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  • Wednesday, 16 Apr 2003


AS IF the news isn’t depressing enough already, now we have SARS. We don’t know what exactly it is but we know it can kill. We don’t know how we can get it so we keep our kids at home and avoid crowded places and planes. Except for the bombs, I feel a bit like an Iraqi under siege. 

For those of us who have worked in public health, the SARS epidemic also makes us nostalgic. It reminds us of another epidemic that is still raging around the world, HIV/AIDS. Despite the many differences between the viruses and the way they are spread, many of the characteristics of the epidemic itself, and the reactions to it, are similar to HIV/AIDS. 

When people first started dying in the early 1980s, there was great fear because nobody knew why. Similarly the first SARS deaths created enormous fear (and they still do) because they were unexplained. The first country to be affected reacted by covering up and denying the enormity of the problem. As a result, people did not know what precautions to take and went about their lives as they always did, causing the spread of the disease. The same thing happened, and is still happening, with HIV/AIDS when some countries refused to acknowledge its existence in their midst and thus facilitated its spread.  

In the early 1980s, Thailand refused to face up to the HIV/AIDS epidemic within its borders for fear it would affect tourism. By the time they finally woke up to it around 1991, an estimated one million people had been infected. 

Epidemics may differ in many ways – in the agents that cause them and the way they are transmitted. But the conditions in which they are spread do not differ much from one to the other. Denial is probably one of the main factors that help to promote epidemics. If you refuse to acknowledge a public health threat exists, then you are not going to inform people how to avoid it, thereby allowing people to both become infected and spread it. That is exactly what happened with AIDS in many countries, and it is also what happened with SARS. 

The other similarity between these two epidemics is the public reaction to the epidemic, which is fear and panic. These are generated by ignorance and until we know for sure what the SARS virus is and exactly how it is spread, the fear will be hard to contain. This explains the reports from Thailand where people blocked the cremation of a SARS victim because they were afraid that the virus could be transmitted through air.  

Even though the likelihood that a virus can survive the high temperature in a crematorium is extremely low, people were not convinced. And they will not be convinced until there is certainty of some kind. 

Fear also manifests itself in stigma and discrimination. In Singapore, people are shunning doctors and nurses because of the high numbers of healthcare personnel who have become infected. Suddenly, such respectable professions have become “high-risk groups”, rather similar to the stereotyping of drug users, gay men and sex workers as “high-risk groups”. Just belonging to such a group is deemed to make you a danger to others, even though you may not have done anything to put yourself in danger nor are you likely to harm others.  

In the case of discrimination against healthcare personnel, it is rather like cutting your nose to spite your face. Why discriminate against people who not only put their lives on the line to save other people, but whom you will have to depend on if you become ill? 

Ultimately, epidemics are resolved not just by scientific and medical breakthroughs but also by political will. If politicians decide that the lives of their own people (i.e. the voters) are the most important things, then they will do everything possible to contain the epidemic. In the long term, this is what will protect the economy of the country and attract investments, because a government that cares about its people is the only type worth putting money on. But if politicians think only of the short-term effect on the economy (or at least as long as until the next election) and do not do the right thing in public health terms, then the epidemic will continue to spread.  

Hiding the facts about an epidemic because it may make a country look bad only creates mistrust, not just in the information given but also in the caring instincts of the authorities. If they don’t care about me this time, what will happen when something even more deadly comes round? And why should I vote for a government that does not care about my health? 

The good thing about SARS, to my mind, is that it manifests itself pretty visibly after a short incubation period and you can contain it through isolation of those infected. That makes it a pretty classic type of epidemic. Once they figure out what it is and how it spreads, it probably will be easily contained. I just hope that once people calm down, they will look at other epidemics with clearer eyes. There should be no excuse for epidemics such as HIV/AIDS that are completely preventable. We know what causes it and how it’s spread, after all.  

Perhaps, what is lacking is only the political will to do the right thing.  

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