Many pharmacies and herbalists in Egypt prescribe their own 'wasfa' (secret drug or herbal elixir). Credit: Cam McGrath/IPS

By Cam McGrath
CAIRO, Aug 10 2014 (IPS)

Magda Ibrahim first learnt that she had endometrial cancer when she went to a clinic to diagnose recurring bladder pain and an abnormal menstrual discharge. Unable to afford the recommended hospital treatment, the uninsured 53-year-old widow turned to what she hoped would be a quicker and cheaper therapy.

A local Muslim sheikh claimed religious incantations, and a suitable donation to his pocket, could cure the cancer. But when her symptoms persisted, Ibrahim consulted a popular herbalist, whose wasfa (secret drug or herbal elixir) was reputed to shrink tumours.

“I felt much better for a few months and thought the tumour was shrinking,” she says. “But then I got much worse.”

When she returned to hospital the following year, tests revealed that the tumour was still there, and the cancer had spread to her lymph nodes. Moreover, the herbal mixture she was taking had caused her kidneys to fail.“Successive [Egyptian] governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery” – Dr Ahmad Bakr, Egyptian health care reform lobbyist

Egypt is a “minefield” of bad medicine, says paediatrician Dr Ahmad Bakr, a health care reform lobbyist. He says successive governments have done a poor job at both regulating the medical sector and educating the public on health issues, leaving Egyptians unable to afford their country’s two-tiered health care system vulnerable to ill-qualified physicians, spurious health claims and quackery.

“Our health care system is deeply deformed,” Bakr told IPS. “It’s not just a matter of low funding and corruption, ignorance (pervades every tier of) the health system, from government and doctors to the patients themselves.”

He says Egypt’s lax regulation and poor enforcement has created room for unqualified doctors to perform plastic surgery out of mobile clinics, peddle snake tonic on satellite television, and dabble dangerously in reproductive health.

It is estimated that one in every five private medical clinics in Egypt is unlicensed, and thousands of medical practitioners are suspected of using false credentials or having no formal training.

“There are a lot of so-called doctors who practise medicine in Egypt,” says Bakr. “They mostly work out of small clinics, but you’ll even find them in the most prestigious hospitals.”

The incompetency goes all the way to the top.

In February, Egypt’s military announced it had invented a device to remotely detect hepatitis C – along with acquired immunodeficiency syndrome (AIDS), swine flu and a host of other diseases. The device, which is said to work by detecting electromagnetic waves emitted by infected liver cells, is based on a fake bomb detector marketed by a British con artist.

The military also claimed that it had invented a revolutionary blood dialysis machine that can cure hepatitis C, AIDS and even cancer in a single treatment.

“I was shocked when I saw these incredible claims were being made with barely any clinical evidence,” says Dr Mohamed Abdel Hamid, director of the government-run Viral Hepatitis Research Lab (VHRL). “With any new medical treatment you should perform peer-reviewed, double-blind clinical trials before announcing it.”

Critics say Egypt’s government contributes to a climate of medical irresponsibility. State media routinely exaggerates health threats and feeds public hysteria, while the knee-jerk reactions of government authorities – including high-ranking health officials – are coloured by popular sentiment and political motives.

Reacting to the global swine flu pandemic in 2009, overzealous parliamentarians passed a motion to slaughter all of Egypt’s 300,000 pigs.

There was no evidence that pigs transmitted swine flu to humans, nor had the virus been detected in Egypt. But officials, swayed by the Islamic prohibition on eating pork, appeared to seize the opportunity of a like-named virus to rid the Muslim-majority nation of its swine.

“The pigs were kept almost exclusively by poor Christian zebaleen (rubbish collectors), who used them to digest the organic waste,” says Milad Shoukri, a zebaleen community leader. “Thousands of families lost their livelihoods to this absurd decree, which had no scientific basis.”

Global pandemics such as severe acute respiratory syndrome (SARS), avian flu and the latest contagion, Middle East Respiratory Syndrome (MERS), have presented golden opportunities for Egypt’s myriad quacks and swindlers to fleece the uninformed masses.

“With each health scare we see the same patterns,” says Cairo pharmacist Amgad Sherif. “People panic and throw science out the window. The low level of education and high illiteracy among Egyptians makes them susceptible to believe even the most ridiculous medical claims.”

When a swarm of desert locusts descended on Cairo, enterprising charlatans took out ad space in local newspapers offering a “locust vaccine” to anxious citizens.

Not surprisingly, the injected serum, which turned out to be tap water dyed with orange food colouring, offered no protection against “locust venom”. But it did leave duped households poorer, and at risk of blood contamination or hepatitis C infection from jabs with unsterilised needles.

“The people doing this only care about getting money from people who don’t know any better,” says Sherif. “They know nothing about medicine and do not follow even the most basic hygiene practices.”

In one popular scam, people claiming to be state health officials troll low- and middle-income neighbourhoods offering costly “preventative medicine” for infectious diseases. The fake medical personnel, dressed in lab coats and wearing official-looking badges, administer bogus vaccinations to unsuspecting families.

“Sometimes they give people injections – who knows what’s in them,” says Sherif.

Health officials say the sham physicians create confusion that affects legitimate health campaigns, such as Egypt’s national door-to-door polio eradication campaign.

Egyptian authorities have also found themselves in a cat-and-mouse game with thousands of “sorcerers”, whose superstition-based folk medicine draws desperate working-class patients suffering physical and psychological ailments. The self-proclaimed doctors and faith healers are particularly difficult to catch, say prosecutors, because they tend to work out of rented apartments and advertise mostly by word of mouth.

An Egyptian judicial official told pan-Arab newspaper Al Arabiya that despite attempts to prosecute sorcerers for swindling and fraud, most cases are dropped when the sorcerers reach a settlement with their victims. “There is almost one sorcerer for every citizen,” he concluded.

