The lesson of SARS for health communication
The SARS epidemic has underlined the importance of open and accurate reporting on health issues — as well as the responsibility of governments to allow this to take place.
There are striking parallels between the current outbreak of severe acute respiratory syndrome (SARS) and the spread of radioactive fall-out from the Chernobyl nuclear power plant accident in 1986. In both cases, the full implications for public health were first widely publicised outside the countries in which the initial events took place. And in each case, the authorities in these countries — the former Soviet Union in the case of Chernobyl, and China in the case of SARS — were accused of a cover-up by initially refusing to admit to the size and nature of the problems involved.
The Chernobyl affair subsequently became one of the factors that led to the downfall of communism. It did this by fuelling public disenchantment in the Soviet Union with the way in which the government sought to maintain its legitimacy by controlling the flow of information to the public, but destroyed its credibility in the process.
No one is suggesting that the Chinese government is likely to meet the same fate, at least not in the near future. And, now that the full gravity of the SARS epidemic has become clear — by the beginning of this week (21 April) there had been 2,001 cases reported in the country, of whom 92 had died — China is co-operating fully with the World Health Organisation in its attempts to bring the situation under control.
Equally significantly, however, the party official in charge of Beijing, Liu Qi, made an unprecedented admission on Monday that he had provided inaccurate information on the SARS epidemic. It followed the decision by the Chinese government to dismiss its health minister last weekend on the grounds that the full extent of the initial outbreak had not been adequately reported.
Like Chernobyl, it has become increasingly clear that efforts to calm public fears by understating the magnitude of a potential health crisis has backfired. This tactic has also undermined the credibility of the government. As one resident of Shanghai put it in an interview last week: "The cover-up is just as frightening as the epidemic".
The merits of open health reporting
If there is a silver lining to the dark cloud of the SARS epidemic, it is the way that it has strengthened the case for open reporting on health issues, as the Chinese government is now implicitly admitting. It may be true, as the Chinese authorities no doubt initially maintained, that irresponsible reporting can inflame inappropriate public concerns. But that is no reason to suppress information; rather, it confirms the need to ensure that the mass media is adequately prepared to report accurately and authoritatively on major public health hazards, and that governments pursue policies on access to information that allow journalists and others to carry out this task.
The temptation to exert excessive control over information is not restricted to communist countries. Last month, SciDev.Net held a workshop on reporting on the science of HIV/AIDS at Makarere University in the Ugandan capital of Kampala. The choice of Uganda for this meeting was not fortuitous. For, as the country's minister of information Basoga Nsadhu pointed out when opening the workshop, the country has led the way in Africa in its openness towards the nature of the AIDS problem that it faces.
It is widely acknowledged that this openness has contributed directly to the relative success of Uganda in tackling AIDS. On the one hand, widespread coverage in the media has raised public awareness about the nature of the disease. On the other, the willingness of those working in the health professions to share their knowledge and experience with journalists has encouraged informed reporting that, in turn, has strengthened the ability of individuals to take effective precautionary measures.
Communication as an instrument of health policy
The clear message with AIDS in Africa is that the mass media can themselves become an important instrument of health policy. Harnessing the communication skills of journalists, as Uganda has shown, is one of the most effective ways of spreading information to the public about the steps that they need to take to protect their health, and that of the communities in which they live. Countries whose governments provide journalists with a blurred message — as South Africa still does on the nature of AIDS, and as China did at the beginning of the SARS epidemic — risk losing a major ally in their fight against disease.
Openness to the press is not just a question of issuing timely and informative press releases. It is also an attitude of mind, namely a willingness to accept that the risks of embarrassment are less than the potential risks of non-disclosure. When it comes to science and medicine in particular, governments need a strong excuse for withholding information. Avoiding embarrassment, or even attempting to allay 'unnecessary' public fears, is not one of them.
Yet there still remains a strong conviction in many parts of the developing world that access to information by journalists, even in these areas, should be strictly controlled. The press officer of a leading research institute in one African country tells how any scientist in his institute requires the permission of its director before speaking with the press. Journalists in another complain that scientists never reply to telephone messages or, if contacted for information, refer the inquirer to published scientific papers, which are unlikely to be easily accessible or appropriate.
The case for greater access
Good health journalism on its own will not stop the SARS epidemic, any more than it can stop the spread of HIV/AIDS. But in both cases, as the Kampala workshop demonstrated in the case of the latter, it has become an essential component in combating the spread of disease. It does this by helping to place responsibility for action where it is likely to be most effective, namely on the shoulders of individuals — not governments — who are best placed to take practical measures.
These measures will only be effective if they are based on sound knowledge. The information technology revolution has helped to ensure this by, in principle, making up-to-date scientific information directly available at virtually zero cost. But journalists and other health communicators cannot be expected to interpret this information accurately on their own. They still require access to scientists and medical specialists to assist them in this task.
They also need governments to encourage such specialists to be more open in their relations with the media. This is happening at a time when the science of the SARS virus, now thought to be able to mutate quickly, is becoming rapidly more complex. If the SARS epidemic has succeeded in opening the door just a bit wider, it will have been a small blessing in an otherwise bleak situation.
The science behind SARS, 22 April 2003
SARS virus cracks Beijing's façade of secrecy (Financial Times)
© SciDev.Net 2003