Leadership, luck seen as keys for Vietnam's SARS triumph
Expert says Taiwan enforcement lacks needed determination,
cooperation
With surges in severe acute respiratory syndrome cases in Taiwan, local experts have been re-emphasizing what was needed to win
the battle against SARS: Rigorously implemented preventive measures, coordinated policies between ministries and local
governments at a central level, and making sure the flow of information on the disease is transparent.
They could have been describing Vietnam. On April 28, the WHO declared that Vietnam was the first nation to contain and eliminate
SARS because there had been no new reported cases since April 8 and no evidence of cases spread from Vietnam to other
countries.
Since the Southeast Asian country reported its first SARS case in February, only 63 cases of infection have been discovered, with
five people dying of the disease. Fifty-three patients have been discharged from hospitals since last month. Vietnam's success was
not a miracle but a combination of swiftness, leadership, transparency, intensity and luck.
As soon as doctors in Hanoi encountered a patient in late February who was suffering from a mysterious atypical pneumonia, they
called in Italian doctor Carlo Urbani, a Hanoi-based communicable disease expert for the WHO. On the advice of Urbani and his
colleagues, medical authorities shut down the Hanoi French Hospital - where the first SARS patient was treated - to new patients
and visitors on March 11.
In early April, the WHO sent six more French epidemiologists to assist the Vietnamese government's effort to contain the epidemic.
After that, the Vietnamese government launched a series of measures to contain the deadly virus.It created a steering committee on
SARS in early April, headed by the health minister. It then designated two hospitals - Hanoi French Hospital and the Medical
Institute for Tropical Diseases - as SARS treatment centers, and two other hospitals were prepared as isolation centers.
In addition to the national steering committee, SARS task forces were set up in 38 out of 61 provinces and cities by the end of
April.The health minister also announced that all SARS patients were to receive the best medical treatment, with all expenses to be
shouldered by the government.
Travel checks and restrictions were also key parts of Vietnam's plan. Vietnam's foreign ministry set up checkpoints at airports,
border crossings, and harbors in April to screen international travelers. The Vietnamese government even temporarily closed its
border with China after learning that the disease originated in Guangdong Province.
In addition, Vietnamese citizens were advised not to travel to any SARS-affected areas. Anyone coming back from the affected
areas would be put under a two-week quarantine. Foreign visitors were required to submit a statement proving they had no
SARS-like symptoms.
Many of these measures are still in place today. Finally, the government made a strong commitment in terms of both education and
funding to enforce its preventive measures. The Vietnamese authorities held training sessions for local health workers and
governments so as to cultivate an accurate understanding of the disease and how it could be prevented from spreading. They also
promptly allocated approximately US$2 million to support containment efforts.
A similar formula has been followed in Taiwan, but Chan Chang-chuan, professor and director at National Taiwan University's College
of Public Health explained why it hasn't worked as well here. "Most of Vietnam's measures have also been used in Taiwan. What we
don't have here is determination and cooperation," Chan said. "They were apparently more effective in Vietnam because it is a
totalitarian nation, which means that it's easier to implement policies. Besides, Vietnam has worked closely with the WHO from the
beginning."
Chan further pointed out that "a lack of centralized coordination has resulted in the escalating SARS crisis in Taipei," citing Taipei
Municipal Hoping Hospital as an example.
On April 24, Hoping Hospital was placed under a two-week quarantine following a SARS outbreak within the hospital. The patients
and people who were on the premises have now been transferred to other isolation centers. But the hasty shutdown by the Taipei
City government led to an increase in the number of probable SARS patients because it led to SARS transmissions inside the
hospital, according to medical experts.
Singapore is another good example, said Chan. "Although Singapore has been known for its strict polices and laws, the city state's
preventive efforts have proven how important it is to precisely implement policies when combating diseases." Singapore was the first
SARS-affected area that closed off a hospital suspected of having a SARS outbreak, and designated it as a SARS hospital.
However, no nurses protested against the quarantine or tried to run away from it.
On the contrary, the medical workers of the hospital were proud of being able to provide treatment for SARS patients while
neighboring residents also expressed their support for the hospital. This is because "the Singaporean government provided a
sufficient amount of information on SARS through the media and introduced positive protective measures as soon as the disease
began spreading," said Chan. "Neither Singapore nor Vietnam has a media environment like the one we have in Taiwan. There are
no sensational SARS reports in those countries that can easily throw the public into a panic," stressed Chan, lamenting how some
Taiwanese media outlets have failed to cooperate with the government's battle against SARS.
According to the professor, containing an epidemic is a highly professional task. "A successful containment cannot be achieved
without close cooperation between the central government and local governments. We can only have one containment policy." "The
disorganized prevention efforts in Taiwan also present a dilemma for young democracies," indicated Chan, whose viewpoints were
shared by Lee Shiao-feng, a history professor at Shih Hsin University.
Reacting to the protests over the government's preventive measures, Lee stressed that "the 'disorder' shown in society's efforts to
contain the epidemic demonstrated that democracy is not deeply rooted in Taiwan's soil. "The concept of real democracy is not
internalized in the minds of Taiwan's people, leading to a misunderstanding of freedom," Lee said.
By Darcy Pan - Taiwan News - May 12, 2003
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