Day One Conclusion: the response so far
WHO global meeting on SARS
On Thursday of this week, 100 days will have passed since WHO alerted the world to the appearance of a severe respiratory illness of undetermined cause that was rapidly spreading among hospital staff in Viet Nam and Hong Kong. Three days later, on 15 March, a second mode of spread became clear: the new disease was travelling along major airline routes to reach distant areas with great speed.
Cases in the initial outbreak sites multiplied at an alarming rate, spilling out of hospitals into the general population and then over borders or along air routes to a growing number of countries. Within a month of the first alert, some 3 000 probable cases and more than 100 deaths had been reported from more than 20 countries on all continents.
And yet despite the speed at which SARS spread, when we look back on the past 100 days, and track key events in the international response, it is the speed and sweep of our achievements that is truly remarkable.
Ladies and gentlemen, We are dealing with a new disease, striking a globalized society. We have seen its rapid international spread. We have seen stock markets move up or down according to the latest success or setback in the SARS situation. We have seen bustling transportation hubs go quiet. We have seen SARS on the front pages and on our TV screens. We have seen the closure of hospitals, schools, and borders. We have witnessed the economic impact, population movements from affected cities, and unwarranted discrimination.
But we have also seen unprecedented international solidarity against a shared microbial threat of unknown dimensions. And we have seen SARS stopped dead in its tracks in some of the worst affected areas.
From the outset, the WHO response to SARS has been guided by one overriding objective: to seal off opportunities for this new disease to establish itself and become endemic. This, simply, is our public health duty. It is gratifying to see that political leaders the world over have responded with a similar commitment to an all-out effort to see SARS defeated.
At the end of April, heads of state from Asian countries met in Bangkok to map out plans for combating SARS. Recognizing that the crisis was shared by all, they set up a SARS information network, established standard protocols for travel by air, land, and sea, and agreed on a communications strategy.
In late May, at the World Health Assembly, I experienced first-hand how seriously SARS is taken by ministers of health, and how much this disease has opened the world’s eyes to the magnitude of damage and disruption a new disease can cause in sectors far beyond health. Delegates adopted, by consensus, a resolution on the International Health Regulations that underscores WHO's role in leading the fight against any infectious disease that poses a threat to international public health.
Ladies and gentlemen, SARS has changed the perception of the infectious disease threat. It has also raised public health to a new level of importance. As we have heard today, SARS is a very resilient and important new disease. This makes our successes over the past few weeks and months all the more impressive.
The first and most compelling lesson we must learn from SARS concerns the need to report, promptly and openly, cases of any disease with the potential for international spread. In a globalized, electronically interconnected world, attempts to conceal cases of an infectious disease, for fear of social and economic consequences, must now be recognized as carrying a very high price. This includes loss of credibility in the eyes of the international community, with a negative economic impact, damage to the health and economies of neighbouring countries, and a very real risk that outbreaks within the country’s own territory can spiral out of control.
SARS also shows the decisive role of political commitment at the highest level. As we have heard today Viet Nam, which became the first country to break the chain of transmission in late April, showed how a developing country, hit by an especially severe outbreak, can triumph over a disease when reporting is prompt and open and when WHO assistance is quickly requested and fully supported.
This success, subsequently repeated in Singapore and very likely soon in Beijing, Hong Kong, Taiwan and Canada shows that SARS can be contained, despite the absence of robust diagnostic tests, a vaccine, or any specific treatment. When awareness, commitment, and determination are high, even such traditional control tools as isolation, contact tracing and quarantine can be sufficiently powerful to break the chain of transmission.
As we have also heard today, progress in understanding the science of SARS has been unprecedented. The urgency of SARS challenged WHO to set in motion high-level scientific and medical collaboration. Within a week after the first global alert, WHO had established three “virtual” SARS-dedicated networks of virologists, clinicians, and epidemiologists to ensure a continuous research effort equal to the magnitude of the SARS emergency. One month after 11 leading laboratories joined the WHO collaborative effort, participating scientists collectively announced conclusive identification of the SARS virus. Complete sequencing of its RNA followed shortly. This success is an encouraging sign of the willingness of the scientific community to collaborate, rather than compete, in solving the mysteries of a threat shared by all of humanity.
On the negative side, SARS has exposed serious weaknesses in health systems around the world. The disease places an enormous burden on health services in terms of infection control, isolation, long periods of intensive care and the demands of contact tracing and follow up or quarantine. Even in areas with highly developed social services, the burden of coping with SARS, the number of hospital patients and health workers who became infected, often brought health systems to the verge of collapse.
Monitoring the evolution of SARS has been hindered by the weak capacity of many national surveillance systems to provide detailed information daily. When surveillance in individual countries is strengthened, it generates the knowledge needed to support sound control measures and thus enhances prospects for global containment.
The magnitude of the response demanded by SARS came at the expense of other diseases. Virtually no country had adequate surge capacity to cope with the SARS caseload, especially since health care workers – the frontline troops at risk – were themselves frequent victims of the disease. The shortage of expert staff to coordinate national and global responses to a rapidly evolving public health emergency is also an issue needing urgent attention.
As a highly publicized, visible, and greatly feared disease, SARS has stimulated an emergency response on a scale that has changed public and political perceptions of the risk posed by all emerging and re-emerging infectious diseases.
Though exceptional in terms of its impact, severity, rapid international spread, and many puzzling features, SARS is only one of around 50 internationally important outbreaks to which WHO and its partners in the Global Outbreak Alert and Response Network respond in any given year. The high level of medical, scientific, political, and public attention focused on SARS is helping the world to understand the severity of the infectious disease threat and the importance of international solidarity in the face of this threat.
From the outset, SARS was perceived to be an extremely dangerous threat requiring an extremely intense response. Concentrated efforts needed to contain SARS brought weaknesses in health systems into sharp focus and stimulated rapid corrective measures, often with WHO support. As a result, many long-standing and seemingly intractable problems that have traditionally weakened health systems have been corrected in fundamental and often permanent ways.
SARS will not be the last new disease to take advantage of conditions in a globalized world. In the past two decades, new diseases emerged at the unprecedented rate of one per year, and this trend is likely to continue. Improved surveillance and reporting systems, mechanisms for collaborative research, hospital policies, procedures for infection control, and channels for informing and educating the public are part of the positive legacy of SARS.
As you work together to map out plans for the future, you can be certain that your conclusions and recommendations will truly make a difference. SARS has opened our eyes to the damage that a new disease can cause on many different levels. It is in the enlightened self-interest of us all to strengthen our defenses against the infectious disease threat in all its dimensions.