Update on William Steiger

I have been interested in Steiger in part because several decades ago I used to work in the office which he now heads, and because he is so controversial an appointee of the Bush administration. The son of a former Republican Congressman, and himself a former education adviser to Tommy Thompson in the Wisconsin government, he was given a political appointment as the director of the Office of Global Health Affairs in HHS when Thompson was made Secretary of the Department. He was nominated to be Ambassador to Mozambique in January 2007, but the Senate has never confirmed that appointment.

I have posted the following concerning his activities over the years:

• The Next Hurrah: Even CDC Not Immune from Political Minders


• Steiger Said to Have Blocked Surgeon General's Global Health Report on Political Grounds


• Do You See a Pattern in Bush Appointments?


• Intellectual Property Watch ? US Seeks Review Of WHO Publication Policy After Report On US Trade Deals


• Daniel S. Greenberg on The Republican War on Science

• Lessons learned from the 1976 Swine Flu Program


• William R. Steiger


• Nations to Discuss Potential Flu Pandemic


• "Democrats Protest Limits on WHO Advisory Panels"


• Chief of HHS Office of Global Health Affairs


• A Very Bad Idea!

Last year the Washington Post reported:

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate. A copy of the report was obtained by The Washington Post.

Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney.

Steiger apparently drafted his own proposal for the report, which the WP has made available on the web. It appears to be OK for a politically motivated defense of U.S. programs. In terms of its public health balance, it would seem to focus too heavily on the Bush administration's bioterrorism initiatives, and too little on the preventable diseases that still cause unacceptably high levels of mortality and morbidity in developing nations.

The Wikipedia entry on William R. Steiger includes the following:

• May 22, 2008 - NRC Handelsblad (a Dutch newspaper) reports that the director of the United States Department of Health and Human Services's Office of Global Affairs, is blocking the acceptance of a resolution condemning the practice of female circumcision during this year's General Assembly of the WHO. The article states that, when it comes to international policy, Steiger has the power to overrule the Secretary, and that, rather remarkably, the United States are the only country in the WHO unwilling to accept this legally non-binding resolution, even though the official U.S. position is that it also strongly condemns the practice. When asked, Adrien Germain (member of the NYC-based lobby group IWHC) states that 'Steiger wants to change a clause mentioning 'reproductive health', an umbrella term supposedly implicitly referencing the condonation of practices such as abortion'.
• Steiger severely criticized a World Health Organization (WHO) report on nutrition as scientifically flawed. The report was also opposed by many industry groups, making Steiger's criticism appear politically motivated. The WHO was further upset because the Department of Health and Human Services said it would choose which U.S. scientists WHO could invite as expert advisers.

Steiger is now one of the members of the Board of Directors of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The Next Hurrah: Even CDC Not Immune from Political Minders

The Next Hurrah: Even CDC Not Immune from Political Minders:

"One of those unique challenges, according to Blount's eight-page memo, is the CDC must request special approval for every overseas assignment from the HHS Office of Global Health Affairs. This adds an additional two to three months of delay in hiring staff for foreign postings, according to the memo. 'Some positions have been delayed for so many months that our partners doubt our commitment and credibility,' Blount wrote.

William Steiger, director of HHS' Office of Global Health Affairs, was out of the country and unavailable for comment, said spokesman Bill Hall. Steiger has come under fire in the past for allegedly micromanaging the overseas work of the department's scientific divisions. Steiger, the godson of former President George H.W. Bush, is President George W. Bush's nominee to be the next U.S. ambassador to Mozambique."

Steiger Said to Have Blocked Surgeon General's Global Health Report on Political Grounds

William R. Steiger has been identified as the
HHS official who blocked the report on global health.
Office of Global Health Affairs via the Washington Post

"Bush Aide Blocked Report: Global Health Draft In 2006 Rejected for Not Being Political," by Christopher Lee and Marc Kaufman, The Washington Post, July 29, 2007.

The article states:

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.....

