Bird flu: the communication challenge
Scientific advances since the three major flu pandemics of the 20th century mean that, in principle, the world is better equipped to prevent bird flu from having the same consequences. But significant obstacles still exist, and greater transparency needs to be the order of the day.
One of the most powerful allies of human disease is human ignorance. At a relatively simplistic level, food poisoning often results from a lack of awareness of elementary principles of hygiene. More complicated is the way that a lack of information about the behaviour of the HIV/AIDS virus — for example, how it can be spread by contaminated needles used by either intravenous drug users or those collecting blood for medical purposes — has contributed directly to the epidemic now facing many parts of the developing world.
The obvious antidote to ignorance, of course, is knowledge. Indeed, one of the most important benefits of modern medical science has been its contribution to our awareness of the way that diseases spread, leading directly to strategies for preventing this from happening. Yet there is another type of ignorance that science can do little about, but can be almost as dangerous. This is when government authorities deliberately keep the public in ignorance.
Last year's crisis over severe acute respiratory syndrome (SARS) saw both sides of the coin. On the one hand, international collaboration between some of the world's leading epidemiologists, molecular biologists and experts in infectious diseases led to the successful containment of a disease which, in other circumstances — and in a pre-scientific era — might have killed hundreds of thousands, if not millions, rather than the several hundred who actually succumbed. Communication of scientific data was, and continues to be, vital in the battle against SARS.
Yet the outbreak might have been contained much sooner if medical authorities in the countries where it was first detected had been more open, both with their own people and with international agencies, about what was going on. Sadly, just as in the early days of the HIV/AIDS epidemic, a reluctance to admit to medical facts led to an inadequate political response, whose full implications were only realised later.
China, at least, has learnt the lessons from its mishandling of the SARS crisis in dealing with the current outbreak of avian influenza, or bird flu. This is a disease caused by a particularly virulent virus that is now sweeping through almost a dozen countries in South East. So far, the disease has mostly remained restricted to birds. However there is sufficient medical and scientific evidence to raise concern that, unless properly handled, the virus could evolve into a highly-infectious human form (for example, if it was to swap genes with an existing human flu virus).
Dealing with this possibility is now a major political, as well as scientific, challenge. For the tight surveillance and monitoring required to ensure prompt action is taken against the spread of the virus among humans requires a transparency of information that is sadly foreign to many of the countries in which concern is growing.
China learnt — the hard way — that in an age of global information flows, knowledge of public health events cannot be suppressed; even more important, it learnt that any attempt to suppress such knowledge only generates distrust. One of the nails on the coffin of the Soviet Union was the way that is mishandled the release of public information about the Chernobyl nuclear accident. The Soviet administration made itself look ridiculous by attempting to deny an event whose reality was obvious to anyone in the country owning a fax machine connected to the outside world. Officials such as the Mayor of Beijing who adopted a similar approach to handling data about SARS have since paid with their jobs.
In general, the Chinese authorities appear to have been keen to learn from their previous mistakes. At the scientific level, collaboration between research laboratories is said to have increased significantly (one of the major criticisms of scientists last year was that they had been reluctant to share information with colleagues in other institutions). And substantial efforts have been made to keep the public informed; for example, the government has organised regular press conferences intended to inform the public about current efforts to contain the disease.
There are still signs that the message has to get across in some other countries in South Asia. Last week, for example, government authorities in Thailand were accused of dragging their feet in revealing details of an outbreak of bird flu that occurred in their country. The charges were made by a senator who claimed that the government, having declared the country bird flu free in May, had waited for two weeks before conceding that the virus had reappeared in a farm near the capital. According to a new agency report, the government's response was a familiar one: according to a spokesman "we don't release information with a lot of publicity because we don't want the public to be overly panicked".
That goal, of course, is eminently sensible. But so, too, were the UK government's declared intentions about ten years ago that British beef was safe to eat, and that Bovine spongiform encephalitis (or 'mad cow' disease) couldn't pass from animals to humans. The problem for Britain was that, once its science was shown to be wrong, it immediately lost a substantial amount of political credibility. And once public trust has been lost, it cannot easily be retrieved.
There is a similar danger with bird flu disease. Attempts to be reassuring may be understandable in economic terms; last year's SARS crisis, for example, is said to have cost Asia $60 billion in lost revenues, mainly through cancelled trips to the region. But reassurance must be based on sound information, not on attempts to draw a veil over information that authorities may be embarrassed to reveal.
Science and health journalists clearly have a key role to play in this process. Partly this is to ensure that they report fully and accurately on outbreaks of bird flu when they occur, while at the same time ensuring that the facts they report are kept in a legitimate perspective. It is with this in mind, for example, that we are publishing a special section of SciDev.Net, entitled 'Bird Flu: The Facts', bringing together questions and answers about bird flu, news of scientific and policy developments, and links to sources of reliable information.
Accurate reporting is one form of reassurance. A second comes from the responsibility of journalists to ensure that governments are acting responsibly in dealing with the communication of facts. Where this is not the case — for example, where countries in East Asia have been slow to cooperate with the World Health Organization (WHO) in supplying information about incidences of bird flu — such failures to communicate should be highlighted in the public media. Governments should not be allowed to use claims of protecting the public interest to disguise activities that actually do the reverse.
Finally, governments themselves must do more to ensure that channels of communication are opened up. This may mean letting journalists talk to individual scientists in research institutions, rather than insisting that all contact goes through official spokespeople. It can even go as far as adopting 'Freedom of Information Laws', such as those which operate in the United States, ensuring that information is only kept secret when there is a clear and legitimate reason for doing so. Transparency at all levels of decision-making must be the order of the day. It may be a tough message for some countries to learn. But in an era when the WHO is describing another worldwide flu epidemic as "inevitable and possibly imminent", anything less could have disastrous consequences.