[Congressional Record Volume 149, Number 56 (Tuesday, April 8, 2003)]
[Senate]
[Pages S4950-S4952]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            WORLD HEALTH DAY

  Mr. SARBANES. Mr. President, since 1948 the nations of the world have 
celebrated April 7 as World Health Day. Yesterday marked this day, 
which serves two important and related purposes. It focuses world 
attention on a specific international health issue that in the judgment 
of the World Health Organization, WHO, poses immediate and urgent 
problems. Further, it is a platform for marshaling resources to address 
this issue, through programs that will continue long after the day 
ends.
  In years past World Health Day has focused on such crucial matters as 
the global eradication of polio and emerging infectious diseases. This 
year's theme is broad: ``Healthy Environments for Children,'' and it 
has never been more timely. While we have made great progress in the 
treatment of infant diarrhea, typhoid, typhus, cholera, yellow fever, 
malaria, dengue fever, and other environment-based diseases, access to 
treatment is limited or nonexistent in many parts of the world. As a 
result, every year more than 5 million children--the most vulnerable 
members of society--die before reaching the age of 14. When war or 
civil conflict disrupts life, the danger of infection rises, as it does 
among those living in refugee camps. But there is no escaping the risk 
anywhere that water is contaminated, food unsafe, air polluted, and 
sanitation systems unreliable. Children fall ill in the very places 
where they live.
  From our experience in treating infant diarrhea we know that 
treatment can be effective and efficient. Every year, 1.3 million 
children die of diarrhea often resulting from lack of access to safe 
drinking water or consuming dirty food. These deaths are preventable. 
If a child has diarrhea, a simple and effective sugar-and-salt solution 
called oral rehydration can treat severe loss of fluids in the body. 
The cost is minimal: just under 30 cents per child--this low-technology 
solution can save these children's lives. This year's World Health Day 
is a call to redouble our efforts not only to treat environment-based 
diseases where they occur, but especially to eliminate the conditions 
where they are bred. It can be done.
  As the grave respiratory infection known as severe acute respiratory 
syndrome, or SARS, appears to be spreading rapidly, World Health Day is 
also an appropriate time to consider the vital role that the World 
Health Organization plays in our interconnected world, where mobility 
literally gives wings to life-threatening diseases. Today's New York 
Times documents the

[[Page S4951]]