Richard H. Carmona, who commissioned the "Call to Action on Global Health" while serving as surgeon general from 2002 to 2006, recently cited its suppression as an example of the Bush administration's frequent efforts during his tenure to give scientific documents a political twist.....

Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services.....

After a long struggle that pitted top scientific and medical experts inside and outside the government against Steiger and his political bosses, Carmona refused to make the requested changes, according to the officials......

In 65 pages, the report charts trends in infectious and chronic disease; reviews efforts to curb AIDS, tuberculosis and malaria; calls for the careful monitoring of public health to safeguard against bioterrorism; and explains the importance of proper nutrition, childhood immunizations and clean air and water, among other topics. Its underlying message is that disease and suffering do not respect political boundaries in an era of globalization and mass population movements.

The report was compiled by government and private public-health experts from various organizations, including the National Institutes of Health, the Catholic Medical Mission Board and several universities.

Do You See a Pattern in Bush Appointments?

Today's Washington Post (WP) has a lead article on the resignation in disgrace of Randell Tobias, the deputy secretary of state responsible for U.S. foreign aid.

WP also has an article implying that Paul Wolfowitz, the President of the World Bank, will be accused of a serious breach of ethics by a panel investigating his service. Yesterday WP ran an article that stated:

Under a diplomatic arrangement in effect since the creation of the World Bank in 1944, the U.S. president has the right to appoint the chief of the institution. Europe has the power to appoint the head of the bank's affiliate, the International Monetary Fund.....

If the board ultimately votes to remove Wolfowitz, a Bush administration official said it would jeopardize the governing arrangements of other international financial institutions, including Europe's right to appoint the leader of the IMF and Japan's authority to name the head of the Asian Development Bank.

Yesterday I posted a message that the European Parliamentary Working Group on Separation of Religion and Politics has urged Ellen R. Sauerbrey, Assistant Secretary of State for Population, Refugees and Migration, to withdraw from a meeting that it considered inappropriate for formal participation by a U.S. government senior official. I have documented over some time the controversy over Sauerbrey's qualifications and political views (Search my blog with the term "Sauerbrey"). One of those prior postings also dealt with the controversial nomination of Julie L. Myers to head the Immigration and Customs Enforcement bureau at the Department of Homeland Security, in a maneuver circumventing the need for approval by the Senate.

Yesterday I posted on the appointment of Cristina Beato as deputy director of the Pan American Health Organization, another appointment that by diplomatic tradition is under the control of the President of the United States. Beato is another controversial Bushie, whose appointment as Assistant Secretary for Health foundered on charges that her resume had been inflated. (I once posted that the Office of Global Health Affairs of the Department of Health and Human Services, early in the Bush administration. required all Department staff seeking to visit PAHO headquarters in Washington D.C. to apply for foreign travel permission to do so; search this blog with the term "Steiger" for other examples of that offices international work in the Bush Administration.)

Look too at my posting on the Bush administration nomination of Josette Sheeran (Shiner) to head the U.N. World Food Program, another intergovernmental program whose head is by tradition appointed by the U.S. Government. Sheeran was once managing editor of the Washington Times, a conservative newspaper, founded in 1982 by Sun Myung Moon.

Ann Margaret Veneman, the Bush administration's nominee who became the executive director of the United Nations Children's Fund (UNICEF), was also controversial, seen to have been chosen for her political ties rather than her expertise in the important areas covered by UNICEF.

Peter Smith, who was the highest ranking American in the United Nations Educational, Scientific and Cultural Organization as Assistant Director General for Education, also recently resigned amid controversy including an audit report that implied improprieties and ethical lapses on his watch. (Click here to read more on that case.)

Then of course there was the case of John Bolton, the controversial Bush administration insider, who resigned his recess appointment as Ambassador to the United Nations when it became apparent that he would not be confirmed in that post by the Senate, having lost the support not only of the Democrats, but of my Republicans. He is notable, among many other actions, for asking the deletion of all references to the Millennium Development Goals from the documentation that was being prepared for the 2005 United Nations Summit meeting.

