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WHO director general brings seasoned urgency to flu battle

Chan guided by lessons learned from SARS in '03

Margaret Chan spoke Friday as the 10-member Association of Southeast Asian Nations plus China, Japan, and South Korea met to forge a common front in the fight against the flu virus. Margaret Chan spoke Friday as the 10-member Association of Southeast Asian Nations plus China, Japan, and South Korea met to forge a common front in the fight against the flu virus. (Pornchai Kittiwongsakul/ AFP/ Getty Images)
By Gardiner Harris and Lawrence K. Altman
The New York Times / May 10, 2009
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NEW YORK - There have been few more dramatic moments at the World Health Organization than the late-night gathering on April 29 when Dr. Margaret Chan, its powerful director general, declared that the human race was in peril.

"After all, it really is all of humanity that is under threat during a pandemic," Chan said to the world's gathered news media.

Since her announcement, worry over the swine flu outbreak has eased. The Centers for Disease Control and Prevention has advised that schools reopen. And coverage of the flu outbreak no longer dominates cable news shows.

But Chan has yet to relax the alert level of the organization, the public health arm of the United Nations. That is because the warning system is based on how far the virus has spread, not its lethality. While most praise the actions of Chan and the WHO in the current outbreak, some have said that the organization needs to adjust its warning system to reflect what is known about the severity of the spreading illness.

"The WHO needs a mechanism to dial down the anxiety levels while educating us about the extent of the transmission," said Dr. William Schaffner, chairman of the preventive medicine department at Vanderbilt University.

In an interview, Chan said she had been guided in her recent decisions by her experiences during the 2003 outbreak of severe acute respiratory syndrome, or SARS, in Hong Kong, where she led the Health Department.

"That helped me to understand that managing a high pressure crisis that affects life and suffering of so many people, I need to approach it with a sense of urgency," she said.

Rules adopted in 2005 by the WHO, based in Geneva, have made Chan perhaps the most powerful international public health official in history. She no longer must beg for cooperation from national authorities but can demand information about threats to global health.

All of this authority is packed into a diminutive woman with large glasses who does not drive, type or cook, is fond of sharp suits and silver pins, and may be among the most qualified people in the world to lead the global response to the threat of a pandemic flu. "She is superbly qualified to deal with emergencies like the one we have been living through," said Dr. Julio Frenk, dean of the Harvard School of Public Health who was Chan's chief rival when she won the top WHO post in 2006.

And it all started because her boyfriend decided to move to Canada. Born in 1947, Chan grew up in Hong Kong and became a teacher. When David Chan, who would become her husband, left Hong Kong for college in Canada in 1969, she worried that the separation would end their relationship. So she consulted her mother, who told her to follow her heart to Canada. Then, when he decided to become a doctor, she worried that his medical studies would leave him no time for her. So she decided to become a doctor with him. But first, she had to win over a dean at the University of Western Ontario who, in her admissions interview, told her that she should become a homemaker, not a doctor.

Chan studied pediatrics and joined the Hong Kong Health Department in its maternal and child health group in 1978. She rose quickly to become the department's leader and faced a terrible decision in 1997 when an outbreak of avian influenza threatened the population. Fresh poultry is a Hong Kong staple, but Chan ordered the region's population of 1.4 million chickens and ducks slaughtered. The outbreak ended.

Public health experts who witnessed her handling of SARS gave her high marks.

Chan was later criticized by some in Hong Kong for failing to respond quickly enough to the 2003 SARS epidemic, although a panel of experts supported her leadership. Her rapid and urgent response to an infectious threat from Mexico last month grew out of that experience, several who knew her said.

In 2005, rules adopted by the WHO gave the director general complete authority to change the global pandemic alert level.

In her announcement on April 29, Chan made it clear that she alone had decided to raise the pandemic alert. In an interview, she said there would always be uncertainty about new disease threats.

"With any new disease, it's difficult to understand the full picture," she said. "One has to be modest to understand that we are competing against an enemy, the virus. And trying to understand it and reduce the anxiety of the world and reduce the suffering of people, that's not easy."

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