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From SARS to Bird Flu :
Public Health and Animal Diseases
Between Hong Kong and Guangdong
Frédéric Keck
CNRS
French Center for the Study of Contemporary China
(CEFC Hong Kong)
Conference in Ritsumeikan University (Kyoto)
4 December 2008
From SARS to Bird Flu :
Public Health and Animal Diseases Between Hong Kong and Guangdong
Introduction :
- Where I come from
- Intellectual references
I SARS in Hong Kong :
- The facts
- The political lessons of SARS
II Bird Flu in Hong Kong
- The facts
- The links between SARS and Bird Flu
III Differences between SARS and Bird Flu
- The fight against SARS prepares the public health mobilization on Bird Flu
- Bird Flu also has an economic aspect, that the SARS precedent leaves aside
Conclusion
- Where we are going
- Anthropological hypothesis
Introduction :
Where I come from
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Two years of ethnographic study at the
French Food Safety Agency (AFSSA)
Shift from Mad Cow Disease to Bird Flu as
two major sanitary crises in France
Anthropological comparison between
different gestions of Bird Flu in the world
considered as an animal disease and as a
human disease.
Intellectual references
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Anthropology of human/animal relationships : animals
are intellectual tools humans use as ways of articulating
social problems (Lévi-Strauss, La pensée sauvage,
1962). Societies trace differently the cut between
animals and humans (Descola, Par delà nature et
culture, 2005)
Sociology of risks : Risk is the major concept by which
modern societies think of themselves as living groups in
relation to an environment (Foucault, Sécurité, territoire,
population, 1978). Lessons from a sanitary crisis are
transposed to another, because they shape the historical
experience of a social group (Dodier, Leçons politiques
de l’épidémie de sida, 2005)
I SARS in Hong Kong : the facts
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21 February 2003 : Dr Liu Jianlun, who has been treating a mysterious disease in
Guangzhou, infects travellers from different countries at the Metropole Hotel in Kowloon.
The disease is transmitted to Hanoi, Singapore, Toronto.
10 March 2003 : Doctors and nurses at the Prince of Wales Hospital fall ill after treating the
mysterious disease brought by a visitor of Metropole Hotel.
15 March 2003 : the World Health Organization (WHO) names the disease « Severe Acute
Respiratory Syndrome » (SARS) to avoid « Hong Kong Flu ». The Department of Health in
Beijing denies the novelty of the disease (talk about atypical pneumonia, feidian xing) and
hides the numbers of patients in China.
31 March 2003 : the inhabitants of Amoy Garden in Kowloon are put into quarantine after an
unusual number of cases (contamination by the ventilation system)
2 April 2003 : the WHO issues an advisory recommanding only essential travel to Hong
Kong
20 April 2003 : Prime Minister Wen Jiabao and President Hu Jintao recognize the
importance of the disease and organize the mobilization of the country. Minister of Health
Zhang Wenkan and Beijing Mayor Men Xuenong are removed from their posts in sign of
« transparency »
23 June 2003 : Hong Kong is declared free of SARS
24 June 2003 : Beijing is declared free of SARS
1 July 2003 : 500 000 persons demonstrate in Hong Kong against amendment of Article 23
of the Basic Law on security
SARS has infected 8446 persons, killing 876, in the world. 1755 infected in Hong Kong 296
dead. Around 2500 infected in Beijing (cases declared to the WHO).
The political lessons of SARS
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Infectious diseases are not over : new infectious diseases can emerge and kill
very rapidly without distinction of class or age.
With modern means of transportation, these diseases can contaminate in a
single day the rest of the world. With urban conditions of living, they can kill
thousands of people by contact.
A new infectious disease can be rapidly known and controlled thanks to the
coordinated efforts of the global community.
Beijing cannot pretend to ignore the rest of the world : public health issues in
China concern the global community.
Guangdong is the place where many infectious diseases emerge, because of its
climate and dense population, and spread, because of its economic growth.
Hong Kong is a sentinel in the Asian public health system, because of its
position next to Guangdong and because of its excellent sanitary condition
(Yersin discovered the bubonic plague virus in Hong Kong in 1894). It is also a
laboratory for the compatbility of public health measures with the rights of
individuals (comparison with Singapore). It has been close to economic
bankrupcy during the SARS crisis (13 300 jobs lossed, 4000 companies closed,
14 000 flights canceled).
Emerging infectious diseases force to redraw social relationships in a securityoriented way (use of masks in hospital and in the streets, stigmatization of
suspected victims, temperature screens in airports,stockpiling vaccines…)
II Bird Flu (Avian Influenza)
in Hong Kong : the facts
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May 1997 : 5000 chicken in Hong Kong farms die of an H5N1 Influenza
virus, a 3-year old boy dies of the same virus.
End of 1997 : 18 people are infected by the same virus, 6 die. The Hong
Kong government culls 1.5 million chicken on its territory.
1999 : two children fall ill with an H9N2 virus.
February 2003 : the H5N1 virus kills a 33 year-old man and his 9-year old
son.
