of decisive action that was needed. Everybody was looking at everyone else.

WILSON: And looking at what might have been, Gostin says, the CDC should have told the patient in no uncertain terms he could not travel. Except for one little quirk, he says: the CDC cannot stop a person from leaving the country; they can only keep him from reentering.

Brenda Wilson, NPR News. Transcript provided by NPR, Copyright NPR.