(Edited by Phil Harris)

By Marwaan Macan-Markar
BANGKOK, Apr 10 2006 (IPS)

When a 12-year-old boy became Cambodia’s latest victim of bird flu, at the beginning of this month, it only added to the uncertainties surrounding this lethal virus that worry scientists and doctors struggling to head off a possible pandemic.

Health workers who conducted investigations in the boy’s village in the south-eastern province of Pre Veng discovered that over 20 people who had close contacts with the victim had shown no sign of being ill from the H5N1 virus. They, like the boy, lived in a neighbourhood where ”numerous chicken deaths and some duck deaths were noted to have occurred,” states the World Health Organisation (WHO).

On the other hand, the case of the boy – who died after gathering dead chickens for consumption in his village – showed just how potent the avian flu virus can be when it strikes. All six people known to have been infected in Cambodia, over the last year, died.

None of the nine countries, where bird flu has killed humans since the beginning of 2004, has Cambodia’s 100 percent fatality rate. In Indonesia, 12 of the 13 people infected since January this year died, followed by China, where there have been six fatalities among eight cases, and Azerbaijan, where five of seven cases turned fatal.

In October last year, 20 months after bird flu outbreaks were first reported in South-east Asia, the fatality rates were hovering around 50 percent, with 62 people having died out of 121 reported cases.

The current human toll is 109 people out of 192 reported infections. The worst hit is Vietnam, where 42 people have died out of 93 cases, followed by Indonesia, where there were 23 human fatalities out of 30 cases, and Thailand, where 14 of 22 cases ended in death.

This erratic pattern of the virus, though, is prompting U.N. experts to conclude that the H5NI strain of avian influenza is still weak and far from mutating into a strain that could be passed among humans and possibly triggering a pandemic.

”This virus when it infects humans is doing so sporadically,” Dr David Nabarro, the senior U.N. system coordinator for avian and human influenza, told reporters here Monday. ”It is very very infrequent that humans do get infected. And we can’t always explain why one person gets it and another person doesn’t.”

The unpredictable quality demonstrated by this lethal virus is part of its nature, added Dr. Somchai Peerapakorn, an epidemiologist at the WHO’s Thailand office. ”We are dealing with the influenza A virus that changes with every generation, because it undergoes mutation all the time and randomly.”

”We know that the virus is mutating but we don’t know when the virus will mutate to give an offspring that is lethal to humans with transmissibility characteristics that will give the human to human transmission,” he said. ”At the moment it is still a bird virus and not a human virus.”

But there is little room for comfort, he cautions, given that the WHO has warned that a human-to-human transmission of the virus could kill millions across the world since humans lack natural immune defence to fight a mutated form of the H5N1 strain. The flu pandemic of 1918, which crossed the species barrier from birds to humans, killed close to 50 million people.

The prospect of such a threat will remain due to another quality of the H5N1 strain of the virus, according to the global health agency. It has the properties to ”acquire genes from viruses infecting other animals.”

According to animal health experts, human activity holds the key to preventing this lethal virus from remaining in circulation and jumping species. ”Human activity (through the trade and marketing of poultry) is the main spreader of the virus,” said He Changchui, head of the Asia-Pacific regional office of the Food and Agriculture Organisation (FAO).

And the successes in Thailand and Vietnam to bring avian flu under control through concerted effort are being singled out as examples for other developing countries to follow. ”There have been no new outbreaks of animal or human influenza in Thailand over the past five months,” said He. ”The disease is well controlled. The last outbreak was in October.”

Thailand’s achievement comes after nearly half of the country’s 76 provinces were hit by the lethal virus during its height two years ago. A combination of government and private sector initiatives, including the use of an army of health volunteers to make regular checks on homes, have contributed to this effort.

Vietnam’s success, according to the U.N. agriculture agency, lies in its countrywide poultry vaccination campaign. ”(Poultry) owner compensation schemes have not only helped alleviate economic hardship (but) has also encouraged timely reporting of new avian influenza outbreaks,” adds the FAO.

Cambodia, on the other hand, is a reason for concern, since villagers are still reluctant to report new outbreaks of bird flu, as was the case in the village where the 12-year-old boy died. A similar situation prevails in another bird flu-infected country, the secretive, military-ruled Burma.

”We are concerned that any weak link could affect the whole system (to control the spread of bird flu),” says Somchai.

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Mar 18 2006 (IPS)

After years of oppression and secretive rule, Burma’s generals appear to have come up against resistance from an unlikely opponent-avian flu virus.

This week’s confirmation by the junta, that the South-east Asian nation is the latest to be hit by the deadly H5N1 virus, marked a dramatic departure from the insularity of a regime that has ruled the country with an iron grip since the 1962 military coup.

A request by the junta for assistance from the Food and Agriculture Organisation (FAO) is winning early praise from the U.N. agency. ”We are pleased that the government of Myanmar (the name given to Burma by the junta) reported the outbreak to FAO and has sought verification of the virus from labs outside the country,” Laurence Gleeson, senior animal health officer at the FAO’s Asia-Pacific regional office in Bangkok, told IPS.

Part of this new openness also includes Rangoon permitting an FAO animal health expert to visit the areas where the avian flu cases in the poultry population were detected, around the town of Mandalay, some 700 km north of Rangoon, and the neighbouring Sagaing divison.

”We are looking for epidemiological traces of the virus, where it came from and the controls that need to be in place to contain its spread,” added Gleeson, who also confirmed that tests conducted Thursday had proved that Burma had the lethal H5N1 virus..

Early studies conducted by the FAO have documented a 40 percent mortality rate, some 120 dead birds, in a chicken farm that had 280 birds in the Pyigyidagun township in Mandalay. Two farms adjacent to it, one of which has 450 chickens, had not been affected.

