From SARS to Bird Flu : Public Health and Animal Diseases Between Hong Kong and Guangdong

1
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

2
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

3
Introduction Where I come from

• 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.

4
Intellectual references

• 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 lépidémie de sida, 2005)

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I SARS in Hong Kong the facts

• 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).

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The political lessons of SARS

• 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 security-oriented way
  (use of masks in hospital and in the streets,
  stigmatization of suspected victims, temperature
  screens in airports,stockpiling vaccines)

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II Bird Flu (Avian Influenza)in Hong Kong the
facts

• 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.

8
The link between SARS and Bird Flu

• 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

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Differences between SARS and Bird Flu

• 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.

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The fight against SARS makes people prepared to
the mobilization on Bird Flu in Hong Kong

• 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.

11
Bird Flu also has an economic aspect, that the
SARS precedent leaves aside

• 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 30s, supply
  for US and Japan in the 50s)
• 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.

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Conclusion Where we are going

• 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 inter-human 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.

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Anthropological hypothesis

• 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.

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Actors implied in sanitary crises concerning
animal diseases

• (SARS) Bat civets Merchants
  Microbiologists Agriculture Dept
• (H5N1) Wild birds poultry Farmers
  Veterinarians Media
  Consumer
• Food industry Physicians
  Health Authorities
• Bird Watchers
  Religious Authorities
• Representation of the animal
  Representation of the animal
• as a living being
  as food