spread of SARS, under a headline reading ``Fear Reigns as Dangerous 
Mystery Illness Spreads.'' SARS apparently first appeared in China last 
November. In February, when the Chinese Government began reporting 
cases to WHO, the organization undertook a major international tracking 
effort, and on March 15 WHO took what the New York Times describes as 
``the highly unusual step of issuing the global health alert.'' Just 
last week the Chinese Government permitted a WHO team to begin work on 
location, in the southern Chinese city of Guanzhou, where the infection 
rate is very high. WHO has also created a network of infections-disease 
laboratories in countries around the globe, and the truly extraordinary 
work undertaken in these laboratories has led to the tentative 
identification of the infectious agent. This marks a tremendous step in 
dealing with the intensifying threat to world health that SARS poses. 
According to the New York Times, SARS ``has become an international 
epidemic,'' and WHO is instrumental in organizing the international 
response.
  It is not just that WHO provides the administrative framework for a 
coordinated response to health issues; its personnel are on the front 
lines in every effort to keep diseases from spreading and in treating 
the victims. For the most part we do not know their names, but we do 
know that they have dedicated their skill and even their lives to WHO's 
mission.
  A WHO physician--Dr. Carlo Urbani, Director of Infectious Diseases in 
the Western Pacific Region for WHO--was the first to recognize SARS as 
a new and deadly disease. He threw himself into the fight to control 
the disease when he saw his first case, in Vietnam, persuading the 
government to adopt infection-control and isolation procedures. He is 
credited, said the New York Times, with ``shutting down Vietnam's first 
outbreak,'' and he was the first to alert the international medical 
community to the danger. Within weeks of his first intervention with a 
patient, however, he was infected. His heroic efforts cost him his 
life.
  Dr. Urbani's medical specialty was worms--nematodes, trematodes, 
hookworms and other parasites, which are, in the words of his WHO 
colleague, Dr. Kevin Palmer, ``a really basic problem for every child 
in the tropics.'' He knew how much damage these parasites do, and also 
how relatively little it would take to eliminate this scourge: a 3-cent 
pill given twice yearly to schoolchildren. His own efforts fell 
squarely within the broader campaign to create ``healthy environments 
for children.'' At the time of his death he was working to secure the 
cooperation of school systems throughout southeastern Asia.
  An eloquent account of Dr. Urbani's career in medicine and his 
tragic, too-early death appears in the today's edition of the New York 
Times. I ask unanimous consent to have the entire story, ``Disease's 
Pioneer Is Mourned as a Victim,'' printed in the Congressional Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (See exhibit 1.)
  Mr. SARBANES. SARS is only the most recent of the many international 
health emergencies that WHO has faced. In the complex effort to reduce 
the spread of HIV/AIDS, WHO also plays an important part. It is 
estimated that of the roughly 750,000 new HIV cases in children each 
year, more than 400,000 could be prevented by treating the most common 
route of infection, mother-to-child transmission, (MTCT). As in the 
case of infant diarrhea, we know that simple, cheap and effective 
interventions are available. The drug nevirapine, for example, reduces 
the likelihood of transmission of HIV from a mother to her newborn by 
up to 47 percent. It is administered in a single dose to the mother at 
the onset of labor and in a single dose to the baby in its first 3 days 
after delivery. The intervention costs less than $4, and the drug is 
now available at minimal or no cost in most countries where poverty 
levels are high and resources scarce. The use of nevirapine to address 
MTCT is based on the work and recommendations from WHO.
  There is hardly any country, no matter how well guarded its borders, 
which can be confident of remaining immune from the urgent health 
problems that beset the world. In fact, for more than half a century 
the World Health Organization has served us well. Most recently, as 
SARS has spread WHO has stepped into the breach, collecting and 
disseminating information and facilitating an international response. 
In oral rehydration and MTCT projects, we have seen how effectively WHO 
can intervene. We must respond vigorously, therefore, as WHO calls on 
us on World Health Day 2003 to confront and vanquish the environmental 
causes that bring unnecessary illness and death to millions of the 
world's children every year. WHO is working to turn this year's 
initiative into an effective global alliance, to bring to local 
communities the resources necessary to raise the health standards of 
children most at risk, and thereby transform their lives. The benefits 
from these efforts will surely ripple outwards: to families, to 
communities, and indirectly to us all. By supporting WHO we can, and we 
should, make a difference.

               [From The New York Times, April 8, 2003.]

                Disease's Pioneer Is Mourned as a Victim

                       (By Donald G. McNeil, Jr.)

