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Brundtland launches new-look WHO
POLICY AND PEOPLE
News in brief French former ministers charged Former Prime Minister of France, Laurent Fabius, together with his Social Affairs Minister Georgina Dufoix and Health Minister Edmond Hervé are to be tried in court on charges of involuntary homicide. The ministers were in power during 1984–85, when HIVcontaminated blood was knowingly used for transfusions. The charge carries a maximum sentence of 5 years and a fine. European disease surveillance July 15 saw a landmark agreement between the European Parliament and member state governments on a system for epidemiological surveillance and control of communicable diseases. The Parliament won the right for the European Commission, rather than a committee of national government experts, to govern the system. Under the legislation, the network will monitor—and offer an early warning and response system—to a non-exhaustive list of diseases. A structure for the operation of the new surveillance system has yet to be decided.
Brundtland launches new-look WHO
T
he first official act by Gro Harlem Brundtland after becoming WHO Director-General on July 21 was to apply a new code for “standards of conduct and financial disclosure”. This obliges all high-level WHO officials “to discuss and, if judged necessary by the Director-General on the advice of the legal counsel, divest themselves of financial and other interests if these affect their independence from external authorities”. Officials in this category have to disclose interests in the private sector, including shares, bonds, patent interests, and directorships. In addition to the DirectorGeneral and members of her cabinet, this applies to other senior officials as well as to their spouses and dependent chldren. Described as conveying a “clear message on high standards from the outset”, the code was approved at the first meeting of Brundtland’s cabinet. From the outset of campaigning for the post, she had emphasised the need for more transparency within WHO. However, no indication was given of possible infringements of the new code.
Brundtland’s 5000-word address to WHO’s 3500 staff—teleconferenced to those in the six regional offices—explained in detail how the organisation is being replanned. The posts of executive director and assistant directorsgeneral have been dispensed with, some to new appointments elsewhere. They have been replaced by nine executive directors—only two from inside WHO—each heading a “cluster” (as such groupings are now referred to). Clusters will deal, respectively, with: social change and mental health; family and health services; sustainable development and healthy environments; communicable diseases; non-communicable diseases; evidence and information for policy; health technology and drugs; general management; external affairs and governing bodies. Brundtland said that “serving WHO is a privilege”. She added: “We can help build healthy communities and populations. We can combat ill-health. We can do our part to combat poverty and suffering. Nothing in life—as I see it— has more meaning.” Alan McGregor
Genetic fingerprints replace footprints in Spain n July 15, officials of the Basque provincial health department approved a pilot system to identify newborns, which is based on DNA analysis of blood samples at birth. The new method, which substitutes use of footprints, offers reliable results within 24 hours and is intended to detect accidental or even deliberate swapping of babies at birth. The Basque health network will thus become the first European public health system to apply the test routinely. It was done experimentally for 12 months in the Hospital de Cruces and the successful results (4800 births with only 3 consent denials) encouraged health authorities to extend it to other hospitals. Immediately after delivery, after
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separation of newborn and mother, a drop of blood is extracted from the umbilical cord by direct puncture with a syringe without anticoagulant. The drop is put on a filter paper attached to the newborn’s medical card. The drop is covered with a transparent seal, which is signed. The blood sample must be drawn quickly and sun exposure must be avoided. All steps are carried out with the informed consent of the parents and in the presence of at least one of them. In the case of caesarean section, the blood sample is taken before mother and newborn leave the operating theatre. The idea arose after experts agreed that the reliability of footprint-based identification is limited. This problem was highlighted by cases of unin-
tentional swapping, which could be solved only by examination of parents’ and babies’ DNA in blood samples. The routine test will be launched next October in all Basque public hospitals. The sample will be kept for an least 3 years and its confidentiality is guaranteed. The identification test is intended to be used only when special circumstances (eg, to verify the parents) make it necessary to match DNA results at birth with those later in a child’s life. In principle, the method will not be used to prove paternity or maternity, nor to study the child’s genetic code. Catalonia is likely to approve the test next and optimistic forecasts say it will spread to other European countries in due course. A more ambitious Catalonian project proposes to attach additional blood samples to the newborn’s medical card and on the official birth-registration documents. Xavier Bosch
THE LANCET • Vol 352 • July 25, 1998
News in brief French former ministers charged Former Prime Minister of France, Laurent Fabius, together with his Social Affairs Minister Georgina Dufoix and Health Minister Edmond Hervé are to be tried in court on charges of involuntary homicide. The ministers were in power during 1984–85, when HIVcontaminated blood was knowingly used for transfusions. The charge carries a maximum sentence of 5 years and a fine. European disease surveillance July 15 saw a landmark agreement between the European Parliament and member state governments on a system for epidemiological surveillance and control of communicable diseases. The Parliament won the right for the European Commission, rather than a committee of national government experts, to govern the system. Under the legislation, the network will monitor—and offer an early warning and response system—to a non-exhaustive list of diseases. A structure for the operation of the new surveillance system has yet to be decided.
