In 2003, when SARS came to Taiwan, it made a considerable impact, both in social and human costs. The government, rather belatedly, set up an infectious diseases control mechanism in response. Two years later, the H5N1 strain of avian influenza arrived, but the way this virus was transmitted was completely different. The government tried to treat it as another SARS, but found its efforts ineffective in containing the spread of the virus. The government also tried to deal with the H1N1 strain of swine flu in the same way in 2009, by quarantining the infected and encouraging more anti-flu vaccinations. The result was that nearly 300 people died. The nation’s record on the prevention of infectious diseases is far from perfect.
China is now trying to contain a new outbreak of avian flu designated H7N9. Chinese health authorities immediately implemented measures learned from their experience with SARS by setting up an infectious disease prevention and control mechanism together with an epidemic control command center. However, does this cover all the bases? SARS was originally passed from animals to humans, but then mutated into a strain that could be transmitted from one human to another. As a result, hospitals themselves became the virus’ main transmission grounds. With SARS, the pathogeny was not the point: The important thing was to improve hospitals’ ability to control the spread of infectious diseases within their own four walls.
The H5N1 virus could only be transmitted from birds to humans, but not from one human to another. In 1997, when avian flu first appeared in Hong Kong, then-head of the territory’s Department of Health Margaret Chan (陳馮富珍) ordered that all chickens be culled to prevent the virus from further spreading. In 2005, when it was suspected that H5N1 had arrived in Taiwan, efforts to control the disease were limited to the hospital system, and the issue of where the virus had originated was largely ignored. So far, H5N1 has yet to affect Taiwan, which is good, because it is anyone’s guess whether the nation’s epidemic prevention facilities are up to the challenge.
This latest virus, H7N9 is, like H5N1, an avian flu strain. However, while it was sufficient with H5N1 to avoid contact with infected birds, given the lack of information about this new strain, it is important to keep one’s distance from all birds to rule out any risk of infection . The medical establishment has yet to determine what type of birds this strain affects — domesticated birds, wild fowl or poultry — or whether it is found on eggs, bird droppings, saliva or other factors.
Although Taiwan has signed a disease-prevention agreement with China, Beijing has been less than forthcoming with news on the latest outbreak. Everything Taiwan has learned about the situation has come from media reports, although it is anyone’s guess how reliable news reports from China’s state-controlled media are. Taiwan has just recently dispatched experts to China to gain first-hand knowledge of the situation, and it is unclear whether they will have access to H7N9 strain samples to conduct their own tests. Clearly, much work needs to be done on the mutual agreement, and soon.
While the public is hoping that H7N9 will not spread to Taiwan, the government has to be prepared for any eventuality. What the nation needs is a comprehensive, coordinated set of measures, including the disinfection of wet markets, poultry farmers and producers signing up to a health management system, a standardized process for dealing with bird droppings and effective segregation of wild fowl from birds on poultry farms. This will require coordination between the health, agriculture, economics and national defense agencies, and it has to be established before any cases emerge, if we are to avoid wasting resources and risking the infection spreading further.