Intellectual Property Watch ? US Seeks Review Of WHO Publication Policy After Report On US Trade Deals

Intellectual Property Watch ? US Seeks Review Of WHO Publication Policy After Report On US Trade Deals:

"A senior United States health official in Washington is urging the head of the World Health Organization to withdraw a WHO-sponsored publication that is critical of US trade policy, charging possible organisational incompetence and calling for a full review of its publication procedures.

“The WHO Secretariat’s decision to publish the South Centre report seriously undermines my confidence in the veracity and reliability of assurances I received from senior staff in the Office of the Director General,” William Steiger, special assistant to the secretary for international affairs at the US Department of Health and Human Services wrote to Acting WHO Director General Anders Nordstrom in August."

Steiger is a recurring character in this blog. Note these two previous postings:

* William R. Steiger
* Daniel S. Greenberg on The Republican War on Science

Daniel S. Greenberg on The Republican War on Science

Read the full review of Chris Mooney's book in the London Review of Books. (Subscription required.)

I consider Greenberg to be the dean of those reporting on the interface between science and politics in Washington. He characterizes The Republican War on Science as "a valuable chronicle of Bush’s persistent efforts to undermine the authority of science in the interests of his anti-regulatory and anti-abortion agendas."

Greenberg himselt offers a scathing list of offenses in his review:

* The president has done his best to cast doubt on the theory of evolution with his respectful nods to the crackpot concept of ‘intelligent design’, a pseudo-scientific fabrication more marketable than its crude kin, creationism.
* The president’s base demands unwavering fealty to the anti-abortion movement, and the Bush camp has obliged, even to the extent of fabricating an association between abortion and breast cancer.
* The administration then turned its attention to condoms, which are an affront to the evangelical preference for abstinence. Mooney notes that both the Centers for Disease Control and the State Department’s Agency for International Development "have altered informational materials on condoms to downplay their effectiveness".
* Bush has repeatedly denigrated the work and warnings of the world’s leading climate researchers, scoffing at their conclusion – based on analyses of vast collections of data – that global climate change is caused in large part by the burning of fossil fuels.
* "Sound science" became a battle cry for Gingrich in his commitment to the wholesale dismantling of government regulations, and it has since been carried forward by the Bush administration in a variety of ploys aimed at undermining regulations disliked by industry.
* The Data Quality Act, a federal law that subjects government agencies to multiple challenges, peer review and stiff standards of scientific evidence when they attempt to mitigate health or environmental hazards, was passed in 2001.
* (Bush's) theatrical, hand-wringing decision regarding stem-cell research, which allowed federal funding only for embryonic stem-cell lines that were in existence prior to 9 August 2001. The decision, Bush said, was painfully arrived at after consultation with religious leaders, bio-ethicists, scientists and physicians. That it made little sense was evident from the start.

William Steiger, the director of the Office of Global Affairs and a godson of the first President Bush, is of some interest to me, since many years ago I worked in the predecessor of that office. "When a joint report of the World Health Organisation and the Food and Agriculture Organisation linked obesity and excessive sugar consumption, particularly in soft drinks, the sugar lobby reacted boldly," according to Greenberg. They recruited Steiger to their support, Steiger, in turn, used the Data Quality Act to attack the FAO/WHO report, "even though researchers in his own department had participated in its preparation and endorsed it as a reliable basis for policy recommendations." Ultimately, "the World Health Assembly omitted any reference to the disputed document in the global strategy for diet and health that it issued in 2004." Steiger’s office went on with efforts to prevent government scientists from opposing the administration’s pro-business preferences, stating that that office would select U.S. experts advising the WHO, and those experts would be required to support US policies. Steiger also "put restrictions on foreign travel by scientists in his department: ‘foreign’ included the Washington offices of the World Bank, WHO and other UN organisations."