In the Sagaing division, according to the FAO, an estimated 10 percent of the poultry population in three chicken farms that had a total of 12,000 birds had died.

But it was only on Thursday that Burma’s citizens learnt of the lethal virus hitting their backyards after it had been kept under a cloak of secrecy for four days. The state-run media revealed fairly candid accounts of the damage that had been caused – over 5,000 birds had been culled and a ban was in place on the sale of chickens and poultry products in the Mandalay area. An appeal was also made for the public to report any more bird flu outbreaks.

The response by the State Peace and Development Council (SPDC), as the military regime is officially known, to the presence of the dead chickens is already being viewed by analysts in the region as an occasion for Rangoon to re-engage with its neighbours and the international community.

”Bird flu represents a unique problem and calls for unique solutions that should prompt the Burmese government to turn for help to the international community,” Kavi Chongkittavorn, a senior editor and columnist on regional affairs at ‘The Nation,’ an English-language daily in Thailand, told IPS. ”Burma could earn some respect by being open, transparent and trusting outside help on this issue.”

Others say that openness from Burma is crucial for its neighbours that have been hit by bird flu or are concerned about a domestic outbreak to take preventive action. Thailand, Burma’s southern neighbour, tops this list, since 14 people have died due to the virus and tens of thousands of chickens have been culled or died since bird flu was first reported in early 2004.

Other South-east Asian nations that have been affected include Vietnam, where 42 people have been killed, Indonesia, where there have been 22 deaths, and Cambodia, where four people have died. China, Burma’s giant neighbour to the east, has reported four human fatalities from bird flu since 2005.

Bird flu, which has led to some 150 million chickens and ducks being culled and dying from the virus across Asia, where it was first detected in the winter of 2003, has now spread to Russia, Central Asia, parts of Europe and Africa.

Public health officials fear that the lethal flu, which has killed over 100 people across the world, has the characteristics of a virus that could mutate into one that could be easily passed between humans, resulting in a pandemic that could kill millions of people.

Till this week’s response to bird flu, the Burmese regime had established a healthy record of contempt for international assistance and regional collaboration to help it deal with a host of problems that both threatened the lives of its people and regional stability.

In August last year, the Global Fund to fight AIDS, Tuberculosis and Malaria, an independent international body set up to finance grassroots efforts to combat the three pandemics, quit working in the country following severe travel restrictions placed on it by Rangoon. Other international humanitarian agencies aiding civilians in Burma were also subject to similar travel bans, virtually making it impossible for them to help the country’s needy.

At the time, Burma was estimated to have between 170,000 to 620,000 people living with HIV. The annual infection rate among its 50 million population was 1.3 percent, making it the second highest in South-east Asia, according to the U.N. agency for AIDS.

Till late 2003, Burma, which is the main source of all strains of HIV that have spread across Asia, according to the New York-based Council on Foreign Relations, refused to acknowledge it had an AIDS crisis, keeping the story off all the country’s media.

The spread of tuberculosis (TB) within Burma and beyond its borders is also worrying public health officials in neighbouring countries, since 97,000 new cases of TB are reported in Burma every year, making it one among the world’s 22 ‘high burden’ countries for the killer disease. A sizeable number of them are multi-drug resistant TB cases.

”The Burmese regime cannot afford to repeat the same mistakes it did with the Global Fund with bird flu,” says Kavi. ”Its initial response suggests it is looking at this problem differently.”

Excerpt:

By Gustavo Capdevila
GENEVA, May 5 2004 (IPS)

Diseases that are associated with animals but which can be transmitted to humans – a process known as zoonosis – pose an unpredictable and growing threat that has international experts in animal and public health worried.

Francoise-Xavier Meslin, World Health Organisation (WHO) coordinator for zoonosis control, described these diseases as a serious emerging problem that affects all regions of the world.

"The current upward trend… what we have been seeing over the past 15 years, an increasing number of these problems occurring, is going to continue," he said.

The WHO expert cited other animal-based outbreaks of diseases in humans, such as SARS (severe acute respiratory syndrome) and avian flu, which have primarily affected the Asian region.

He mentioned others that "have not attracted the attention they deserve," including Ebola fever, "which is an African disease for the time being," Rift Valley fever (also known as the Hanta virus), West Nile, "which was exported recently to the United States", the Nipah virus and bovine spongiform encephalopathy, widely known as mad cow disease.

Meslin noted that SARS is considered a "potential zoonotic disease" because it has not yet been proved whether "civet cats played a role in the transmission of the disease to humans."

The SARS outbreak in 2003 was a severe blow to China, Vietnam, Hong Kong and other Asian nations to a lesser extent, and also claimed many lives in Canada.

WHO authorities said the SARS cases reported on Apr. 22 in Beijing are under control, as the origin of the transmission was the National Virology Institute in the Chinese capital, where some researchers were infected while studying the disease.

Avian flu is another problem in Asia that eludes resolution, says Dewan Sibartie, of the Paris-based World Organisation for Animal Health (OIE).

This disease is spreading at a slower pace, but every day there are reports of new cases of infected birds, said doctor Sibartie.

The first outbreak of avian flu was confirmed in Hong Kong in 1997. It was transmitted to 18 people, and six died.

The 2003 epidemic was more intense, affecting nine Asian countries. Since December, around 100 million chickens have either died from the disease or were slaughtered to prevent contagion.

Thailand reported 12 cases affecting humans, of which eight proved fatal. In Vietnam, there were 23 people affected, and 15 died.

Sibartie said the OIE is preparing health guidelines for regulating trade in birds and poultry around the world.

Experts from the OIE, WHO, and the United Nations Food and Agriculture Organisation (FAO) this week gathered in Geneva to study emerging zoonotic diseases. Their number, says Meslin, "is very, very large."

"In both the developed and the developing world, the number is increasing continuously," the WHO specialist said.

