THERE is increasing concern that efforts to contain the SARS pneumonia virus will prove futile. Yet it might just have been nipped in the bud if effective action had been taken early on. The delay highlights the problem of countries trying to suppress news of emerging diseases for fear of the economic impact, and the lack of clout international health authorities have to intervene to prevent an outbreak turning into an epidemic.
Severe acute respiratory syndrome, or SARS, appears to have started in the southern Chinese province of Guangdong in November last year. In March, Liu Jianlun, a 64-year-old medical professor who had been helping to fight the outbreak, went to Hong Kong for a wedding. When he developed a temperature shortly after arrival, he went straight to the Princess Margaret Hospital and asked to be put in isolation.
But the hospital staff had heard only rumours and official reassurances about a mysterious outbreak of pneumonia in Guangdong. They didn鈥檛 isolate him carefully enough, and started falling ill themselves. Nor did the authorities try to warn his contacts. Nine of the guests on the floor of the Metropole Hotel where he stayed became infected and carried SARS to Singapore, Canada, Vietnam and other hospitals in Hong Kong.
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If the hospital staff had known the seriousness of the problem they might have taken more stringent measures. And if China itself had acted sooner, SARS might have been limited to Guangdong. Now it may be too late to halt its spread.
The World 午夜福利1000集合 Organisation in Geneva does have a Global Outbreak and Response Network, which gathers news of outbreaks from various sources and sends a weekly 鈥渞umour list鈥� to national health officials, asking for confirmation. It did that soon after rumours of a new form of pneumonia first surfaced in China. But then the system hit its fatal flaw. 鈥淕OARN can only go into a country when asked,鈥� says Jack Woodall, moderator of ProMed, an Internet bulletin board for emerging diseases. And GOARN is not allowed reveal what it knows without the consent of the country affected.
But China did not warn its own doctors about the disease until late January, and even then the warning was top secret and could not be discussed with doctors in Hong Kong. According to some reports, Guangdong health officials feared that publicising a disease before the Chinese New Year would have had a severe impact on the economy.
On 10 February, news of the pneumonia outbreak was posted on ProMed. The next day, perhaps not coincidentally, China finally informed the WHO about the disease and asked it to send in a team. It would not be the first time a country has admitted to a disease outbreak only after a posting on ProMed.
The WHO sent in a team, but it was allowed only as far as Beijing and was not given all the available information. Meanwhile, the disease spread to Hong Kong and beyond. On 15 March, the WHO issued a global alert and asked to go to Guangdong.
China refused to let the team in until last week. At the same time it revised the number of cases it had reported from several hundred to over a thousand, and admitted the virus has spread to outlying provinces such as Sichuan, where the healthcare system is generally poorer than in Guangdong.
Would it have helped if the WHO team had gone in earlier? Yes, say experts familiar with the investigation. But while the outgoing head of the WHO, Gro Harlem Brundtland, has openly criticised China, others will not say anything publicly for fear of discouraging what cooperation the Chinese are providing.
Privately, they note that SARS started primarily as a disease of hospital staff. It could have been controlled or even extinguished if tackled at that point. Outbreaks of Ebola, which has a similar pattern of spread, are controlled this way. But Chinese authorities did not take these measures.
The WHO has been trying for 10 years to convince member states to give it the powers it needs to tackle such outbreaks. Ideally, the WHO would have the right to demand access to a country on short notice, as inspectors can under some international weapons treaties. But officials concede that the US, for example, will never permit this.
Instead, the WHO is merely proposing that countries apply a 鈥渄ecision tree鈥� devised at the Karolinska Institute in Stockholm to establish whether a new disease has international significance. Then the WHO wants the power to at least certify whether the country is doing a good job of containing it. The hope is that countries will take advice if the WHO says they are not.
But member countries have been reluctant to grant even these modest powers, and the proposal will not come up for a vote at the WHO until 2005.
And even if the WHO were given more powers, it can do nothing as long as a country suppresses news of an emerging disease for fear of the economic impact. It is currently talking to the World Trade Organization about ways to compensate countries for any loss caused by acting responsibly and notifying authorities about possible outbreaks as soon as possible.
The SARS epidemic, of course, demonstrates that the price of keeping quiet about epidemics can be very high if they do get out of control. Economists are already predicting slower growth than expected throughout the Far East as a result of SARS, and if it continues to spread, the global consequences could be severe.
Yet, as with AIDS, China still seems to be in denial. Last week health minister Zhang Wenkang announced that SARS was under control and that Beijing was safe for foreigners even as cases began to emerge in the capital and a Finnish man who had recently arrived in the city lay dying of SARS in a local hospital.