Greenberg is offended by the "political passivity of that community, despite the many assaults on its integrity, and the seething discontent that is now evident among individual scientists. The ‘war’ in the title is a lop-sided conflict, initiated and pursued by the administration. On the science side, it has consisted of petitions by Nobel laureates and other eminences, press releases, occasional editorials in scientific journals and feeble efforts to mobilise anti-Bush votes in 2000 and 2004. Though disturbed and offended by the administration’s manipulation, distortion and suppression of scientific data, science is not at the barricades. Most deplorable is the failure of the scientific establishment to help the public understand the reality and implications of Bush’s assaults on science."

Lessons learned from the 1976 Swine Flu Program

Read Annex 11 to the .Pandemic Influenza Response and Preparedness Plan in full.

"On January 27, 1976, an outbreak of respiratory disease was identified at Ft. Dix, New Jersey. On February 12 the CDC influenza laboratory notified the CDC Director that a swine influenza virus strain had been isolated from patients that possessed hemagglutinin and neuraminidase subtypes that had not circulated for more than 50 years.......An emergency interagency meeting was held on February 14, and state health officials were notified on February 18. On March 10, the Advisory Committee on Immunization Practices (ACIP) reviewed available data and concluded that person-to-person transmission of swine influenza had occurred but there was no way to determine whether or not a pandemic would occur. CDC notified the Department of Health and Human Services and recommended mass immunization. On March 24 President Ford met with CDC, FDA, and NIH representatives and other experts. There was a unanimous recommendation to initiate mass immunization.......

"The first vaccine was shipped to State Health Departments on September 22 and the first injections were given on October 1. Vaccination programs proceeded based on state plans and capacities, with some aggressively implementing mass vaccination and others implementing more limited programs. Overall, between October 1 and December 16, more than 40 million civilians were vaccinated; 85% by public sector providers (this compares with ~10 million persons vaccinated during the previous influenza season). Several million more were vaccinated in Veterans Administration and Department of Defense programs..........

"By the time the vaccination program ended, 532 GBS (Guillain-Barré syndrome) cases and 32 deaths had been reported. CDC surveyed neurologists in several states and calculated the GBS risk among vaccinated and unvaccinated persons. The results suggested an increased risk among those who were vaccinated. On December 16, based on CDC�s recommendation and after consultation with the President, the Assistant Secretary for Health announced the suspension of the swine influenza vaccination program. Although some persons at high-risk for severe influenza complications received the swine influenza vaccine subsequently, the large-scale vaccination program was not resumed. Neither a swine influenza pandemic nor focal outbreaks following the one initially identified at Fort Dix occurred.....

"Program decisions made early in the process were not modified based on new information Â? e.g., the absence of any Swine influenza cases detected by surveillance following the Ft. Dix outbreak Â? because of concerns over logistical obstacles and impact on program support by the medical community, policy-makers, and the public....

"Drs. Feinberg and Neustadt were asked by the Carter administration to review the swine influenza program, focusing specifically on the decision-making process. They concluded in The Epidemic That Never Was, 'Decision-making for the swine flu program had seven leading features. To simplify somewhat, they are:

Â? Overconfidence by specialists in theories extrapolated from meager evidence.
Â? Conviction fueled by a conjunction of some preexisting personal agendas.
Â? Zeal by health professionals to make their lay superiors do right.
Â? Premature commitment to deciding more than had to be decided.
Â? Failure to address uncertainties in such a way as to prepare for reconsideration.
Â? Insufficient questioning of scientific logic and of implementation prospects.
Â? Insensitivity to media relations and the long-term credibility of institutions.'"

I worked on an international health plan in the White House in 1977, early in the Carter Administration. I recall the mass immunization campaign against the swine flu organized by the previous administration as a debacle, costing a fortune, and probably causing some real harm in the hope of preventing a threat of a pandemic flu -- a threat that was not on that occassion real. A Washington Post reporter totalled the cost:

About 45 million people had been immunized. The federal government eventually paid out $90 million in damages to people who developed Guillain-Barre. The total bill for the program was more than $400 million.

