Text of my ‘When Worlds Collide’ column published in Ceylon Today Sunday broadsheet newspaper on 2 June 2013
How should we respond to a rapidly spreading infectious disease like a particularly virulent form of influenza? What precautions are essential to safeguard ourselves? When do preventive actions go beyond the reasonable to disrupt social and economic systems? How to avoid run-away panic?
There are no easy answers, and we can only learn from experience. As the prospect of new influenza outbreaks looms on the horizon, some media discussions have recalled what happened with Severe Acute Respiratory Syndrome (SARS) a decade ago.
Public health professionals define a pandemic as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”.
Some pandemics, like HIV/AIDS, build up slowly over time. Others, like various types of flu, spread much faster. SARS was a good example of this latter kind, where the World Health Organisation (WHO) and public health authorities of affected countries found them running a deadly race against a new coronaVirus that first emerged from China’s Guangdong province.
The first case of this infectious illness was detected there in November 2002. As it spread during that winter, local officials tried to downplay it, which allowed it to become a countrywide health emergency within weeks.
It was only in February 2003 that China finally admitted to the extent and nature of the problem. That ultimately failed cover-up cost the mayor of Beijing and the minister of health their jobs. But by then, the virus had spread beyond its borders.
Race Against SARS
At that time, WHO’s current Director General Dr Margaret Chan was in charge of Hong Kong’s Department of Health. On 12 March 2003, she alerted the global health agency about the new, flu-like illness detected and being treated in her territory. In the days that followed, cases were reported from Vietnam, Singapore, United States, Canada and elsewhere.
“By March 15, it was clear that the first new disease of the 21st century was spreading explosively along the routes of international air travel,” she recalled in a recent op-ed essay.
WHO named the new disease as severe acute respiratory syndrome, or SARS. They also defined characteristic symptoms and asked all air travellers to be alert and vigilant.
What happened in the weeks and months that followed has been well documented. While some governments – such as Singapore’s — quickly took control of the situation, others underestimated the threat or were overwhelmed by the pace of events.
As Dr Chan sums up: “In the four months following the March alerts, SARS closed schools, businesses and some borders. Air travel to Hong Kong and other severely affected areas seemed to halt overnight. Tourism dried up. Consumers stayed at home. Economic losses mounted… By the time the outbreak was declared over, on July 5, nearly 8,500 people had been infected and nearly 800 had died.”
While these casualties were relatively low compared to past pandemics, economic impact was enormous. Within weeks, airline and tourism industries had lost billions of dollars due to public fears. Some airlines and businesses declared bankruptcy.
One estimate of global economic costs from SARS placed it around USD 40 billion. The World Bank put it at USD 54 billion, much of it in lost tourism income. Clearly, the cost of panic was high.
Each time media reports about new types of influenza emerging, we are reminded of SARS. This year, to mark the 10th anniversary, the lessons have been revisited in various academic and policy meetings.
As Margaret Chan reflects, “SARS taught the importance of meeting an emergency with whatever tools are at hand. SARS was a 21st century disease in its mode and speed of spread. But it was eventually defeated using the 19th century tools of case detection, contact tracing, isolation and infection control.”
Lessons of SARS
Effective public communications was part of the public health response in most affected countries. Governments found out that, on balance, it was far better to disclose information early – even when they didn’t know everything – than to allow rumours to fill that void.
SARS experiences have fed into on-going discussions on the role of information and communication during disaster and humanitarian emergency situations.
During the past decade, the world’s humanitarian and disaster management communities have acknowledged the central and crucial role of information and communication — not just for public outreach, but as a frontline activity and an integral part of response.
On the policy and regulatory front, one key development is the new International Health Regulations (IHR). Adopted in 2005 and in force since June 2007, it is a legal instrument that binds 194 countries worldwide to report to WHO any severe, new disease that has potential to spread beyond borders.
A key document that came out around the same time is WHO’s Outbreak Communication Guidelines (2005). Drafted at an international expert meeting in Singapore in 2004, the guidelines are intended for both public health officials and other crisis managers.
These guidelines formed the backdrop to an Asian broadcasters’ workshop that I facilitated this week during Asia Media Summit 2013 held in Manado, Indonesia.
The workshop, titled “Be Prepared: Managing Your Organisation through a Global Pandemic”, was organised by the Commonwealth Broadcasting Association (CBA) in collaboration with the Asia Pacific Institute for Broadcasting Development (AIBD). Both are professional bodies that network public and commercial broadcasters (radio and TV).
The guidelines recognize that communication, mostly done through the media, is a feature of a disease outbreak environment. It adds: “Unfortunately, examples abound of communication failures which have delayed outbreak control, undermined public trust and compliance, and unnecessarily prolonged economic, social and political turmoil.”
Marking a sea change in thinking, it says: “WHO believes it is now time to acknowledge that communication expertise has become an essential outbreak control as epidemiological training and laboratory analysis…”
These guidelines, provided to all member state of the inter-governmental agency, underline the value of authorities communicating with the public “in ways that build, maintain or restore trust”. This is true, it says, across cultures, political systems and level of country development.
It cautions, however, that trust building measures are often counter-intuitive. For example, acknowledging uncertainty, or avoiding excessive reassurances. Similarly, it stresses that that the benefits of early warning outweigh risks.
In short, if authorities trust the public, chances are that it will be reciprocated. Of course, past track record of an agency or government would also play a part.
The 2005 document was certainly a leap forward, but eight years on, the web’s expansion and rise of social media have changed the dynamics of emergency communications.
This is the point that communications scholar Dr Rohan Samarajiva and I made in a global op-ed published by SciDev.Net in February 2013: “The controlled release of information is no longer an option for any government. In the age of social media and 24/7 news channels, many people will learn of distant hazards independently of official sources.”
We were talking about rapid onset disasters like tsunamis and cyclones. But the generic concerns can apply to pandemics as well.
We added: “The proliferation of ICTs adds a new dimension to disaster warnings. Having many information sources, dissemination channels and access devices is certainly better than few or none. However, the resulting cacophony makes it difficult to achieve a coherent and coordinated response…”
Crying wolf in the global village has become a lot easier. Perhaps we should revisit those 2005 guidelines.