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SARS: How Singapore outmanaged the
others
By Alan Fung
HONG KONG
- Mainland China and Hong Kong have much to learn from
tiny Singapore about risk-communication management, say
two American experts in assessing the severe acute
respiratory syndrome (SARS) fiasco.
The three
countries/territories top the world chart of reported
SARS cases. While residents worry whether they will be
the next SARS victim, many have also raised such
questions as "What has our government done for us?" and
"Are they doing the right things?" and "Is my government
telling the whole truth about the disease?" Regarding
those questions, Peter Sandman, PhD, a
risk-communication specialist in Princeton, New Jersey,
and his wife Jody Lanard, MD, a psychiatrist, told Asia
Times Online that Singapore deserved applause in
contrast to the other two.
"In risk-management
terms, Singapore is singularly well positioned to
respond to the SARS epidemic. For managing urgent health
problems, you can't beat a country like Singapore that
knows it can't hide the problem but genuinely can
respond as strenuously as needed. So the good risk
management isn't such a surprise," the two experts wrote
in a communique to ATol.
"But Singapore's open
and responsive risk communication is impressive. In
risk-communication terms, Singapore has certainly earned
the cautionary compliment it received from the WHO's Dr
Osman David Mansoor: 'If Singapore cannot get it under
control, it is going to be very hard to get it under
control anywhere else.'
"In spectacular
risk-communication fashion, Singapore has 'shared
control' with its public," Sandman and Lanard wrote.
"The most dramatic example of this was the joint Health
and Education ministries' decision March 25 to close
nearly all the schools - not on medical grounds, they
said, but because 'principals and general practitioners
have reported that parents continue to be concerned
about the risk to their children in schools'. In one
sentence, Minister Teo Chee Hean assured four groups of
stakeholders that they were being heard and taken
seriously: principals, general practitioners, parents -
and the general public. The ministers can't do
everything the public wants - but the public knows its
wishes will be considered."
While Singapore
picked up the communication task from Day 1, mainland
China, the country hit most disastrously by the SARS
outbreak, has appreciated the need to communicate for
less than a week. As the Ground Zero of SARS, the
Chinese government apologized last Friday for its
tardiness, and the world found it extraordinary that the
word "apologize" emanated at all from China when Li
Liming, director of the Center for Disease Control,
said, "Today, we apologize to everyone ... Our medical
departments and our mass media suffered poor
coordination. We weren't able to muster our forces in
helping to provide everyone with scientific publicity
and allowing the masses to get hold of this sort of
knowledge."
Said Lanard and Sandman: "You don't
get credit for apologizing if you don't apologize for
what you did. And what officials of the PRC [People's
Republic of China] did was to cover up the epidemic.
They profoundly stonewalled the World Health
Organization's efforts to investigate. The world is
furious with them because they lied, not because they
suffered poor coordination.
"This apology is
misleading rather than candid. It is bureaucratic rather
than human. It is defensive rather than apologetic. It's
just that they also, and much more desperately, need to
acknowledge that they misinformed their own people and
the world. And like Hong Kong they need to put in place
accountability mechanisms to credibly guarantee that it
won't happen again. Even as we write this advice, we
recognize that the PRC government is intrinsically not
accountable, and considers dishonesty appropriate in a
wide variety of situations. We doubt the officials who
lied feel in the wrong about their dishonesty, while
they may actually feel in the wrong about poor
coordination."
Mainland China refused entry to
World Health Organization (WHO) inspectors until last
Thursday, then announced on the same day it "apologized"
that it is "safe to live in China" and said SARS can be
cured. Health Minister Zhang Wenkang urged people not to
cancel trips to Guangdong province, where hundreds of
people have been sickened by SARS. "The PRC's
credibility is just about zero on SARS," said the
Americans' communique. "Earlier in the epidemic, and
continuing to this day, PRC officials tried to control
all information centrally, rather than encouraging
decentralized sources to report openly. They are
inappropriately over-confident rather than acknowledging
their genuine uncertainty. They have been patronizing
and contemptuous of their people's ability to cope. But
mostly they have lied.