Other observers are even less sympathetic to the Ford Administration. Donald Rumsfeld, who was then and is again the nation's Secretary of Defense, it has been charged by the Whale website, "made the imminent 'swine flu' a political issue to add some spark to the campaign of President Ford." Lawrence Gostin of Georgetown Law School gives Big Pharma a share of the blame: "The pharmaceutical industry convinced political leaders to hold it harmless against lawsuits while, at the same time, profiting from a massive vaccination program actively promoted by government."

This time there seems to be a lot more evidence that an Avian Flu pandemic is a serious and imminant threat. Public health officials recall both the history of the 1918 flu pandemic and that of the mythical 1976 swine flu pandemic. Still, we walk a fine line between inadequate reaction and over reaction to the threat. Certainly we need to postpone decisions that can be postponed, and reexamine dicisions with new evidence as time goes by and experience with the epidemic accumulates. Certainly too, it is wise to invest in means to prevent a possible pandemic, even if that pandemic never actually occurs. Still, one hopes for people with the proper training, long experience, and mature professional judgment to lead in the decision making. My recent blog entries include evidence suggesting that President Bush's top flu pandemic advisors, William R. Steiger and Stewart Simonson, may not have that needed background.

Technorati tags: flu, K4DBlog

William R. Steiger

William R. Steiger is the Department of Health and Human Services' "point person for international health" and is presumably a key person in the internatinal meeting on Avian Flu starting today in Washington (see previous posting). He has held the position of Director of the HHS Office of Global Health Affairs for some time. According to his official biography, "Dr. Steiger was previously Education Policy Advisor for Wisconsin Governor Tommy G. Thompson. His portfolio included finance and policy matters for primary, secondary, university, and technical education in the state." He seems to be trained in education rather than public health, with little previous international experience.

According to a news story in Science magazine last year, "Steiger, 34, a political appointee who has close ties to the Bush family." The article noted, that "when HHS clamped down on foreign travel by its scientists, Steiger began personally approving each trip. When industry groups criticized a World Health Organization (WHO) report on nutrition, Steiger slammed it as scientifically flawed. When the department declared that it would choose which U.S. scientists WHO could invite as expert advisers, Steiger signed the memo." (Another source identifies Steiger as George H.S. Bush's godson.)

In April 2004, Steiger, according to another report, "wrote government scientists informing that they must receive pre-clearance by his office to act as consultants in meetings of the World Health Organization. As a condition of their employment with WHO, scientists must agree to advocate U.S. policy. A Health and Human Services (HHS) spokesperson defended the decision stating, 'No one knows better than HHS who the experts are and who can provide the most up-to-date and expert advice.' But Dr. D.A. Henderson, an epidemiologist who received the Presidential Medal of Freedom in 2002 and acts as an advisor to HHS Secretary Tommy Thompson, stated, 'I do not feel this is an appropriate or constructive thing to do. In the scientific world, we have a generally open process. We deal with science as science. I am unaware of such clearance ever having been required before.'"

Sharon Hrynkow, acting as director Fogarty International Center at NIH, is reported in 2004 to have sent the following to NIH staff:

"NIH has been instructed by the Office of the Secretary, Office of Global Health Affairs, that travel of NIH staff to U.N. international organizations located in the United States is to be considered foreign travel, thus requiring ICs [institutes and centers] to submit [Notifications of Foreign Travel] per the usual process,"

The World Bank, the Pan American Health Organization, UNICEF, the United Nations Development Programme and other U.N. organizations were covered by the dictum.

When I worked in the Office of International Health, which eventually became the Office of Global Health Affairs, it was headed by the then Acting Surgeon General, and lead by public health professionals with distinguished careers in international health. I would feel more confident if the U.S. effort to energize the world against Avian Flu were headed by such people today! This does not seem to be the case, however.


Technorati tags: flu, K4DBlog

Nations to Discuss Potential Flu Pandemic

Read the full article in the Washington Post.

"Amid growing concern that the world may be on a collision course with a deadly avian flu pandemic, health officials from about 80 countries are meeting in Washington today to map a collaborative strategy for minimizing the deaths and disruption an outbreak might wreak.

