Plugging gaps in epidemic control

By Yang Yung-nane 楊永年  / 

Sun, Apr 28, 2013 - Page 8

On Wednesday, the Centers for Disease Control (CDC) confirmed the first case of H7N9 avian influenza in Taiwan when a 53-year-old businessman returning from Suzhou, China, was diagnosed with the virus.

Epidemic prevention experts have said they would not be surprised if instances of human-to-human transmission of the virus begin to emerge.

To avoid an epidemic and the severe consequences that would follow, it is of the utmost urgency that the nation initiate outbreak prevention measures.

Here are three suggestions on how an epidemic prevention system could be devised and made operational:

First, it is necessary to have a comprehensive grasp of all epidemic prevention information.

It is likely that the CDC is the agency which has the quickest access to the best information.

However, the agency may be hindered by four blind spots:

It will not know immediately when a Taiwanese in China infected with H7N9 leaves for Taiwan; it will not know when and where in Taiwan it will be confirmed that that person carries the virus; there is uncertainty as to whether medical institutions have the ability to report epidemic-relevant information in the quickest way possible; and it is uncertain if the CDC will be able to inform the whole bureaucratic apparatus — in particular the epidemic prevention system and its top bureaucrats — about the status of an outbreak, its seriousness and its consequences in the most time-efficient way.

Given these blind spots, it is uncertain whether it will be possible to gain a comprehensive grasp of all epidemic prevention information.

Second, it is necessary to fully mobilize all epidemic prevention resources.

Having a complete grasp of epidemic information is a prerequisite for the effective and correct mobilization of preventative resources.

There are four issues regarding whether the full mobilization of those resources will result in the authorities gaining complete control over the situation: The CDC may not have complete resource information, or it may have failed to conduct a detailed inventory of resources, and even if the centers have a resource inventory it will not necessarily be able to mobilize those resources.

For example, the Bureau of Health Promotion is on an equal footing to the CDC, so it is not an absolute certainty that the centers will be able to effectively mobilize the bureau.

Also, not all epidemic prevention resources are under CDC control, there are also government and privately run medical institutions, and a public health system divided between national and local governments which means that for political reasons, cooperation may not be entirely without problems.

Finally, since the current outbreak originated in China, there are questions as to whether the cross-strait political situation will affect the effectiveness of the mobilization of epidemic prevention resources between the two sides.

The third factor necessary for the implementation of an epidemic prevention system is the full mobilization of the administrative system.

The general administrative system is bigger than the medical or public healthcare systems. If an epidemic spreads and becomes very serious, it will become necessary to mobilize the entire administrative system to contain an outbreak in the same way that it is mobilized when a natural disaster occurs.

The complete mobilization of the administrative system may involve inter-ministerial, cross-agency, cross-level and interdisciplinary issues.

Imposing a ban on the slaughter of chickens, managing the nation’s borders and issuing travel warnings are all important measures. However, regardless of how the administrative system is mobilized, it could run into cooperation or integration difficulties due to the character of an agency or its organizational culture.

The Cabinet has set up a disaster prevention and protection office so that when a disaster occurs, it can play a integral role.

The problem is that neither the CDC nor the Department of Health may be familiar with the platform for integrating disaster prevention and protection, which could cause blind spots when fully mobilizing the administrative system.

Adding considerations about private sector or community epidemic prevention systems, the situation becomes even more complicated.

The nation’s epidemic prevention system should be fully prepared to deal with a possible spread of the H7N9 virus.

It is not the responsibility of the CDC alone, but also of the government and the public.

The government controls more information and resources than any other entity, so it should have a comprehensive response and mobilization plan for dealing with any outbreak.

In addition, to keep the public constantly informed of the latest information about an epidemic, it should provide clear explanations of the situation so that the public is able to gain a thorough understanding of the problems and difficulties in epidemic prevention.

This is the only way to obtain the public’s participation in containing an outbreak.

Yang Yung-nane is a professor in the Graduate Institute of Political Economy and the director of the Research Center of Science and Technology Governance at National Cheng Kung University.

Translated by Perry Svensson