Wednesday, August 9, 2017

Makwala's Involuntary Medical Disqualification

UPDATE: As I completed this post I see that Makwala has been given an extraordinary opportunity by IAAF to compete in the 200m via a time trial (solo) sprint. This story continues to develop. Official IAAF statement here.

The video above shows sprinter Issac Makwala, a sprinter from Botswana and one of the world's fastest runners, being turned away involuntarily from the athlete's yesterday at the 2017 IAAF World Championships in London.

This post seeks to document what appears to be a gross violation of a athlete's due process rights with profound and irreversible consequences for his career as a professional athlete. I'll update as new information is available and am happy to take comments or critique.

This episode involves an outbreak of norovirus, a high contagious gastrointestinal bug that broke out among athletes and their entourages who were reportedly staying at The Tower Hotel in London (the hotel denies any responsibility). Some 30 people were reportedly affected. Norovirus causes vomiting and diarrhea but is not generally viewed to be serious, with symptoms going away after a few days with no treatment.

On 6 August the IAAF shared advice with athletes and their entourages staying at the hotel (emphases added):
To contain the situation and protect your athletes, we strongly request you
comply with the following directions

1. Report to the Guoman Tower Hotel Medical Room (430) as soon as possible any episode of diarrhoea and vomiting. This report should include the name, category of the person and the room number 2. The person must be isolated and hotel staff will assist in allocating another room. 3. Recommendations from Public Health England say the affected person must remain isolated for 48 hours after the last episode of vomiting or diarrhoea and therefore, the person will need to take their meals in their room.

The Hotel have applied Public Health England’s recommendations on enhanced cleaning procedures and will support all measures in relation to these matters.

Individuals must be vigilant on personal hygiene and apply the following:

1. Wash your hands thoroughly after going to the toilet, using soap, hot water and clean towels. 2. Wash your hands before having a meal or a drink. 
There was nothing in the advice about disqualification. In fact, over the weekend athletes diagnosed with Norovirus continued to participate in the events, such as Germany's Neele Eckhardt, shown below.

The advice from Public Health England being referred to by the IAAF can be found here (and highlighted below).
According to reports, over the weekend, Makwala was observed to have thrown up, barfed, puked (though details here are contested as well). On 7 August Makwala was disqualified ("withdrawn" in the IAAF parlance) from the 200m by the IAAF, which stated, "Isaac Makwala (BOT) was withdrawn from the men’s 200m (1st Round) due to a medical condition on the instruction of the IAAF Medical Delegate (Rule 113)."

Rule 133 refers to the IAAF Competition Rules, and it states:
The Medical Delegate shall have ultimate authority on all medical matters.
As Michael Johnson noted, soon thereafter things started getting weird.
Makwala claimed he was perfectly healthy and ready to run. But the IAAF was prohibiting him from participating. That led to the situation shown in the video above where Makwala was forcibly prevented from entering the venue.

According to the official Twitter account of the government of Botswana (yes, this is serious), Makwala represented to officials that his forced withdrawal was a legal matter under UK law.
In its 8 August statement on the situation, the IAAF used language indicating that they were following "UK health regulations":
As per UK health regulations, it was requested that he be quarantined in his room for 48 hours, a period which ends at 14:00hrs tomorrow (9 Aug). 
This statement is -- in measured language -- disingenuous. There are no such UK "heath regulations" related to a "quarantine." In fact, the Public Health England statement released by the IAAF makes absolutely no mention of regulations or quarantine:

In fact, the statement notes that the virus is "rarely serious."

So here is how the situation looks:
  • The IAAF made a decision with profound, career-altering impact on an elite athlete;
  • This decision was made with no apparent due process, very little reliance on evidence and ambiguous criteria for the forced disqualification;
  • The athlete and his medical team reject the diagnosis made by the IAAF;
  •  Even if he was infected, was the DQ necessary? Some experts think not (e.g., here and here);
  • At least one other athlete with the same alleged symptoms was allowed to participate;
  • The IAAF falsely suggested that UK law or regulation triggered the decision. 
At a minimum the IAAF (or some other body) should empanel an independent investigation into this situation, including the decision and the communication associated with it. Clearly things can be much improved.

Finally, below is a lengthy BBC interview with Dr. Pam Venning, head of the IAAF medical services for the World Championships and the authority with the power to disqualify an athlete involuntarily under IAAF Rule 113. (Note: Some people can't see the video, which may be due to your point of access or a geoblock, try this link also.)


  1. Petty comment first: You could have got Dr Venning's name right.
    Further, guidance in the UK, as you show, is that in the event of D&V an affected person should be isolated until symptom free for 48 hours. Doesn't matter if a schoolchild, doctor or cleaner, those are the guidelines that should be followed to prevent the infection spreading.
    In this case you can't allow the athlete to compete within his 48 hour quarantine, he could potentially infect many other people, by direct & indirect contact and not just athletes.
    I don't think you can discount a medical practitioner's history taking as "very little evidence" as its based on the patient's testimony. Neither can you describe national guidelines as "ambiguous criteria" when it is both evidence & practice based.
    Makwala has not been the only athlete affected by D&V at these championships, nor the only one not to have competed. He is likely to be the only one the IAAF had to withdraw from an event because he was entered in two. If an infected athlete competed, there'll be a reason. Most likely they didn't disclose their illness history.
    Communication does seem to have been a problem in this case, but as at least six Botswanan officials attended each meeting with IAAF medical staff, perhaps the problem lies with the team rather than the federation?

  2. Thanks for the comment, I've fixed the typo. Here at TLT editorial duties are both shared and appreciated.

    Clearly there are circumstances where an athlete may need to be withdrawn from competition against their will for reasons of health and safety. There is thus a line to be drawn somewhere between Ebola and a runny nose. IAAF would do itself and its athletes a service by making the criteria upon which this line is drawn perfectly clear as well as the process for making such decisions, including rights of appeal. Athletes should probably be involved in the formalizing of such processes. I'd guess that many would trade off a risk of developing the runs a few days after competing in exchange for an opportunity of a lifetime. But we won't know until athletes are involved and there is sunshine on such decisions.