"The meeting, hosted by the State Department, marks the beginning of a major international trust-building project that U.S. officials said must be successful if scientists and public health officials are to have a fighting chance of quenching a nascent outbreak before it goes global.

"'Pandemics are diseases without borders and that's why we're focusing our attention on them,' said William R. Steiger, the Department of Health and Human Services' point person for international health, in an e-mail yesterday. 'We know that a threat against one nation is a threat against the world.'

"Today's meeting is part of a flurry of activity in the United States and abroad, all spurred by evidence that a strain of bird virus endemic in Southeast Asia is accumulating mutations that could ease its lethal spread from person to person......

"President Bush is scheduled to meet with drug company executives today to discuss strategies for developing new and speedier methods for making flu vaccine. Current techniques take many months to ramp up -- a time scale that is acceptable for the routine annual production of vaccines but that would be wholly inadequate if a rapidly spreading and especially deadly strain of avian flu were to erupt."


Technorati tags: flu, K4DBlog

"Democrats Protest Limits on WHO Advisory Panels"

Science -- ScienceScope article:

"Some Democrats in Congress want the Bush Administration to halt what they see as efforts to exert political control over science.

"Their focus is a 1-year-old policy on sending federal scientists to meetings of the World Health Organization (WHO). In the past, WHO would directly invite individuals from the Department of Health and Human Services (HHS) to serve as advisers on topics such as avian flu and potentially cancer-causing chemicals. But in April 2004, then-HHS secretary Tommy Thompson's global health chief, William Steiger, announced that invitations needed to go to his office, which would choose the appropriate experts. The policy upset researchers at the National Institutes of Health and the Centers for Disease Control and Prevention as well as outside public health leaders and scientific groups.

"In a 28 April letter to new HHS Secretary Michael Leavitt, the 11 Democrats on the House Science Committee ask him to rescind the policy or explain the value of what legislators call a 'counterproductive' and 'potentially dangerous' policy. An HHS spokesperson said the department expects to respond 'in an appropriate time frame.'"

For years the United States sought to oppose countries that sent incompetent (or worse) representitives to WHO. Now the Administration has seriously damaged the credibility of such efforts!

Chief of HHS Office of Global Health Affairs

Science -- Kaiser 305 (5690): 1552:

"William R. Steiger, the point person on international health for HHS Secretary Tommy Thompson, has made a name for himself everywhere--from the National Institutes of Health (NIH) to the Centers for Disease Control and Prevention (CDC) to the halls of academia. Then again, not many bureaucrats would want the kind of attention he's received."

A Very Bad Idea!

Ideas on WHO Delegates at Odds (washingtonpost.com):

"WHO has agreed to send invitations to specific scientists through the U.S. government, rather than to contact the experts directly. This arrangement, largely a matter of protocol, is one the organization has with China, Russia and a few other of its 192 member countries.

"HHS officials, however, believe WHO has acceded to its request that the U.S. government be allowed to 'identify an appropriate expert who can best serve both of our organizations' after WHO provides a general description of the expertise it is seeking."

It is hard enough for WHO to put together a good expert committee without HHS getting in the way! Getting a group together that knows the current scientific and clinical literature, and the health conditions in the countries that need help from WHO is hard. WHO deals with real issues -- the best treatment for malaria, how to prevent the spread of HIV/AIDS, how to deal with malnutrition, diahrreal disease and respiratory disease. Failure in the quality of advice given by such committees is measured in death and disability. Scientists and doctors generally see an ethical responsibility to participate in these meetings giving their best advice, independent of the political stance of their governments.

The article goes on to say that HHS Secretary Tommy G. Thompson's special assistant for international affairs, William R. "Steiger also noted that federal employees 'do not and cannot' participate as individuals but 'serve as representatives of the U.S. government at all times and advocate U.S. government policies.'" If so, I hope they will no longer be invited to serve on committees of the Institute of Medicine, the National Academy of Sciences, nor the National Academy of Engineering. The Academies expect people they appoint to give their individual best professional judgment, not the positions of their employers.