Official reaction to a chemical disaster in China this week - denial and cover-up - does not bode well for the response to any potential H5N1 avian flu pandemic.
First, let's review why it's important to respond quickly to any bird flu outbreak among humans.
In the case of a totally new strain of virus (like Influenza A H5N1), no one has immunity. If a person has never had a disease (e.g., only 100+ people have been infected by H5N1) and never been vaccinated for it (no H5N1-specific vaccine exists), then his immune system has never had the opportunity to build antibodies to it. We're all vulnerable to H5N1 if it ever gains the ability to readily pass from person to person. It could spread like wildfire.
Should a new virus gain the ability to readily spread among people, that initial outbreak likely would occur at one or a few locations (not simultaneously in thousands of places), according to public health experts. If limited to a few sites and if health officials are alerted to what's happening QUICKLY, there is some chance that steps could be taken to contain the disease in those locations and keep it from spreading. No guarantee, but a chance.
In order to recognize the occurance of a disease, we depend upon "surveillance" - alert medical personnel watching for signs of the disease in their community. For surveillance to be of benefit, (1) local medical personnel must be trained and equipped to watch for and recognize the disease outbreak and (2) information about any outbreak must be quickly, honestly, and openly shared with the rest of the world. ("Honestly and openly" is sometimes called "transparently.")
- Sometimes the personnel aren't adequately trained and equipped.
- Even with training and tools, sometimes observers make mistakes - they don't recognize medical evidence for what it is.
- Some people are not honest and open.
That third item has all the makings of a tragedy.
Now, consider what's happening today (November 25, 2005), as reported in The Globe and Mail:
A massive slick of poisoned water was flowing through one of China's biggest cities yesterday, tainting its water supply and provoking outrage over the government's attempts to cover up another environmental disaster.
The 80-kilometre-long stretch of potentially deadly toxic water was flowing through Harbin, a northern city of four million people, after a chemical explosion whose effects had been deliberately concealed for 10 days.
The entire city has been ordered to stop using its water supply for the next two days at least. ...
The crisis was expanding into an international incident as the Russian city of Khabarovsk, farther downstream, is bracing for the impact of the poisoned water which is likely to reach the Russian border within 14 days.
...The latest disaster began with a huge explosion on Nov. 13 at a PetroChina benzene factory in Jilin province, about 380 kilometres upstream from Harbin. ... The factory was only a few hundred metres from the Songhua River, yet officials did not issue any warning of pollution on the river.
About 100 tonnes of toxic chemicals were flowing down the river, directly toward Harbin and benzene levels were soon more than 100 times above the safe maximum. But the extent of the threat was officially concealed for 10 days, until wildly spreading rumours began to cause panic across Harbin.
As recently as Monday, the city government insisted that the fears of contaminated water were "just a rumour." Finally, on Wednesday, the national government revealed the reality of the disaster, triggering angry reactions from many Harbin residents and Chinese media commentators.
And from the Associated Press in The Guardian:
Officials kept news of the spill secret for days and initially said they were shutting off water merely for maintenance.
...The missteps in Harbin are further straining the credibility of a government grappling with spreading bird flu outbreaks and rising public anger over corruption.
"If information is not given in a timely, accurate and transparent manner, it will leave room for rumors to spread," said a column printed in the China Youth Daily newspaper that gave an account of the local government's misinformation and confusion.
...One paper called on Beijing to learn a lesson from its outbreak of severe acute respiratory syndrome, or SARS, which emerged in late 2002. The government was initially criticized for withholding information about the pneumonia-like disease, drawing international criticism.
...China has not responded to a U.N. request made earlier this week for information about the spill or an offer to help assess the environmental damage, said Vladimir Sakharov, who heads the Geneva-based Environmental Emergencies Section under the United Nations Environment Program and the U.N. Office for the Coordination of Humanitarian Affairs.
"We need basic, official information from the Chinese side, which we do not have," Sakharov said.
...In neighboring Russia, concern was growing about 435 miles downstream in the border city of Khabarovsk. Officials told Russia's Itar-Tass news they weren't getting enough information from the Chinese side.
As I said at the outset, this and similar incidents do not bode well for the urgent matter at hand.
As the World Health Organization stated in its report, "Avian influenza - assessing the pandemic threat": [2.6Mb .pdf]
Faced with an infectious disease threat that will inevitably be shared by all, the international community must rely on surveillance systems within affected countries to detect and report human cases...
And the WHO says there are lessons to be learned from past pandemics:
Over the centuries, most pandemics have originated in parts of Asia where dense populations of humans live in close proximity to ducks and pigs. In this part of the world, surveillance for both animal influenza and clusters of unusual respiratory disease in humans performs an important early warning function.
An editorial in today's Financial Times entitled "China's toxic cover-up" sums up the world's concerns about some Chinese officials' tendency toward secrecy, denial, cover-up, and silence:
...Why did it take more than a week for the 9m people of metropolitan Harbin - a city larger than most European capitals - to be told their drinking water was threatened by toxic benzene ...?
Why did PetroChina ... not immediately warn of the danger posed by the benzene, now making its way in an 80km slick past Harbin and towards the Russian border? Why did the Harbin government begin by lying about the problem, announcing that water supplies were being cut for maintenance purposes?
...After three days of contradictions, the central and local governments have delivered a belated trickle of information and plentiful supplies of bottled water.
...they must abandon the party's habit of secrecy. Beijing's refusal to come clean about the outbreak in China of severe acute respiratory syndrome (Sars) contributed to the spread of a disease that killed hundreds of people in Asia in 2003. Today, health officials suspect that the Chinese government is either unwilling or unable to give an honest account of the spread of bird flu inside the country.
So since China is quite possibly the epicenter from which an H5N1 pandemic might originate....