       When the microbe that causes severe acute respiratory 
     syndrome is finally isolated, some people will know what to 
     call it. They want a Latin variation on Carlo Urbani's name.
       If SARS was an infectious cloud blowing out of southern 
     China, Dr. Urbani was the canary in its path. Working in a 
     hospital in Hanoi, Vietnam, as a mysterious pneumonia felled 
     one nurse after another, he sang out the first warning of the 
     danger, saw the world awaken to his call--and then died.
       If not for the intuition of Dr. Urbani, director of 
     infectious diseases for the Western Pacific Region of the 
     World Health Organization, the disease would have spread 
     farther and faster than it has, public health officials 
     around the world say.
       It was a tricky call. There is nothing as telltale about 
     the disease as the bleeding of a hemorrhagic fever or the 
     bumps of a pox, and its symptoms mimic other respiratory 
     conditions.
       Dr. Urbani, 46, died on March 29, a month after seeing his 
     first case and 18 days after realizing he was coming down 
     with the symptoms himself.
       ``Carlo's death was the most coherent and eloquent epilogue 
     his life could produce,'' said Nicoletta Dentico, a friend 
     from the Italian chapter of Medecins Sans Frontieres, or 
     Doctors Without Borders, which Dr. Urbani once headed. ``His 
     death was as a giver of new life.''
       And it was in keeping with his medical philosophy. When Dr. 
     Urbani spoke in 1999 at the ceremony in which Doctors Without 
     Borders accepted the Nobel Peace Prize, he described doctors' 
     duty ``to stay close to the victims.'' ``It's possible to 
     study an epidemic with a computer or to go to patients and 
     see how it is in them,'' said Dr. William Claus, the group's 
     emergency coordinator for Asia. ``Carlo was in the second 
     category.''
       In Italy, he had pushed the organization into working with 
     the poorest of the poor, with Gypsies in Rome and with 
     African and Albanian boat people who were landing in Sicily 
     and Calabria.
       Even as a student, said Fabio Badiali, a childhood friend 
     who is now mayor of Castelplanio, their hometown on the 
     Adriatic Coast, he had been a volunteer, organizing groups to 
     take the handicapped on countryside picnics. As a family 
     doctor, he had taken vacations in Africa, traveling with a 
     backpack full of medicine.
       He had accepted the W.H.O. post, friends said, because he 
     wanted to be back in the third world and working with 
     patients. It was that instinct that took him to the bedside 
     of Johnny Chen, an American businessman who entered Vietnam-
     France Hospital in Hanoi on Feb. 26 with flulike symptoms.
       Dr. Urbani might not have been an obvious choice as a 
     consultant in Mr. Chen's case. In his heart, friends said, he 
     was ``a worm guy,'' a specialist in parasites.
       ``Other people didn't think worms were sexy,'' said Dr. 
     Kevin L. Palmer, W.H.O.'s regional specialist in parasitic 
     diseases and a friend. ``but it's a really basic problem for 
     every child in the tropics.''
       Dr. Urbani was an expert in Schistosoma mekongi in Vietnam, 
     in the food-borne nematodes and trematodes of Laos and 
     Cambodia and the hookworms of the Maldives.
       Dr. Lorenzo Savioli, who worked with Dr. Urbani in the 
     Maldives, said they worked from sunup to sundown, ignoring 
     the famous beaches and reefs, tracking hookworm epidemiology 
     and training workers at a malaria control laboratory, who 
     were used to working with blood, in testing for worms. Over 
     rice and fish in the evenings, Dr. Savioli said, they had 
     joked, ``Nobody at headquarters was going to believe we were 
     spending our days in the Maldives over fecal samples.''
       Dr. Urbani was a worm zealot, Dr. Palmer said, because they 
     did so much damage but could be so easily treated. For 
     example, he said, a 3-cent pill administered to 
     schoolchildren twice a year could rid them of most intestinal 
     worms. Dr. Urbani was working to have school systems in 
     southeastern Asia cooperate.
       He also attacked a worm that lived on fish farms. He could 
     not get Cambodians and Laotians to give up eating undercooked 
     fish,

[[Page S4952]]