Brundtland launches new-look WHO
T
he first official act by Gro Harlem Brundtland after becoming WHO Director-General on July 21 was to apply a new code for “standards of conduct and financial disclosure”. This obliges all high-level WHO officials “to discuss and, if judged necessary by the Director-General on the advice of the legal counsel, divest themselves of financial and other interests if these affect their independence from external authorities”. Officials in this category have to disclose interests in the private sector, including shares, bonds, patent interests, and directorships. In addition to the DirectorGeneral and members of her cabinet, this applies to other senior officials as well as to their spouses and dependent chldren. Described as conveying a “clear message on high standards from the outset”, the code was approved at the first meeting of Brundtland’s cabinet. From the outset of campaigning for the post, she had emphasised the need for more transparency within WHO. However, no indication was given of possible infringements of the new code.
Brundtland’s 5000-word address to WHO’s 3500 staff—teleconferenced to those in the six regional offices—explained in detail how the organisation is being replanned. The posts of executive director and assistant directorsgeneral have been dispensed with, some to new appointments elsewhere. They have been replaced by nine executive directors—only two from inside WHO—each heading a “cluster” (as such groupings are now referred to). Clusters will deal, respectively, with: social change and mental health; family and health services; sustainable development and healthy environments; communicable diseases; non-communicable diseases; evidence and information for policy; health technology and drugs; general management; external affairs and governing bodies. Brundtland said that “serving WHO is a privilege”. She added: “We can help build healthy communities and populations. We can combat ill-health. We can do our part to combat poverty and suffering. Nothing in life—as I see it— has more meaning.” Alan McGregor
Genetic fingerprints replace footprints in Spain n July 15, officials of the Basque provincial health department approved a pilot system to identify newborns, which is based on DNA analysis of blood samples at birth. The new method, which substitutes use of footprints, offers reliable results within 24 hours and is intended to detect accidental or even deliberate swapping of babies at birth. The Basque health network will thus become the first European public health system to apply the test routinely. It was done experimentally for 12 months in the Hospital de Cruces and the successful results (4800 births with only 3 consent denials) encouraged health authorities to extend it to other hospitals. Immediately after delivery, after
O
300
separation of newborn and mother, a drop of blood is extracted from the umbilical cord by direct puncture with a syringe without anticoagulant. The drop is put on a filter paper attached to the newborn’s medical card. The drop is covered with a transparent seal, which is signed. The blood sample must be drawn quickly and sun exposure must be avoided. All steps are carried out with the informed consent of the parents and in the presence of at least one of them. In the case of caesarean section, the blood sample is taken before mother and newborn leave the operating theatre. The idea arose after experts agreed that the reliability of footprint-based identification is limited. This problem was highlighted by cases of unin-
tentional swapping, which could be solved only by examination of parents’ and babies’ DNA in blood samples. The routine test will be launched next October in all Basque public hospitals. The sample will be kept for an least 3 years and its confidentiality is guaranteed. The identification test is intended to be used only when special circumstances (eg, to verify the parents) make it necessary to match DNA results at birth with those later in a child’s life. In principle, the method will not be used to prove paternity or maternity, nor to study the child’s genetic code. Catalonia is likely to approve the test next and optimistic forecasts say it will spread to other European countries in due course. A more ambitious Catalonian project proposes to attach additional blood samples to the newborn’s medical card and on the official birth-registration documents. Xavier Bosch
THE LANCET • Vol 352 • July 25, 1998