International

Partially because of the profound economic impact of SARS, partially because of the fear it had created among their citizens, heads of state, diplomats and politicians became involved early and visibly, fully participating in outbreak control through frequent press briefings, declarations, and provision of political and economic support to the global containment effort.

—David Heynmann, in Fidler 2004, p. xiv

As the SARS epidemic intensified, the ten member states of ASEAN (the Association of Southeast Asian Nations) grew increasingly aware of the threat the contagion posed to their people and their economies. Anxiety in this region actually was intensified by earlier shocks to governance in the region, such as the Asian economic crisis of 1997-98, as well as the regional environmental "haze" issue that resulted from ubiquitous fires throughout the region during the same time period. Indeed, fear arose in Singapore that SARS could provoke its worst economic crisis since the country had gained independence.35 While such concerns over economic loss were shared by leaders in this region, the rapidly spreading epidemic also generated a strong sense of the urgency of regional cooperation. On April 26, the Health Ministers of the ASEAN countries and those of China, Japan, and South Korea met in Kuala Lumpur to voice their willingness to cooperate. On April 29, leaders from the ASEAN countries attended the emergency summit in Bangkok.36 The Bangkok summit was initiated by Prime Minister Goh Chok Tong of Singapore, who was also instrumental in setting the agenda. ASEAN thus became the ideal platform for discussing this issue. Initiated by Goh, the communiqué issued by Bangkok summit articulated a "collective responsibility to implement stringent measures to control and contain the spread of SARS and the importance of transparency in implementing these measures."37 ASEAN members agreed that all countries in the region would immediately commence mandatory screening for SARS at their borders. The declaration issued by member states agreed on various measures to stop SARS transmission, including sharing information on the movement of people by building a SARS containment information network, coordinating prevention measures by standardizing health screening for all travelers (i.e., common protocols for air, land, and sea travel), adopting an "isolate and contain" approach (rather than a blank ban on travel), and establishing an ad hoc ministerial-level joint task force to follow-up, decide and monitor the implementation of the deci sions made at this meeting and the "ASEAN + 3"38 health ministers' special meeting on SARS.

China and representatives from Hong Kong were invited to attend a follow-up summit later the same day. During that special meeting, however, ASEAN diplomats were very careful not to directly criticize Beijing's mishandling of the epidemic, but rather to solicit China's cooperation in dealing with a highly sensitive issue. The idea was for ASEAN leaders to agree on a set of resolutions and measures for China to sign on to. Aware that the image of the China and the reputation of its new leadership were at stake, Wen was cooperative during the Bangkok conference. He pleaded for understanding from other ASEAN leaders. "In the face of the outbreak of this sudden epidemic," he said, "we lack experience with its prevention and control. The crisis-management mechanism and the work of certain localities and departments are not quite adequate."39 This was an astonishing admission of culpability from a regime that is loath to admit responsibility for any mistake or wrongdoing. In an ASEAN-China joint statement, China agreed to "associate itself with the measures proposed by the ASEAN declaration." This endorsement by Beijing was indeed remarkable, given that a total embracement of the measures decided by the ASEAN leaders would be perceived in China as an act of submission.40

A central problem to pathogen surveillance and containment throughout the region was the dearth of public health infrastructure among many of the poorer countries, an issue of state capacity. To strengthen regional capacity, Beijing provided $1.2 million, subsequently emulated by Thailand and Cambodia.41 While it was a positive gesture, such meager amounts did not truly generate any significantly increased levels of regional public health infrastructural capacity. Despite the rhetoric of cooperation, containment remained the responsibility of its sovereign member states to implement those principles and to engage in suppression of the contagion.

The political analyst Eric Cheow argues that the fact that the SARS virus developed and emerged in Guangdong province suggests that poverty and low state capacity are the principal variables governing the emergence of infectious disease. "As East Asians develop a sense of community," Cheow writes, "they must look urgently into developing the poorer regions so they will not remain poor, underdeveloped and, thus a hotbed of chronic diseases, which may have been eradicated in the richer and more developed countries."42 Such assumptions betray a certain degree of ignorance regarding the ecological mechanics of microbial emergence and evolution. As was noted above, selective evolutionary pressures will force microbes to adapt to (and colonize) ecological niches in countries of both high and low state capacity.43 Ergo, the assumption that the most virulent and transmissible of new pathogens necessarily emanate from the least developed countries (and regions within those countries) is empirically specious.44

Moreover, the success of various countries in controlling the epidemic demonstrates that a prosperous country that exhibited significant levels of endogenous capacity (such as Canada) had a much more difficult time in containing the infection than did countries of lower capacity, particularly Vietnam. The most recent epidemiological evidence suggests that SARS appears to thrive under conditions that promote nosocomial trans-mission.45 Therefore, the sealed, air-conditioned hospitals of developed societies appeared to facilitate SARS transmission. Conversely, Vietnamese hospitals are often open-aired, diminishing the probability of nosocomial transmission. In other words, the SARS coronavirus appears to be more transmissible in the sealed hospital and urban environments of countries with technologically sophisticated health infrastructures. SARS, then, would seem to pose a greater threat to countries of higher capacity, and thus the effects of pathogens on a given society are dependent to some degree on the human ecology of the society involved. This suggests that, in the face of a nosocomial pathogen such as SARS, social ingenuity may offset any lack of technical ingenuity and infrastructure.

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