     Dr. Palmer said, but he hoped to solve the problem by 
     teaching fish farmers to divert sewage from their ponds.
       He was also testing the use of a veterinary drug to kill 
     worm larvae that can reach human brains and cause seizures.
       And, said Daniel Berman, a director of the Doctors Without 
     Borders campaign for cheaper lifesaving drugs, Dr. Urbani was 
     pushing Vietnamese farmers to grow more sweet wormwood, a 
     plant that can produce artemisinin, a new malaria cure.
       Still, when a troublesome case turned up in Hanoi, Dr. 
     Palmer said, the W.H.O. staff usually said, ``Call Carlo,'' 
     because he was also known as an expert clinical 
     diagnostician.
       Mr. Chen was such a case, suffering with pneumonia and 
     fever, as well as a dry cough. The hospital suspected that he 
     had the Asian ``bird flu'' that killed six people in 1997 and 
     was stopped by rigid quarantines and the slaughter of 
     millions of chickens and ducks.
       Rumors of a mysterious pneumonia had been coming out of the 
     Guangdong region of southern China, but the Chinese 
     authorities had been close lipped, even instructing local 
     reporters to ignore it.
       Although no one then realized the significance, Mr. Chen, 
     48, had also stayed in the Metropole Hotel in Hong Kong. He 
     may have picked up the disease from a 64-year-old Guangdong 
     doctor in town for a wedding, staying in Room 911. 
     Investigators theorize that the doctor infected 12 other 
     guests, several from the same floor, who carried the disease 
     to Singapore, Toronto and elsewhere.
       By the time Dr. Urbani arrived at Vietnam-France Hospital, 
     the microbe that Mr. Chen carried was spreading. Before he 
     died, he infected 80 people, including more than half of the 
     health workers who cared for him. The virulence of his case 
     alarmed world health officials, helping lead to the 
     extraordinary health alert that W.H.O. issued on March 15. 
     But Dr. Urbani, who first saw Mr. Chen in late February, 
     quickly recognized that the disease was highly contagious and 
     began instituting anti-infection procedures like high-filter 
     masks and double-gowning, which are not routine in 
     impoverished Vietnam. Then he called public health 
     authorities.
       Dr. Palmer recalled Dr. Urbani's conversation: ``I have a 
     hospital full of crying nurses. People are running and 
     screaming and totally scared. We don't know what it is, but 
     it's not flu.''
       On March 9, Dr. Urbani and Dr. Pascale Brudon, the W.H.O. 
     director in Hanoi, met for four hours with officials at the 
     Vietnam Health Ministry, trying to explain the danger and the 
     need to isolate patients and screen travelers, despite the 
     possible damage to its economy and image.
       ``That took a lot of guts,'' Dr. Palmer said. ``He's a 
     foreigner telling the Vietnamese that it looks bad. But he 
     had a lot of credibility with the government people, and he 
     was a pretty gregarious kind of character.'' With dozens of 
     workers at the hospital sick, it was quarantined on March 11. 
     Infection-control practices were instituted at other 
     hospitals, including the large Bach Mai state hospital, where 
     Dr. Claus of Doctors Without Borders oversaw them. Dr. 
     Urbani's quick action was later credited with shutting down 
     Vietnam's first outbreak.
       In the middle of it, Dr. Savioli said, Dr. Urbani had an 
     argument with his wife, Giuliani Chiorrini. She questioned 
     the wisdom of the father of three children ages 4 to 17 
     treating such sick patients. Dr. Savioli said Dr. Urbani 
     replied: ``If I can't work in such situations, what am I here 
     for? Answering e-mails, going to cocktail parties and pushing 
     paper?'' In an interview with an Italian newspaper, Ms. 
     Chiorrini said her husband knew the risks. ``He said he had 
     done it other times,'' she recalled, ``that there was no need 
     to be selfish, that we must think of others.''
       But on March 11, as he headed to Bangkok for a conference 
     on deworming schoolchildren, he started feeling feverish and 
     called Dr. Brudon. ``He was exhausted, and I was sure it was 
     because he had had a lot of stress,'' Dr. Brudon said later. 
     ``I said, `Just go.' ``But she had second thoughts. ``I 
     called my colleagues in Bangkok and said, `Carlo doesn't feel 
     well, and we should be careful.' ''
       Dr. Scott Dowell, a disease tracker for the federal Centers 
     for Disease Control and Prevention, who is based in Thailand, 
     met him at the Bangkok airport near midnight. Dr. Urbani, 
     looking grim, waved him back. They sat in chairs eight feet 
     apart until an ambulance arrived 90 minutes later, its 
     frightened attendants having stopped for protective gear.
       For the first week in a Bangkok hospital, Dr. Urbani's 
     fever receded, and he felt a bit better. But he knew the 
     signs. ``I talked to him twice,'' Dr. Palmer said. ``He said, 
     `I'm scared.' ''
       That was uncharacteristic for a man who was known as big, 
     charming and full of ironic wit. In Italy, he staved off 
     boredom by hang gliding. In Hanoi, he negotiated the insane 
     traffic on a motorcycle and took his children on overnight 
     car jaunts to rural villages. He carried Bach sheet music and 
     stopped at churches, asking if he could play. W.H.O. experts 
     flew in from Australia and Germany to help. One scoured 
     Australian drug companies for ribavirin, a toxic antiviral 
     drug that was said to have helped some cases. It did not help 
     Dr. Urbani, though, and was withdrawn.
       Then patches showed up on a lung X-ray, and he told his 
     wife to take the children and return to Castelplanio. 
     Instead, she sent them ahead and flew to Bangkok. By the time 
     she arrived, his room had been jury-rigged as an isolation 
     ward. Carpenters had put up double walls of glass, and fans 
     had been placed in the window to force air outside.
       The couple could talk only by intercom, and Ms. Chiorrini 
     saw him conscious just once. As his lungs weakened, Dr. 
     Palmer said, he was put on a respirator. In a conscious 
     moment, Dr. Urbani asked for a priest to give him the last 
     rites and, according to the Italian Embassy in Bangkok, said 
     he wanted his lung tissue saved for science.
       As fluid filled his lungs, he was put on a powerful 
     ventilator, sedated with morphine. The end came at 11:45 on a 
     Saturday morning. Doctors and nurses heavily shrouded in 
     anti-infection gear pounded on his chest as his heart stopped 
     four times, Dr. Dowell said, but it was useless.
       Most of those who had died of SARS were old or had some 
     underlying condition that weakened them, but ``he worked with 
     patients for weeks, and we suspect he got such a massive dose 
     that he didn't have a chance,'' Dr. Palmer said. ``It's very 
     sad,'' Dr. Claus said, ``that to raise awareness as he did, 
     you have to pay such a price.''

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