Ten years ago the World Health Organization declared SARS a global emergency. In China, where the epidemic started, the first response was a coverup.
Ten years ago this week, the World Health Organization issued a global health alert – its first-ever – about the dangers of Severe Acute Respiratory Syndrome, SARS.
In China, where the epidemic had originated, the government was still denying that anything was wrong. Officials were not telling their citizens anything and were lying to the WHO about the death toll. Eventually, medical professionals held SARS responsible for sickening 8,422 people worldwide and killing 916 of them.
“The Chinese government’s coverup and inaction were major contributors to the spread of SARS,” says Huang Yanzhong, a public health expert with the Council on Foreign Affairs in New York.
A decade later, Chinese citizens still doubt that their authorities tell them the truth; the blogosphere is currently thick with skeptical reactions to the Shanghai government’s insistence that nearly 6,000 dead pigs in the city’s water supply do not constitute a health threat.
(To learn more about the dead pigs in Shanghai's water supply, read the Monitor article on how China's officials are responding)
But experts here and abroad say that Beijing learned its lessons from the fiasco in 2003, at least as far as fulfilling its international obligations.
“SARS was a watershed moment,” says Joan Kaufman, director of the Beijing-based Columbia Global Center for East Asia who has spent her life studying China’s public health system. “It set in motion changes that have changed the face of the system.”
In 2003, China’s healthcare system was in tatters, undermined by years of insufficient funding and lackadaisical political attention. Today, says Sian Griffiths, a professor of public health at the Chinese University of Hong Kong, “China does very impressive real time reporting on infectious diseases” using a computerized system that reaches into the farthest corners of the country. “Surveillance is hugely better than it was.”
And whereas in 2003 the Chinese government refused to allow a WHO team to visit Guangdong, the epicenter of the SARS epidemic, keeping its members in Beijing for five weeks, today the authorities are in close and cooperative touch with the UN body.
“There is no doubt that there have been some very significant changes,” says Professor Huang. One of those changes: Infectious diseases are no longer legally classified as state secrets.
In 2009, for example, when the H1N1 strain of flu spread around the globe, the Chinese government went to the other extreme.
The authorities launched countrywide manhunts to track down the fellow airplane passengers of tourists found to be ill, and imposed draconian quarantine restrictions on visitors from abroad whether or not they had shown any sign of infection. There was no question of keeping the potential threat a secret as it was in 2003.
In 2003, the authorities hid the extent of the SARS epidemic because of fears people would panic – a major concern for a government whose top priority has been social stability, says Isaac Mao, a Chinese Internet analyst who heads the Sharism Lab, a think tank in Hong Kong.
In those days, he recalls, “the government had many advantages, such as a monopoly over public voices. Their mentality has not changed … but the paradigm has changed” with the rapid spread of social media. “Many millions of individuals now have great power in their handhelds,” Mr. Mao argues. “The government will never again be able to manipulate the media in its traditional centralized fashion.”
“The government realizes that its old governance approach no longer works,” adds Huang. “They share information only because they are now convinced that being more transparent is a more effective way of maintaining stability” than being secretive.
Where once the government feared that too much information might cause problems, it now takes a different tack, says Wu Fan, head of the Shanghai Center for Disease Control. "The government learned a lesson from SARS," she says. "If you don't say anything to the public they will be scared and that causes social problems." The government "changed it's attitude to tell people quickly what is happening," adds Dr. Wu.
That approach has not been universally adopted, Huang points out. The Environment Ministry recently refused to publish soil pollution figures on the grounds that they are a state secret. Shanghai residents are dubious about the reassurances they are getting about their drinking water.
And sometimes political events have dampened the authorities’ enthusiasm for the new openness. In 2008, for example, in the runup to the Olympic Games, the Anhui provincial government tried to cover up a deadly onset of hand, foot, and mouth disease (HFMD) so as not to spoil the national atmosphere. The central government also banned all reporting on the discovery of melamine in milk powder, which was held responsible for killing six infants, until the games were over.
A year later the authorities faked the figures, Huang believes, so as not to have to report any H1N1-related deaths before the celebrations marking the 60-year anniversary of the founding of the People’s Republic in October 2009. The government also suspended all reporting on the disease during the weeklong celebrations.
“Political considerations sometimes gain the upper hand in government decisions whether to report a deadly outbreak or not,” Huang argues.
While that may well be the case with local epidemics posing no threat to the outside world, agrees Dr. Kaufman, she does not think that “if SARS happened again, political expediency would outweigh international accountability.
“The consequences would be too great,” she says. “SARS was a big lesson for China in global citizenship.”