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Emily Newman

Emily Newman

WHO Contagious Disease Representative

Emily Newman was born in Iowa City in 1953. She attended the University of Michigan, earning a Master’s Degree in Public Health in 1980. After spending 14 years at the National Institute of Health, Ms. Newman joined the World Health Organization in 1994.


Questions:

1. How has the international system of reporting and containing outbreaks of dangerous contagious diseases developed?
In the mid-19th century, the increased speed of travel and larger numbers of travelers meant that outbreaks of infectious diseases could attain epidemic proportions in many countries more quickly than in previous centuries. Limiting the spread of diseases became a joint effort, with governments taking measures to contain outbreaks at home and warning other governments so they could take action to ward off spread to their countries. Success requires that governments identify outbreaks of an infectious disease soon after the initial cases appear, isolate persons who have the disease, and minimize the number of non-infected persons who come in contact with the currently infected or any place where germs are likely to be present. Seeking to avert cross-border spread of an infectious disease has long involved quarantining travelers, animals, and shipments of goods that might carry germs from places where outbreaks have occurred until after the incubation period of the disease has passed.
2. What role does the WHO currently play in containing outbreaks?
Essentially, the WHO employs a staff of health professionals to work with member governments to detect, identify, and limit the spread of infectious disease. The WHO’s origins began in the mid-1800’s with the establishment of the International Public Health Office, which worked as a multinational organization to foster cooperation between governments and prevent the spread of highly contagious diseases. The World Health Organization (WHO) as it exists today was established as a UN specialized agency after World War II. The WHO published its International Health Regulations in 1969 to develop formal international regulations on cooperation against infectious disease. These regulations were still in effect during the SARS epidemic.
3. How does the WHO work with member governments?
The WHO, as a non-governmental organization, has no enforcement powers over the member states. It doesn’t have the kind of legal power within a country that say a national health ministry would have. We cannot, for example, order hospitals or others to take particular public health measures. WHO was put in charge of a cooperative system of having national authorities provide warnings about outbreaks of infectious diseases, particularly those likely to spread across national borders, and encouraging mutual cooperation to limit the spread to as few people as possible. States can get help from WHO staff or public health agencies in other states for organizing collaborative work in identifying causes of infection and developing methods of treatment among medical labs around the world. However, states are not obligated to let WHO teams visit disease-stricken areas or have their medical labs participate in collaborative work. It’s purely voluntary on the part of the state.
4. What made the SARS case different from other outbreaks of infectious disease?
The 1969 Regulations require reporting outbreaks only of certain listed diseases, not of any new disease likely to spread. Since SARS was a new disease, there was no obligation on the part of the Chinese government to report it. No one was really sure what they were dealing with in the early days. To me, that makes it all the more important to contact an international organization like the WHO and bring in all the resources you can to find out what you’ve got on your hands and how best to stop it. The Chinese, in the initial stages, chose to handle the outbreak internally, which under the 1969 regulations they had every right to do. Would things have turned out better if the WHO had been contacted sooner? It’s not for me to guess, but we do have an awful lot of resources to bring to bear in these kinds of situations.
5. How did the SARS case affect WHO policies and procedures?
Even before the SARS case, there had been several outbreaks of other serious diseases that led us to rethink and revise our standards on the containment of contagious diseases. So that revision process was already underway when we became aware of the SARS outbreak. I would say, however, that SARS, in combination with other serious outbreaks like ebola and avian flu, certainly sped up the process. We released a updated version of the International Health Regulations in 2005 that dealt more specifically with containing new and highly contagious diseases like SARS.
6. Would things have turned out better if the WHO had been contacted sooner?
It’s not for me to guess. I do know that once we became aware of the severity of the outbreak, we worked round the clock to try to stop it. After we secured some patient samples our worldwide virology lab network went right to work on identifying what was causing the disease. We spared no effort or expense. We even set up a secure website for data exchange and daily teleconferencing. Our virologists agreed within 24 hours of opening the website that a virus was causing the disease, and about a week later 3 of our labs had isolated one of the coronaviruses that causes SARS.

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