WHEN Severe Acute Respiratory Syndrome (SARS) first appeared, it had all the hallmarks of a true crisis: urgency, potential to create widespread and substantial (and perhaps even catastrophic) damage, and significant novelty. The novelty is that there were no obvious similar experiences that could provide reliable guidance about how best to respond.
Situations of high urgency that are not novel – a modest earthquake, for example, in an area long known to be susceptible to such events – should not create a crisis; public officials and the larger public should be prepared with plans, trained and practised response teams that are adequately resourced, and a command and communications structure that should permit effective response to the situation. Thus, a reasonably predictable situation should produce only a routine emergency – not a crisis.
By this definition, the outbreak of SARS last winter and spring was clearly a true crisis. The crucial question for today is how should we be organising and preparing public and private organisations and the public at large for a possible reappearance of SARS.
A central responsibility facing public officials and relevant private organisations now is to ensure that if SARS does reappear (in some reasonably predictable form), it does not again become a crisis.
There are several forms in which SARS could reappear that are reasonably predictable based on its behaviour over the last eight months. We can distinguish four different possibilities, each of which calls for different elements of an overall prudent response:
CASE 1: SARS could simply disappear. This is, obviously, a widely shared hope – but hope is an emotion, not a policy. We can hope that this scenario has high probability, and we can hope that it comes true, but it is not safe to rest policy on this assumption by itself.
Response: If our hopes are realised, we will not have to deal with a recurrence of SARS. We should remain ready, with a well-developed reporting and response system, in case it does recur – but if it does not, we will not need to expend resources beyond those necessary to support reporting, reasonable planning, and appropriate readiness for action.
CASE 2: SARS could disappear for an indefinite period and then reappear episodically in a form similar to its recent appearance.
Response: If we find ourselves in Case 2, with episodic recurrences of SARS outbreaks, we will find the prudent investments in reporting, planning, and readiness made in response to the possibility of Case 1 both wise and useful.
In addition, Case 2 will require the expenditure of operational funds to provide an appropriate response in the case of each outbreak.
Thus, the possibility of Case 2 calls for the same reporting, planning, and readiness funds as Case 1, and also for maintaining availability of resources to pay for an operational response where it is needed.
Prudence would also suggest investments in medical research on SARS.
CASE 3: SARS could emerge this fall in essentially the same form as it took last year, and thereafter exhibit a reasonably consistent annual cycle.
Response: Like Case 2, Case 3 calls for investments in reporting, planning, and readiness and for available operational funding – but now all of these resources would have to be arranged on an expected annual basis.
CASE 4: SARS could reappear in some completely unpredicted and unpredictable form.
Response: If we find ourselves in Case 4, the reappearance of SARS would again present significant novelty, and we would have to face it, as before, with ingenuity and improvisation.
There is no good way to prepare for the additional features that this kind of event presents – except to maintain high-performance public organisations and infrastructure and to practise improvisational responses.
Given the uncertainty about which of these four cases will occur, reasonable prudence would call for building an effective and comprehensive reporting system so that the authorities are able to recognise the reappearance as quickly as possible.
Which cases should we be preparing for?
Case 1 is, of course, our fondest hope – but it is only that. Thus, we have at least to prepare for Case 2 (episodic recurrence). We would have to consider ourselves lucky if SARS does not reappear at least episodically, so we clearly need to be prepared if it does.
Do we need to prepare for Case 3 (an annual recurrence)? Since we are prepared for an episodic recurrence, then we should be ready for the first annual recurrence; if SARS does appear next fall and disappears again in the spring, then we will have a reasonable presumption that it has an annual cycle, and we can prepare accordingly.
But what about Case 4? We always need to be prepared for the appearance of unexpected, potentially deadly diseases.
How do we do this? Much of the first line of response will be provided by the public sector – and therefore we need to maintain strong public sector administrative, planning, and response capacities, together with robust systems for being able to raise resources when necessary.
In summary, given the range of possibilities we face regarding future SARS outbreaks, prudence would counsel:
(1) Development of a comprehensive reporting mechanism to provide early detection and early notification to public health and other relevant officials should there be a renewed outbreak;
(2) Reasonable efforts at planning and maintaining readiness to deal with the possibility of a renewed outbreak;
(3) Identification of operational resources that would be required in the event of an outbreak;
(4) Development and maintenance of a general public capacity to respond to novel dangers – for example, by improving coordination among different government agencies, practising the ability of different response organisations to work together and to improvise in unusual circumstances; and
(5) Aggressive efforts to inform the public about (a) the possibility of future SARS outbreaks, and (b) what may be required from the public and from individual members of the public in the event of future outbreaks.
The overwhelming implication of our existing knowledge of SARS is that if it recurs and we are not ready, we have failed in the most elementary of public duties – the duty to anticipate and prepare for likely hazards to public health.
Such a failure will turn what should be a routine challenge into a true crisis. This would then be a crisis of our own making.
He will address a full-day seminar on ‘Leadership in Crisis Situations’ in Kuala Lumpur on Sept 25 2003. Please call MIM at tel. 03-2164 5255, see www.mim.edu or e-mail firstname.lastname@example.org further details.