February 2004 : the H5N1 appears in Vietnam and Thailand, 31 persons are
infected, 22 die (70% mortality rate)
March 2006 : 16 persons infected, 11 dead with an H5N1 virus in China,
mostly in Shanghai. The virus spreads to Indonesia, Turkey, Egypt, and
Western Europe.
18 September 2007 : 10 000 ducks die with H5N1 in the Panyu district,
Guangdong. 100 000 ducks are culled to avoid spreading the disease and
to restore the trust of consumers on the eve of the Moon Festival.
The link between SARS and
Bird Flu
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The authorities who were in charge of fighting SARS in Hong Kong in 2003
now fight against Bird Flu at the world level (Margaret Chan, head of the HK
Department of Health, is now director of the WHO in Geneva)
The microbiologists who were working on Bird Flu at the University of Hong
Kong (trained by Robert Webster, Kenneth Shortridge and KY Yuen)
identified the causal agent of SARS as a coronavirus (Mali Peiris, 21 April
2003) and traced its animal origins in the wild markets of Guangdong (Guan
Yi, 23 May 2003)
Administrations and scientists delayed the identification and eradication of
the SARS agent for two weeks because they first thought it was H5N1.
Vaccines against SARS are produced with the same techniques as vaccins
against Bird Flu (evolutive vaccines using reverse genetics)
The lesson of Bird Flu : new viruses emerge because they get mutated and
reassorted in the animal population
Differences between SARS and
Bird Flu
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SARS is due to a virus whose ecology and mutations are
now well-known (from the bat to the civet to the human).
Bird Flu is due to a virus whose possibilities of mutation
and reassortment are much wider (combination of a bird
flu with a human flu would be catastrophic)
SARS has mutated to an inter-human form, Bird Flu is
for the moment mostly an animal-to-animal, and
sometimes an animal-to-human, disease.
The mobilization against SARS lasted 6 months, the
mobilization against H5N1 has lasted for 10 years.
The fight against SARS makes people
prepared to the mobilization
on Bird Flu in Hong Kong
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Airport companies have organized urgency
plans for a pandemic in the next two years.
Hospitals have allocated 1000 beds for the cure
of bird flu patients.
Microbiologists follow the mutations of the virus
in the world, and particularly in Guangdong,
through computer networks.
Bird Flu also has an economic aspect,
that the SARS precedent leaves aside
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Cost of culling, indemnisations for poultry farmers.
Inflation caused by the closure of some poultry commercial lines
(compare with blue-ear for swine)
Biosecurity measures in farms and transportation system : Hong Kong
is considered as a model
The poultry farms system in Hong Kong has been designed to produce
poultry in better sanitary conditions than Guangdong, despite its higher
cost (first industrial farms in the 30’s, supply for US and Japan in the
50’s)
In 2001, 100 million people crossed the border between Hong Kong
and Guangdong, for commerce or leisure. Reversal of the two-centry
trend : humans go from Hong Kong to Guangdong, poultry go from
Guangdong to Hong-Kong. Can this border be controled and closed in
case of an inter-human form of H5N1 emerging ?
SARS produced emergency measures to save a threatened economy.
Can the economy be built on the preparation of a threat that has not
appeared yet ? Problem of the economy of preparedness.
Conclusion :
Where we are going
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Extrapolating from the precedent of the Spanish Flu in 1918, the
WHO estimates that an H5N1 pandemic could cause 60 million
dead.
Scientists are surprised that H5N1 has not mutated yet to an interhuman form. Others say it will never mutate. The mutation is a low
probability-high consequences risk.
The question is not : when will the pandemic happen ? But : are
societies prepared for it ?
Companies and governments have plans saying what they should
do in case of a pandemic - not only H5N1 - and identify critical
activities that need to be sustained.
The SARS has reconfigured the economy in Asia (2004) and in the
rest of the world (2005) around the preparation of a pandemic.
There are almost no more poultry farms in Hong Kong. They have
become biodiversity reserves.
Anthropological hypothesis
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Why have sanitary crises in animal diseases (SARS, Bird Flu, Mad
Cow Disease, Foot-and-Mouth disease, Blue-tongue, Blue ear) become
so numerous in the last twenty years ?
One hypothesis : 9/11 has opened a new era of bioterrorism and
biosecurity. Chickens have become « virus bombs » and China is ready
to explode.
My hypothesis : sanitary crises in animal diseases are due to a
contradiction in the same representation (or cognitive dissonance)
between two views of the animal, as good to eat and as a dangerous
living being. Humans have always been wary that the animals they
have domesticated would revenge against them (J. Diamond : viruses
are « the lethal gift of livestock »).But this cognitive contradiction,
expressed as an emotion of fear, has become more important in urban
societies, where the animal is not present as a living being but only as
a food ready to consume.
The role of social sciences is to redraw the spectrum of actors
implicated in a sanitary crisis and to make public their controversies,
so as to give these crises their critical rationality, and explain why they
are formative of modern individuals.
Actors implied in sanitary crises concerning
animal diseases
(SARS) Bat civets
Merchants
Microbiologists
(H5N1) Wild birds poultry Farmers
Veterinarians
Food industry Physicians
Bird Watchers
Representation of the animal
as a living being
Agriculture Dept
Media
Consumer
Health Authorities
Religious Authorities
Representation of the animal
as food