Mexico's Health Chief Receives Plaudits
Monday, May 11, 2009
MEXICO CITY -- The face of the flu outbreak in Mexico is all bushy eyebrows and droopy mustache, and it speaks in tones deeply somber but not quite funereal. The face belongs to a previously obscure gastroenterologist named José Ángel Córdova, the health secretary, who is now the second most powerful man in Mexico.
For 17 consecutive days, Córdova has been giving the nation and the world a daily diagnosis of an epidemic -- and explaining the tough measures that he and Mexico are taking to confront it.
The treatment appears to be working, and Mexico and Córdova are winning applause from global health experts for a swift, coordinated, transparent response that probably saved lives here and abroad.
"I think we should all shout, 'Gracias, Mexico!' I believe the Mexicans have prevented a true pandemic from happening," said Laurie A. Garrett, senior fellow in the global health program at the Council on Foreign Relations and author of "The Coming Plague," a book about newly emerging infectious diseases.
Every day, sometimes twice a day, in a series of 27 nationally televised news conferences, Córdova explains his bar graphs and pie charts in a measured monotone, probably not unlike the way he might tell his patients the results of their colonoscopies.
Unlike the Chinese government, which hid SARS patients in military hospitals and stonewalled international health monitors, the Mexican health secretary takes questions from the news media as he defends often-unpopular decisions -- closing restaurants, schools and churches, and barring fans from soccer games. He explains why the government believes that "social distancing" is a vital tactic to slow the spread of the virus.
"I am like this. I will not change ever. I always have been like this," Córdova said in an interview, explaining how he has tried to communicate the threat without inciting panic. "We will continue sharing the information because we are sure this information will be useful to the other countries, and we don't wish for the other countries to suffer."
In the wake of avian flu outbreaks, some developing countries have balked at sharing samples of their viruses, out of concern that developed countries and their pharmaceutical industries are exploiting the pathogens to patent vaccines that would later be sold. Córdova said Mexico has given over samples of the virus to international organizations to help develop a vaccine.
If Mexico had not closed down commerce and government as it did, according to calculations by Óscar Mújica, an analyst with the Pan American Health Organization, the virus would have killed 8,605 people and put more than 30,000 people in the hospital. The death toll from swine flu stood at 48 people as of Sunday.
"Now you hear some people saying that it was an excessive response. But what people seem to forget is that the reason why this crisis is now coming down was because the initial response was so vigorous," said Julio Frenk, dean of the Harvard School of Public Health and Mexico's health secretary from 2000 to 2006. "I think Mexico did a great service to the rest of the global community. It gave other countries of the world time to prepare themselves."
When the outbreak began, Mexican President Felipe Calderón was constitutionally required to be protected from infection and the health secretary was required to assume extraordinary powers to control the epidemic.
This clout helped Córdova take decisive action at a time when his decisions to limit public life in Mexico were costing the country billions of dollars in lost business revenue.
"It was really complicated, because I needed to explain and try to be clear what will happen if we don't make these decisions," he said.
Calderón's support for the measures was crucial, Córdova said. From the beginning, Córdova said, Calderón's directive was: "We must move faster than the epidemic."
Mexicans have paid a heavy price. Finance Secretary Agustín Carstens officially declared Thursday that the Mexican economy was in recession and that inflation was accelerating. He forecast that the economy could contract by 4.1 percent this year because of the global financial crisis and the swine flu outbreak. The epidemic cost Mexico $2.3 billion, as consumer spending plunged and foreign tourists disappeared.
Córdova's step-by-step measures were taken from a plan devised in coordination with the World Health Organization after the earlier outbreaks of SARS, or severe acute respiratory syndrome, and avian flu. Mexican epidemiologists had run models calculating that a lethal avian flu virus could infect a million people in eight weeks and kill more than 50,000.
Such a toll was on Córdova's mind, he said, when he first heard of the outbreak of a suspicious influenza. "The first problem was this is a new virus, and nobody knows what was going to be the behavior of the new virus. Nobody knows," he said.
The confirmation that Mexico was facing a new swine-human flu came April 23 at 3:00 p.m. in a conference call with Canadian and U.S. health officials. By 11:00 that night, Córdova went on television and announced the closing of schools.
After shutting down every school in Mexico City, the government expanded the closures nationwide. Troops deployed across the capital to hand out millions of face masks to pedestrians. Within a few days, posters materialized in subways and public squares instructing people to wash their hands and go to the hospital promptly if flu symptoms manifested themselves.
Some of the measures went against the grain of Mexican society. The government barred fans from soccer games, allowing the televised matches to continue in empty stadiums. Sunday Masses were called off in one of the most Catholic countries in the world. All nonessential government and commercial activity was vastly scaled back, including restaurants, theaters, museums, movie theaters, gyms, pools and sporting events.
Despite the shock and expense of such decisions, Mexicans largely abided by the measures and the shutdown was orderly. The government stopped short of other measures, such as closing borders or stopping public transportation.
Mexico was more prepared than many countries might have been to handle such an outbreak. It had a national early warning system in place to look for unusual clusters of infectious disease. It had a stockpile of a million doses of flu treatment ready for an emergency.
"I am just floored by how good their response has been. Couldn't ask more from a country, especially a poor country, a developing country," said Paul J. Gertler, professor of health services finance at the School of Public Health at the University of California at Berkeley, who has worked in Mexico. "I think the whole world will be better prepared for what comes in the fall because of Mexico."