The experts from the three international institutions identified the principal causes behind the diseases, including environmental degradation, "whether linked to agricultural practises or urbanisation."

"Also the globalisation of movement, of people or goods – including animals – is a very important factor in the spread of these agents and diseases," said Meslin.

FAO representative Jan Slingenbergh said in comments to IPS that among the causes behind the expansion of these diseases, farming practices is one of the few factors that can be reformed to help fight the phenomenon.

The same cannot be said of globalisation or climate change processes, which are more complex and would require the participation of a broad array of sectors to reverse the spread of zoonotic diseases.

The three institutions recognise the difficulties they face in identifying future diseases that can spread from animals to humans – there is a constant evolution of risk factors, said the meeting’s participants.

One of the experts’ recommendations was improved coordination in medical and veterinary responses when new diseases appear.

The next step, agree the OIE, FAO and WHO, is to raise political awareness and support for public and animal health infrastructure.

Because, said Meslin, if infrastructure is not reinforced, particularly in developing countries, "the proper surveillance system will not be put into place, the proper response system will not exist."

An international network is essential to support countries in efforts to assess the risk of new zoonotic diseases, he said.

Excerpt:

By IPS Correspondents
NEW YORK, Nov 25 2003 (IPS)

Public health officials worldwide say they are better prepared for a re-emergence of the SARS virus, but concerns persist that developing countries might lack the resources to quickly respond to an outbreak.

SARS, or severe acute respiratory syndrome, is a flu-like illness caused by a corona virus. First reported in Asia in February 2003, it quickly spread to more than two dozen countries in Asia, Europe and North and South America, mostly via infected travellers.

Symptoms of SARS include high fever, headache and respiratory problems. Doctors believe it is transmitted through the coughing or sneezing of infected patients, most of whom develop pneumonia.

According to the World Health Organisation (WHO), during the 2003 outbreak 8,098 people worldwide became sick with SARS, and 774 died.

Although the virus was eventually contained, with the last infection reported Jun. 25, public health experts warn that it could re-emerge, particularly with the onset of winter in the northern hemisphere.

"I think the developed countries are generally well prepared to deal with SARS if it comes back, although there will once again be substantial reaction and concern if new cases start to arise," said Dr. Arthur Reingold, head of epidemiology at the School of Public Health, University of California at Berkeley.

"As for poor countries, they are probably not very well prepared for SARS," he told IPS.

Ruth Berkelman, director of the Centre for Public Health Preparedness and Research at Emory University in Atlanta in the State of Georgia, agreed.

"It is unlikely that countries that lack a sound public health infrastructure have been able to prepare adequately for an epidemic of SARS," she said. "One question would also be how quickly an epidemic in these countries could be identified."

In China, where 75 percent of the SARS fatalities occurred, officials are erring on the side of caution – after coming under criticism for initially covering up the spring 2003 outbreak.

Beijing has resumed 24-hour surveillance to receive daily SARS updates from all area hospitals, and plans to set up an Internet-based reporting system to link 60,000 hospitals and local disease control centres around the country.

At some of the nation’s airports, officials are again scrutinising travellers to identify those who might be sick, although no new cases have been reported so far.

But on Nov. 20, senior Chinese officials in Beijing – which saw more than 2,000 SARS cases and nearly 200 deaths during the outbreak – warned that the public health system is still incapable of rapidly responding to another SARS outbreak.

Speaking at a conference in the city, Vice Mayor Niu Youcheng pointed to inadequate funding, a generally slow response to public health crises, weak sanitary facilities and the absence of health facilities in rural areas.

"Beijing still lacks open and transparent monitoring networks and information reporting systems to cope with emergency health crises," Niu said.

But even adequate resources are not a guarantee of success against SARS, as the city of Toronto discovered when three waves of the virus claimed the lives of 38 people and spooked tourists and business travellers planning to travel there.

Officials say SARS gained a foothold in Canada’s largest city due a lack of coordination and communication between government agencies in the crucial first weeks of the outbreak.

For example, when local health officials discovered the first cluster of cases late one night in March, they did not have the emergency phone numbers for Health Canada or the WHO. Nor did they have phone numbers for Toronto doctors.

Canada, which had 438 confirmed SARS cases altogether, just suspended airport screening measures – like thermal scanners to detect fever – but says it will reinstate them should any new cases crop up anywhere in the world.

In Hong Kong, one of the epicentres of SARS, the government has reportedly spent 60 million dollars on isolation wards in hospitals and a rapid communications system to share information about new cases.

Dr. Paul Lusamba-Dikassa, regional adviser for communicable diseases surveillance and response at the WHO Regional Office for Africa, said the WHO has conducted orientations to strengthen national surveillance systems and guidelines on hospital infection control and management of SARS.

"In a number of countries, SARS epidemic preparedness and response plans were developed and implemented," Lusamba-Dikassa told IPS. "Measures taken in South Africa and Zambia enabled the isolation of patients, contacts tracing and containment of the disease."

There are currently several laboratory tests to detect the SARS virus. However, the WHO notes that the system for global alert is weakened by the fact that at least one-half of the world’s population has no access to services that can perform simple chest X-rays.

"A major concern is the occurrence of cases in resource-poor settings, where health infrastructures might not be able to cope with the demands of case detection, isolation, intensive care and contact tracing," said the agency.

"Developing countries might not experience explosive increases in cases for the same reasons as seen elsewhere. Many other factors, such as crowding on wards and lack of adequate isolation facilities, could contribute to so-called ‘super-spreading’ events.."

The Asian Network of Major Cities for the 21st Century (ANMC 21), a grouping that includes some of the hardest-hit urban centres, agreed earlier this month to step up efforts to prevent cross-border transmission of the virus, continue surveillance efforts and early identification and quarantine of suspected cases, and to create a website of SARS-related information.