"We're mad at them
because they lied, and continue to lie. WHO speaks in
diplomatese about China's increasing cooperation. What
WHO is saying internally about China would be
unprintable in a family newspaper. China's apology will
count when they apologize for lying. And it will never
happen."
Most of China's reported cases of SARS
occurred in Guangdong province, and when the disease
spilled over to infest neighboring Hong Kong, the world
was stunned.
Hong Kong,
a special administrative region (SAR) of China (the SAR
government has been understandably reluctant to
acknowledge the acronym SARS) started to behave like the
mainland but ended up following the path of Singapore
(see HK plays down pneumonia fears
, March
18). In terms being candid versus secretive and
misleading, Hong Kong started off almost as badly as it
possibly could have, with Health Secretary Yeoh
Eng-keong's statements on March 14 that "Hong Kong is
absolutely safe and no different from any other big city
in the world".
Compounding this lie to the
world, Yeoh continued: "Hong Kong does not have an
outbreak, okay? We have not said that we have an
outbreak. Don't let the rest of the world think that
there is an atypical-pneumonia outbreak in Hong Kong."
After a fortnight's struggle, the SAR government
admitted the reality on March 27 and agreed then to take
all necessary measures.
Yet the SAR is still no
match for Singapore in crisis governance. As Sandman and
Lanard pointed out, over-reassuring and dishonest
statements continued, emanating as recently as last
Wednesday from Hong Kong Chief Executive Tung Chee-hwa,
who said in a media session: "I think we need to look at
these facts and to understand particularly that there is
a cure there - it can be cured."
The experts
commented: "There is no reputable medical organization
in the world that thinks there is a definite cure for
SARS yet. Most people recover, thank God, but they were
not cured as far as we know; they received supportive
and sometimes experimental care.
"The key to
recovering credibility is to repeatedly apologize in
detail for prior misstatements ... You can (and should)
apologize when you know you are in the wrong ... even if
you don't feel you are in the wrong. Dr Yeoh also does
not get to say when he has apologized enough; he does
not get to say, 'It's time to put this behind us.' That
is for others to say."
A country without a free
press such as the PRC can hide its problems, or at least
is tempted to try. And so it did in the SARS case.
Really lamentable, however, was the fact that Hong Kong,
which used to boast of its free press, tried to follow
the mainland example.
Singapore seems to be
standing in a better position on its handling of the
SARS crisis. However, Sandman and Lanard did have some
minor criticisms of Dr Balaji Sadasivan, Singapore's
minister of state for health.
"... You must
understand ... those who've been quarantined. If you're
a neighbor, you must understand ... this family that's
going through this distress. So remarks of people trying
to avoid families or medical staff ... these sort of
reactions are irrational, and may actually make things
worse," Balaji Sadasivan was quoted as saying.
Commented the experts: "What is good about this
quote is the empathy it shows for those who have been
quarantined, and for others (such as medical workers)
who are heavily burdened by the epidemic. He could have
gone even further, pointing out that it is wrong, though
natural, for SARS victims and even their families to
feel loathsome and ashamed. It is not shameful to be
sick. What would be shameful, he could have said, is to
evade a quarantine and thereby risk spreading the
infection. But his use of the word 'irrational' to
describe what he sees as excessive precautions - such as
avoiding contact with medical staff - is a mistake on
three grounds. It is a minor mistake, but the grounds
for considering it a mistake raise principles that are
not minor.
"The right to call someone's response
to SARS irrational is forfeited by anyone, or any
government, that hasn't been entirely forthright about
the disease. When the authorities might be withholding
or distorting some information, excessive caution is
entirely rational, and criticism from those who did the
withholding or distorting is certain to boomerang. In
this respect Singapore certainly has more right to
criticize than Hong Kong and Hong Kong has more right
than the PRC. But even Singapore's right is a little
compromised by early over-reassurance and
overconfidence," they concluded.
(©2003 Asia
Times Online Co, Ltd. All rights reserved. Please
contact content@atimes.com
for information on our sales and syndication policies.)
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