Amidst the seasonal chatter of virulent H5N1 influenza strains and lingering concerns about H1N1 arose a new topic of interest this April: the emergence of a new flu strain, H7N9, which had previously never been seen in humans. First reported to the WHO on March 31, the new strain had already caused 77 cases and 16 deaths in China as of April 16.
Promisingly, Chinese officials have already started to crack down on H7N9′s spread. Measures have included a closure of poultry markets in Shanghai and a culling of poultry stocks in the areas surrounding affected cities. Culling, in particular, will be important for preventing the spread of virus, since H7N9 has been shown to have low pathogenicity; (that is, it produces no symptoms in infected animals.) And since public health officials are reinforcing the message that H7N9 does not generally appear to be transmissible from human to human, limiting the spread between and from affected birds will be particularly crucial for containing the cases.
Ten Years After
This rapid response to H7N9 contrasts starkly with China’s response to the high-profile SARS epidemic almost exactly 10 years ago. In the initial stages of SARS, starting on November 16, 2002, local and central Chinese authorities covered up the outbreak, fearing social and economic instability if control measures like quarantines and market shutdowns were undertaken. As SARS cases began to appear in other countries, it became clear that China’s refusal to acknowledge that SARS was a problem and institute effective control measures was threatening the health of the international community. Only on February 11, 2003 was the outbreak reported to the WHO, almost three months after it began. By April 20, 2003, two central figures involved in the cover-up were sacked, and China’s position began to shift towards reporting the SARS crisis honestly.
The recent Chinese response to the H7N9 epidemic has clearly improved on the speed of the SARS response, and certain actions taken by the new President Xi Jinping’s administration reflect his commitment to increased transparency. In terms of scientific transparency, the Chinese have provided the WHO with the gene sequence for the virus, allowing for crucial research that can reveal the source of the virus and how it spreads between animals and humans. In terms of government transparency, state censors have permitted news stories about the toll of H7N9 to be published in Xinhua, the official state press, providing numbers ahead of the WHO count. Editorials have even been published critiquing the government response to the SARS epidemic 10 years after, reflecting the government’s recognition that silence is not a sustainable response to crisis.
Room for Growth
Despite improvements in China’s response to health crises, however, there is still much room for improvement. For one, while Chinese authorities were much faster to release news of the emergence of H7N9 than SARS or even H5N1, there was still a critical delay between the first suspected case (February 18), or even the first major cluster of cases (March 18), and the first official notification to the WHO (March 31).
Officials have cited multiple reasons for this delay. For one, the unusually low pathogenicity of the virus makes it difficult to trace infected birds, and this hindered the official detection and response to the epidemic. Furthermore, this recent focus on the threat of H5N1 means that even serology tests conducted on poultry to detect antibodies for influenza may have focused on detecting H5N1 only, rather than detecting all strains of the flu. And after the virus was transmitted to humans, officials claimed that they wanted to wait for official lab confirmation on the identity of the virus, which arrived on March 29, before they reported the new strain to the WHO two days later.
However, others have speculated that the real reason for the delay was not scientific, but political. Notably, the announcement was delayed until after the National People’s Congress on March 16, 2013, during which government power was transferred to new leadership, and dissent was discouraged to a an even greater extent than usual. If so, it does not bode well for China’s image to be known for prioritizing politics over health.
The cost of disease extends beyond the immediate public health budget, to lost economic productivity and numerous intangibles caused by unpredictable responses to outbreaks. And delays amplify that cost; the more infection control responses are delayed, the longer it takes for the pathogen to be sequenced, the slower the control of the outbreak, and the slower the development of an effective vaccine. Delays in response, even on the order of days, mean poorer preparation and capacity among health care agencies to respond effectively to the new threat. The more the virus is allowed to spread, the more persistent it will be, and the greater impact it has on local and global economies.
While China has greatly sped up its response to health crises in the ten years since SARS, this incident makes it clear that it still has much room for improvement. As an April 3 Xinhua editorial noted, “If there is anything that SARS has taught China and its government, it’s that one cannot be too careful or too honest when it comes to deadly pandemics.” The Chinese had an opportunity before and during their National People’s Congress to prove their commitment to transparency and the welfare of their people over politics. It was an opportunity wasted.
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