At a recent meeting in Geneva organised by the WHO, public health experts agreed that finding a vaccine for the virus remained an important part of prevention. This week, Chinese researchers announced they had identified a candidate vaccine, which will be tested in human trials next month.

"The quick progress of many groups in the area of SARS vaccine development is outstanding and most encouraging," Marie-Paule Kieny, director of the WHO Initiative for Vaccine Research, told IPS.

"This being said, it is unlikely that a commercial SARS vaccine would be available before one to two years from now," she added.

"Therefore, in the possibility of another outbreak, governments and public health institutions would have to face the emergency with measures such as those deployed during the past epidemic.

"Fortunately, we are better prepared, diagnostic tools are available, and potential drugs could be on track."

Excerpt:

By IPS Correspondents
SINGAPORE, Jun 26 2003 (IPS)

For South-east Asians who have had to live uneasily from one mask to the next, the waning of the SARS outbreak is a relief. Piles of used masks no longer clog public rubbish bins, and health workers are breathing easier.

But the region’s defence against the Severe Acute Respiratory Syndrome has entered a new stage, after the removal by the World Health Organisation (WHO), effective Jun. 24, of the recommendation that all but essential travel to Beijing – the last area in the world still covered by this warning – be postponed.

Now, as anti-SARS measures focus on vigilance and containment, two areas of interest remain: the race to find a cure for SARS – as well the attendant commercial spin-offs – and the validity of the definition of SARS.

The hectic activity in Singapore surrounding the Jun. 20 scientific conference on SARS research held here provided an indication of the first concern regarding the commercial potential of a cure to SARS.

Research institutes, hospitals, universities and the private sector have submitted 77 research proposals with a view to securing fund grants through Singapore’s Agency for Science, Technology and Research.

The conference, which immediately followed the Jun. 18-19 global conference on SARS in Kuala Lumpur, organised by the World Health Organisation (WHO), also revealed the scale of efforts related to SARS research in this city-state that is building itself into a biotechnology hub.

Research groups here are likely to collaborate with those elsewhere, said a spokesperson for the Agency for Science, Technology and Research.

Yet the U.S. Centres for Disease Control and Prevention (CDC) and the British Columbia Cancer Agency (BCCA) in Canada, have already applied for patents on the SARS genome, thereby inviting criticism.

”As an alternative, these agencies could have published the genome, thus preventing others from being able to patent it,” wrote Dr E Richard Gold of the faculty of law in McGill University, Canada, in a recent issue of the medical journal ‘The Lancet’.

The two organisations aim to not only prevent others from patenting the genome, but also to obtain the exclusive right to use and sell molecular forms of the genome.

But there is competitive manoeuvring too. The patent option provides the U.S. and Canadian organisations more leverage in dealing with the University of Hong Kong’s Versitech Ltd – which has also applied for a patent – and indeed others that could patent various uses of and products that interact with the SARS genome.

One such organisation is the U.S.-based health care company Abbott Laboratories, which announced in June plans to market and distribute a new SARS diagnostic test kit to assist government laboratories in Asia within weeks.

The company claims that the kit – developed by German biotechnology firm Artus GmbH – can detect at early stages of the disease the coronavirus suspected of causing SARS.

However, the feverish moves to and from the patent office by research groups are not defensive patenting, according to Chee-khoon Chan, coordinator of the Citizens’ Health Initiative and associate professor at the School of Social Sciences, Universiti Sains Malaysia, in Penang. ”The U.S. biotech industry really got going when the U.S. National Institutes of Health (the American focal point for health research) decided to allow their research grantees to commercially exploit NIH-funded research findings,” he told IPS. Until that time, he said, these findings had been the intellectual property of NIH as ”public trustee”.

Dr Kalyan Banerjee, virologist and former director of the Indian National Institute of Virology, agreed: ”Patenting is bound to happen as there is huge commercial value.”

Of more immediate concern to the WHO and health authorities in China is an outbreak of Japanese encephalitis in Guangdong province, where the coronavirus that causes SARS originated. The disease is mosquito-borne, attacks the brain and the spinal cord, and is endemic to many parts of Asia. China reports thousands of cases a year.

That it has immediately followed the SARS outbreak, rapidly killed 18 children and infected over 200, and emerged in the same region where SARS began, has prompted WHO to closely monitor its progress.

Japanese encephalitis is a seasonal disease, and medical researchers are questioning whether SARS too will be seasonal, and whether it may reappear in October or November.

Much will depend on an improved diagnostic test, which Dr David Heymann, WHO’s executive director for communicable diseases, regards as a ”top priority”.

At the Kuala Lumpur meeting, Heymann warned: ”The next influenza season will result in a large number of patients with symptoms easily confused with SARS… a more precise and sensitive case definition is absolutely essential to keep health services from being overwhelmed.”

The WHO case definition is aimed at prompt isolation of any person who might have been exposed to the SARS virus. WHO continues to recommend that suspect cases be immediately isolated and remain so until either a probable diagnosis is made or another agent is determined to be the cause.

It is a definition that has worked well to contain the outbreak in this initial emergency response to the SARS outbreak, but health workers and medical researchers in the frontlines of the battle against SARS have called for a more precise definition for longer term surveillance.

Among them is a group from the Chinese University of Hong Kong. Following their study of patients in a SARS screening clinic in Hong Kong, the group concluded: ”Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital.”

Whether WHO guidelines and definitions change with a virus that has already shown its ability to mutate is unclear. Indeed, some of the criticism of the WHO from within Asia has long been that it is inflexible, not recognising differences in cultural and social perceptions of health and disease.

Dr N S Deodhar, a former additional director of General Health Services in India and member of the International Epidemiological Association, told IPS that ”the WHO has served to mystify” matters. This approach, he added, undervalues epidemiological investigation to determine transmission routes and the social and economic contexts of the disease.

