Page 2 of 2 Swine flu tests confidence in China, Japan
By Peter J Brown
Unlike last year's massive Sichuan earthquake, with its huge death toll and
wide devastation of infrastructure, China had time to see H1N1 coming and to
recognize that this contagion could be lethal. Vice Premier Li Keqiang had made
the rounds at the Chinese Center for Disease Control and Prevention in Beijing
on April 29 to ensure that morale was high, and trucks and planes were standing
by with the right medical supplies on board.
In Beijing, President Hu Jintao and the Standing Committee of the Politburo
held a meeting on April 30 that was made public immediately after it ended, a
rare move indeed. President Hu put all of China on notice that addressing the
threat of swine flu was
an urgent priority and that an immediate increase in all surveillance,
inspection and quarantine-related activities was underway. This is when Chinese
Health Minister Chen Zhu made his above-mentioned statements, and expressed his
sense of confidence.
China has an excellent capacity to mobilize, yet when it comes to the quality
of the public health response, vast differences occur from province to
province. As for the status of China's emergency communications systems,
structural and bureaucratic limitations are likely to pose a greater problem
than the emergency communications networks or IT technologies in use.
The May 2008 earthquake provided China with a long list of lessons learned, and
recommended improvements. These are no doubt being addressed by Chinese
emergency management and disaster response officials, but have they been
addressed successfully only a year later? Despite progress, this seems
unlikely.
In an article published in medical journal The Lancet last August - "The untold
stories of the Sichuan earthquake" Dr Emily YY Chan, assistant professor at the
Chinese University of Hong Kong's School of Public Health, described a "lack of
multidisciplinary teams" along with a noticeable gap in actual disaster
response and preparedness training.
Due to the harsh economic conditions in China, whereas Dr Chan described a
rural zone in 2008 where the absence of young people was immediately apparent,
in 2009, many of those same young people are either home or are in the process
of returning home. This demographic cluster accounts for upwards of 15% or more
of the population. This means that the more remote areas of China which
experienced urban or outward migrations in the past now have much higher
population densities - a factor that will challenge public health officials
even more if a pandemic occurs.
Among other things, she described the "lack of experience and training in
mental health needs" and health-care staff which were "chronically fatigued and
emotionally disturbed by the traumas they had witnessed." No surprise there.
Even the US admits that its disaster response coordinators must put more
emphasis on mental health. In fact, mental health and information sharing were
specifically addressed on a high priority basis by the so-called Homeland
Security Presidential Directive-21, which was issued by the US in 2007, two
years after Hurricane Katrina struck the Gulf Coast of the US.
While China tries to mend fences with Mexico, and as hotel guests at the
sealed-off Metropark Hotel in Hong Kong try to keep their spirits up during
their soon-to-end ordeal, Japan is coming to the stark realization that
something is seriously askew in the way it handles emergency communications,
and alerts and warnings.
In early April, Japan received an unpleasant wake up call.
"In two false alarms hours apart that Defense Minister Yasukazu Hamada called
'inexcusable,' the Self Defense Forces wrongfully alerted the public that North
Korea had launched a rocket from the Musudan-ri launch pad. The ministry
retracted both announcements, blaming them on computer glitches and
communications blunders. The latter one went nationwide," reported the Japan
Times on April 5.
"We apologize for the confusion caused by the false alarms," Defense Minister
Yasukazu Hamada told reporters Saturday. He also revealed that Chief Cabinet
Secretary Takeo Kawamura had told the ministry to be more careful in handling
information.
Less than a month later, once the H1N1 outbreak was well underway, Japan
started down the same path. This time, there were no government-issued false
alarms, rather these were generated indirectly and perhaps quite by accident by
the Japanese media. As a result, this writer finally gave up trying to assess
the accuracy of articles about potentially ill people either arriving at Narita
Airport in Tokyo or returning from Canada to Yokohama.
Because Japanese officials were often quoted in these same articles, Japan
appeared almost unable to control what exactly it was trying to convey to the
Japanese public and the rest of the world - not a good strategy in the face of
a looming pandemic. After all, how many times can you communicate inaccurate
information before the general public just ignores these messages altogether?
Another concern. During the North Korean missile test last month, it also
became clear that the Japanese government's internal, multi-agency information
sharing mechanisms were somewhat suspect, too.
"A day after having erroneously announced the launch of a missile from North
Korea, the Defense Ministry experienced further communication problems when
responding to the actual launch Sunday," The Yomiuri Shimbun reported on April
7. "The ministry was forced to delete information on the supposed splashdown
point of the missile's second-stage booster from press materials after its
initial estimate had to be corrected. Meanwhile, the changing situation threw
the Fisheries Agency into confusion in its efforts to confirm the safety of
fishing boats operating in the sea at the time."
Chief cabinet secretary Takeo Kawamura was unaware of the change. He became
aware of it only after a reporter brought it up at a scheduled press
conference. It was later revealed that the Japanese Coast Guard was left out of
the loop as well.
This might not be as significant a failure as the nationwide transmission of a
false alarm, but in light of all the notifications and the lengthy preparation
time in advance of the actual missile launch by the North Koreans, this
disconnection at the highest levels of the Japanese government is indeed
troubling. The fact that different Japanese government agencies - even the
prime minister's office - were not being kept informed on a need-to-know basis
during a time of high alert was one thing. Why, at the same time, certain
proper procedures involving message logs, acknowledgments and verifications
were not being followed was something else entirely.
Japan cannot neatly separate the two events, and try to downplay what happened
in early April, because this might invite another failure in the future. The
same lack of predictability and poor performance resulting in an otherwise
random pair of system failures - you can bet that more than one system failed -
might adversely impact the Japanese government's attempts to cope with an H1N1
outbreak, if and when it occurs in Japan.
The threat of swine flu is not evaporating before our eyes. As for avian flu,
it has been bumped off the radar screen, at least for the moment as far as the
general public is concerned. China and Japan do not need to re-invent the wheel
in order to make necessary improvements and corrections here, although they do
need to make up their minds about what needs to happen next, sooner rather than
later.
Peter J Brown is a freelance writer from Maine, US. He has worked on
plans and procedures involving emergency communications for hospitals and
multi-agency response teams. His related commentaries have appeared in the
Washington Times, Journal of Emergency Management and Disaster Medicine &
Public Health Preparedness, a journal of the American Medical Association.
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