Tale of SARS, H1N1: Once burned, twice shy

When news of a mysterious infectious disease in North America first emerged in late April, the question on many people's minds was: Is this another SARS? Asian countries like China are still haunted by the 2003 specter of the severe acute respiratory syndrome or (SARS), which killed nearly 800 people worldwide, seriously challenged healthcare systems and had a devastating impact on economies.

But this time it was found that the virus was influenza A(H1N1), a re-assortment of swine flu from North America, Asia and Europe, as well as bird flu and human influenza. This new virus has not been seen before in humans and animals, sparking urgent international efforts to study its clinical features, epidemiology and impact on global public health.

Today, the world is better equipped to respond to outbreaks of infectious diseases. SARS awakened the international community to the need for preparedness through enhancing disease surveillance and investing in healthcare systems and resources. SARS was also an impetus for revising the International Health Regulations (2005), one of the most important landmarks in global public health this decade.

At the national level, China offers a good example of how far we have come on disease control since SARS. Based on the experiences and lessons learnt from SARS, the State Council in May 2003 issued a new Regulation on Public Health Emergency Response to strengthen surveillance for new disease outbreaks and to improve reporting and response in cooperation with technical agencies. The National Law on Communicable Disease Prevention and Control was revised in August 2004.

In recent years, China has developed a national pandemic preparedness and response plan to cope with the threat of the deadly H5N1 bird flu virus. The government has invested in healthcare facilities and strengthened laboratory services and diagnostic capabilities. In addition, health workers at all levels have been trained in technical and other areas such as risk communications.

Three weeks ago, after the World Health Organization (WHO) informed the Chinese Ministry of Health about the outbreak of A(H1N1) in North America, the plan originally designed for H5N1 was activated with the same effect.

China immediately enhanced its surveillance system and alerted healthcare workers at all levels to report any unusual influenza-like symptoms. The flow of information between WHO and the Ministry of Health has been swift and transparent, with daily calls and meetings to exchange information on global and national developments.

Right from the beginning, there has been a high-level political commitment to prevent and control the spread of A(H1N1) in China. Eight working groups have been set up with officials from ministries such as health, agriculture, foreign affairs, commerce, and science and technology, and agencies like China Center for Disease Control and Prevention, and the General Administration of Quality Supervision, Inspection and Quarantine. Such a multi-sector coordination is crucial because if a pandemic breaks out, it will affect not just the health sector but also potentially every sector of society.

China's experience shows that the same actions and responses can be applied to different types of emerging infectious diseases such as pandemic flu. Long-term investments in preparedness do pay off.

Faced with a new virus like A(H1N1), there is a universal need for heightened vigilance and prompt, coordinated action. Guiding these global efforts are the International Health Regulations (IHR 2005) that were revised in the wake of SARS. The IHR (2005) has a new set of rules to support the existing global outbreak alert and response system and to make countries improve international and national surveillance and reporting mechanisms for health scares. Their aim is to help countries prevent, protect against, control and respond to the global spread of disease while avoiding unnecessary interference with international traffic and trade.

Under the IHR (2005), we have seen an unprecedented level of international cooperation against A(H1N1). Affected countries are sharing information on the genetic sequencing of the virus. Rapid diagnostic test kits have been developed and are being distributed around the world. Once an overseas traveler is confirmed to have contracted A(H1N1), a global network of contact tracing is activated to try to limit the spread of the disease.

Live virus samples have been shared with countries keen to develop a vaccine. Discussions are also underway on vaccine production and distribution in an equitable way to ensure that less developed countries can get them.

Nonetheless, these are still early days. Based on current information on A(H1N1), it is impossible to say what will happen next. The virus could fade away gradually, or mutate into something more severe. Another possibility is that we could continue to see sporadic cases emerge over the next few months, followed by a second wave when winter approaches the Northern Hemisphere.

Like the rest of the world, China cannot afford to lower its guard. The country faces three unique challenges - the sheer size of its population, the diversity in development and resources across provinces, and the large migrant population that is mobile and often falls through the cracks of public healthcare. Together with other UN agencies, WHO is ready to help China face these challenges.

China must maintain a high level of surveillance. Early detection and treatment of infected persons is the best way to check the spread of the virus and mitigate its impact. Healthcare facilities and services must be battle-ready to fight an outbreak.

Public education is another important line of defense. People at all levels of society must be informed about A(H1N1) and how to avoid human-to-human transmission through respiratory droplets. The measures are simple: Practice good personal hygiene, cover the mouth while coughing, not spit indiscriminately, wash hands frequently, avoid crowded places, stay home if you feel unwell and consult healthcare professionals for suspicious symptoms.

Just like President Hu Jintao declared a "people's war" against SARS six years ago, the public should be mobilized against this new threat. It can be done. The same voice that got ethnic minorities singing folk songs about SARS in the Guangxi Zhuang autonomous region, the same vision that put SARS messages on murals in the Inner Mongolia autonomous region, the same initiative that inspired rural students to start their own hand-washing campaign against the hand, foot and mouth disease, must all come together to develop a robust public education campaign against A(H1N1).

New infectious diseases such as A(H1N1) are emerging at the unprecedented average of one a year. Now more than ever, it is time to take public health personally.

The author is World Health Organization's representative in China.

(China Daily 05/21/2009 page9)