Excerpt:

By Stephen Leahy
BROOKLIN, Canada, Jun 25 2003 (IPS)

While the World Health Organization recently declared an end to the SARS crisis for now, Canada’s health system is still reeling over its failure to initially control the disease in Toronto.

Canada’s biggest and richest city is now coping with the end of a second wave of the epidemic, and appears to have avoided a third wave, officials said. SARS – severe acute respiratory syndrome – claimed its 38th Toronto victim Jun. 22 and 14 people remain critically ill.

The Toronto numbers are small compared to the global total of 790 deaths and nearly 8,500 infections since the virus first emerged last November in China.

But the disease’s persistence in Toronto and higher than expected death rate of 12-15 percent has driven up health care costs, spooked tourists and business travellers, and knocked an estimated 1.5 billion dollars (1.1 billion U.S. dollars) out of the city’s economy.

And it could have been much worse.

"If there had been a flu outbreak at the same time as SARS, we would have had a public health disaster," Dr. Lionel Mandel, an infectious disease expert at McMaster University in Hamilton in the province of Ontario told IPS.

Part of the problem is that Canada’s once acclaimed public health care system, and hospitals in Ontario in particular, have been starved of funds for many years, says Mandel. "Health care has been under a great deal of stress and SARS nearly brought the system to its knees."

In recent years, many Canadian governments have favoured tax breaks for citizens and businesses over funding for public institutions such as health and education.

Ontario’s health system had been stretched to the breaking point by chronic under funding and staff shortages before SARS, agreed Dr. Elliot Halparin, president of the Ontario Medical Association (OMA), in an interview.

"Medical staff are exhausted and personnel from the U.S. had to be brought in to help out," he said. "Even if there are no more new cases, it will take months, if not longer, to recover."

Money woes aside, there were other factors, including a surprising lack of preparedness. When Toronto public health officials discovered the first cluster of cases late one night in March, they did not have the emergency phone numbers for Health Canada or the WHO. Nor did they have phone numbers for Toronto doctors.

There was a lack of co-ordination and communication between various levels of governments in the crucial first weeks of the outbreak as well.

Perhaps the most important factor in the spread of the disease was the common practice of shuttling patients from one hospital to another. Toronto’s hospitals have various specialities and thousands of patients are transferred between them each day. Also, many nurses work part-time at two or more hospitals.

Not surprisingly, SARS-infected patients and medical staff spread the disease from hospital to hospital, so that more than 70 percent of SARS transmissions have been attributed to Toronto hospitals.

Although SARS only infected some 350 people it has led to loss of confidence in Canada’s public health system, because it proved unable to control the outbreak, said Paul Gully, senior director general of Health Canada, in news reports.

"I was surprised at how much trouble first-world hospitals were having with SARS compared to those in China and Vietnam," Dr. Earl Brown, a virologist and flu specialist at the University of Ottawa in Ontario, told IPS.

That may be a matter of differences in reporting cases, antibodies in Asian populations or even differences in the SARS virus itself, Brown speculates. "I initially was very worried about the impact on Asia when I saw the outbreak starting."

One of the mistakes Canada made was to downplay the risk at the beginning of the outbreak, he says. That resulted in some people not complying with quarantines – which in nearly all of the 15,000 cases were voluntary, involving a 10-day isolation in their own homes.

SARS symptoms do not manifest for up to 10 days after infection.

Mandel believes Canada’s health officials have something to learn about how the outbreak was handled in Taiwan and Singapore. "It’s a wake up call for Canada and the rest of the world about emerging infectious diseases."

Brown says the outbreak demonstrates that there are lots of ‘hot’ viruses moving around the globe, including dengue fever. "SARS didn’t have much of a run this time," he said. "It will come back."

Excerpt:

By Baradan Kuppusamy
KUALA LUMPUR, Jun 19 2003 (IPS)

After all the speeches at this week’s first global conference on SARS, the diagnosis has to be that although three months of unprecedented international cooperation has stemmed its spread this time around, much more remains unknown about the deadly virus.

There remains no definite answers to any of the key questions about the origin, natural reservoir and survivability of the Severe Acute Respiratory Syndrome (SARS) virus, which has killed more than 800 people and infected nearly 8,500 in some 32 countries.

A cure is years away at best. SARS probably can never be eradicated, they say. The best defence still is isolation, quarantine and travel restrictions – which struggling economies find unpopular and want to avoid because of the huge financial losses involved.

Hope for the best and prepare for the worse as winter approaches, Margaret Chang, director of health in Hong Kong, told 1,200 world experts and public health officials at one session at the World Health Organisation (WHO) conference that ended here Wednesday.

But among the fears most often aired in the conference and the corridors outside it was the concern that poor countries that have little or no capacity to fight the infection would be unable to cope if and when a second outbreak occurs, and that SARS would become a poor person’s disease.

Certainly, WHO experts kept saying, the virus has only been contained but not eradicated, even if worst-hit places like China have seen new infections drop sharply and Taiwan was taken off the travel restrictions list on Jun. 17.

"These countries with weak health infrastructure need urgent help now to improve surveillance, isolation and clinical facilities," said WHO Director General Gro Harlem Brundtland.

The tremendous global interest in SARS has not necessarily helped address the problem, because much of it is fed by fear and lack of knowledge.

The number of hits to the WHO website alone has jumped from 12,000 hits or visitors before the outbreak to about 10 million a day. But WHO experts say that much of this interest is fuelled by fear and an exotic fascination with the new and and unknown. Privately, one expert remarked, the fascination borders on ”celebrity status”.

They also worry that the blaze of publicity has sidelined larger issues like the public health dimensions of the outbreak and the capacities of poor economies to meet the challenge.

”This huge interest should translate into concerted cooperation and sharing of knowledge to help poor countries come to grip with the dangers of emergent viruses like SARS,” said Dr Angus Nichols from the Health Protection Agency in Britain.

An equally important issue, experts say, is the reluctance of the cash-rich private research organisations and pharmaceutical giants to share their resources and knowledge with public health officials of poor frontline countries like Vietnam and even China.

Already, a wide gulf has opened up between those who know and have the capacity to know fast and those without both capacities.

Among the range of suggestions along this line were the creation of a bank of SARS cells from all infected persons, and the creation of a central database that all researchers can use. Experts also proposed that SARS screening methods and other guidelines be standardised and international cooperation be used to develop a single, reliable test kit.

But these proposals may remain just that without badly needed funds. "We are not a money bag…we are depended on allocations and our resources are severely limited," said Brundtland.

Meantime, health and science experts’ efforts to track the SARS virus will continue, although key answers remain unanswered: What really is the SARS virus? Who is its natural host or hosts? How and why did it jump species?

Several SARS mysteries were also topics of much discussion here – including why some patients deteriorate rapidly and others do not, why children are uninfected when adults die. Another puzzler is the phenomenon of so-called ”super-spreaders”, who infect dozens of people while other infected persons do not infect anyone. "We have contained the disease…now we are looking for possible ways to eradicate it," said Dr David Heymann, the director of communicable diseases at the WHO. "But to make the first moves to eradicate we need to know a lot more about the SARS virus, its origin, natural host and why and how it jumped species."

Even SARS’ animal origin – supposedly from the civet cat – is not a 100 percent certainty. "It is even possible that a small and isolated group of humans are the natural host," said Australian veterinary epidemiologist Dr Hume Field. ”We need to do more studies…more systematic testing.”

Some public health experts like Hong Kong’s Margaret Chang, who have to fight the infection and protect people, are uncomfortable with the abundance of theories, probabilities and hypothesis. "Frankly, it (theorising) has not been helpful for us (public health decision makers)," she said.

They worry that the virus will exploit the low level of hygiene and sanitation in poor societies and end up as a poor people’s disease.

"SARS has forced us to rethink the sanitation conditions of entire societies and also the conditions of work of people like sewage workers, slaughter houses and animal and food handlers. What was safe before is no longer safe after SARS," said Dr Jamie Bartram, WHO expert on water, sanitation and health.

One real fear is that SARS would spread and take root in poor countries and become endemic like malaria. It would be a huge disaster given poor water and sanitation conditions made worse by civil strife and lack of political will. "There is a urgent need now for such an emergency," Bartman said.

WHO officials say the fear of SARS and the economic cost of an outbreak is changing official attitudes about improving health capacities, but that the resources being committed remain insufficient.

"It is a shame to call SARS a blessing in disguise but yes, it is true," said Mohamed Said Patel, a WHO expert. "We should capitalise on it and lobby politicians for funds for disaster preparedness and public health."

Excerpt:

By IPS Correspondents
BEIJING, Jun 9 2003 (IPS)

For Chinese journalist Bai Weitao, the last few months have been nothing less than a nightmare that changed the life he knew, and made him value all the little things he took for granted.

For some three weeks from April to May, Bai had to be quarantined rather suddenly. He was found to have talked to a couple whose six-year-old girl was diagnosed as having atypical pneumonia, as the Severe Acute Respiratory Syndrome (SARS) is referred to in China.

"I was put into a hastily transformed small room with nothing but a cot. My only link to the outside world was a mobile phone, which has to be recharged everyday. Everyone was frightened to see me, as if I were the epidemic itself, " Bai recalls in an interview.

Fear and loneliness have plagued many more among the nearly 30,000 people who have been quarantined at some point in this city of 16 million people, since the Chinese government took extreme steps to curb the SARS epidemic.

Since then – the quarantine system has been key to stopping chains of transmission – Beijing’s reported number of cases has fallen from more than 100 a day in mid-April to less than 10 in recent weeks.

Amid this trend, doctors worry about complacency. Indeed, new cases reported last week on Jun. 3 showed that SARS is far from gone from the country even if the epidemic has peaked.

This also means that Beijing’s residents are getting to used to life with SARS. Already, restaurants are starting to see patrons coming back. Fewer people are donning face masks and traffic jams have begun to reappear as more residents go out of their homes.

"When people’s alarm hits a peak, they will have a strong desire for a release and relax themselves in different ways, like shopping or having a party," says Zhi Ran, director of the SARS counseling hotline in Beijing. They may not pay due attention to preventive measures against infection, such as hand washing and sanitation. "This is very dangerous," he warns.

But whatever the number of SARS cases, the disease has already changed the routine of many here – and it will continue to be at the back of their minds until it is stopped or a vaccine is found.

Their recent experience is something that Wang Jiangang and his wife, the parents of the girl that had SARS and who Bai came in contact with, will not forget. Staying in isolation in a hotel room in west Beijing, they were unable to sleep soundly when their daughter was hospitalised for SARS.

"A patch of my hair turned white overnight. And I lost almost four kilos. Not a day passed without my having a bad dream, and every time I shouted in my dream, my husband would haul me from bed," says Wang’s wife.

Hotlines have been set up for people who have been caught unawares by SARS or fear they might have it. With just 20 days after opening two hotlines in late April, the Huayu Centre for Crisis Intervention got more than 1,000 calls.

"From the calls one could feel that the psychological shadow cast over the public (by SARS) far exceeds its actual impact," says Fan Lihua, director of the centre.

Doctors, nurses and medical workers are not exempted from the prevailing fear, given that some 400 medical workers have caught SARS on the job, or about one in every six SARS patients.

At the peak of infection in late April, many hospitals suffered from a lack of cleaners who, not being formal employees, deserted their jobs.

For medical workers, sticking to pressure-filled routines to fight SARS while keeping themselves safe from it has been far from easy as the anti-SARS campaign stretches into months.

"When the outside temperature is around 30 degrees Centigrade, we still have to put on three layers of protection wear from head to feet, with three surgical masks each with 16 layers as well as goggles covering the face. Everyday, we are soaked to the skin with sweat," says Liu Xuetao, a nurse working in a hospital set up for SARS patients on the outskirts of Beijing.

Medical workers have taken to using disposable diapers so they can complete their six-hour shifts inside their protective gear – and not have to go through tedious hygiene procedures required each time they go to the toilet. Many drink the minimum amount of water during their shifts to avoid having to take those breaks.

Estimates are that 60 percent of residents have been shunning crowded places because of fears of SARS, but many are also seeking outdoor activities that are seen to be less risky.

Parks that used to be frequented mostly by the aged are now filled with people of all ages, desperate to inhale fresh air and do outdoor exercises to boost their immunity against SARS. "We dare not venture into other places with high density of people. It’s safe here with an open lake and the entrance is cheap," says Chang Jie, who takes her 7-year-old son the Lianhuachi (Lotus pond) Park near the West Beijing Railway Station.

Because cinemas, concert halls and Internet bars have been closed since Apr. 26 to avoid high human concentrations that might add to the spread of the virus, other residents are turning to the virtual world at home.

An on-line survey by the Qianlong news website of 437 Internet users shows that over half have been watching on-line movies during the ‘special vacation’ due to SARS, since school was closed.

Close to 40 percent of respondents say working at home has even increased their efficiency.

For the city’s 1.7 million primary and high school students, the unexpected vacation since Apr. 24 has not been squandered. Before the schools in the city proper resume on Jul. 14, the municipal education committee pooled together the resources of seven on-line schools to offer free courses through the Internet.

Excerpt:

By IPS Correspondents
BLANTYRE, May 26 2003 (IPS)

The Severe Acute Respiratory Syndrome, which has been reported in Southeast Asia and Canada, is causing panic in Southern Africa.

A week after Zambia quarantined travellers from Southeast Asia to verify their status in the wake of SARS outbreak, Malawi’s health authorities have followed suit.

The ministry of health has banned travellers from Canada, China, Hong Kong, Philippines, Inner Mongolia, Taiwan and Singapore to prevent the deadly lung disease from entering Malawi, says health minister Yussuf Mwawa.

Taiwan – one of Malawi’s emerging trade partners – has cancelled a visit by a business delegation to attend the two-week Malawi International Trade Fair, which opened in the commercial capital, Blantyre, on May 24.

"Taiwan has voluntarily agreed not to send its delegation to Malawi for the Fair. Ambassador Chen of Taiwan is agreeable and sympathises with our concerns," says Mwawa.

A committee on SARS, headed by health secretary Richard Pendame has been put in place and would work closely with the Malawi Immigration Department to check on visitors from SARS-infected regions, he says.

Chancellor Kaferapanjira, chief executive of the Confederation of Chambers of Commerce and Industry, which organises the annual fair, has said the Taiwan pavilion, would be manned by locally based Taiwanese mission staff.

Taiwan, along with China and Hong Kong, is one of the hardest hit by SARS. Seventy-two Taiwanese have died of the disease since March. The total number of cases is now 585.

Worldwide, the SARS death toll stands at around 730 deaths. Up to 9,000 people have been infected, according to the World Health Organisation (WHO).

Chui Shu-ti, the health chief in Taiwan’s capital, Taipei, resigned on Sunday, becoming the second health official to step down in the past two weeks allegedly over failure to control the disease.

An outbreak of SARS in Malawi, with a population of about 10 million, could pose debilitating effects on the country’s weak public health services, according to Mwawa.

When the SARS scare reached the sub-region after it was first reported in March the government of Malawi said it had no resources to put up any preventive mechanisms.

Taiwan has been one of the traditional patrons at the Malawi International Trade Fair, since it was established 14 years ago.

The Taipei-based China External Trade Development Council (CETRA) says the Malawi trade fair has boosted trade between Taiwan and the landlocked southern African state, which is a net importer. According to CETRA, Taiwan’s exports to Malawi were worth 3.4 million U.S. dollars, reflecting an increase of 147 percent of trading, in 2001, while Malawi’s were around 7.3 million U.S. dollars.

This year’s Malawi International Trade Fair has attracted more participants than last year’s. Some 217 local companies are participating in the fair, while foreign exhibitors have come from Germany, Pakistan, United Arab Emirates, Tanzania, South Africa, Zambia, Kenya, Mozambique and Zimbabwe, according to the organisers.

They say the increase in participation was a sign of confidence in anticipated growth of the Malawi economy, but have expressed concern over SARS travel restrictions.

Prospects for economic growth were raised last week following the fall in Malawi’s inflation rate – from 14.8 percent in December to 9.8 percent in April. It is the first time that a single-digit inflation rate has been achieved in seven years in Malawi.

Excerpt:

By IPS Correspondents
BEIJING, May 25 2003 (IPS)

As the SARS outbreak here appears to ease a bit, hopes are growing that China’s tardy tackling of the epidemic might have a positive side effect – and force its leaders to confront the country’s lopsided reforms in public health.

By taking too long to reveal the real dimensions of a health crisis that had the potential to travel around the globe, China set in motion a chain of negative reactions – from the loss of its international standing in the region and beyond, to economic losses and social tensions across the country.

The global number of SARS cases stands at 8,141 cases as of the weekend. China, where the virus is believed to have originated, is the worst hit country, with 2,491 cases and 163 deaths.

To prevent a repetition of a SARS scenario in the future when an infectious disease becomes a major social, economic and political problem, experts say that China would have to initiate genuine reform of its neglected and underfunded public health system.

"SARS is perfect in a way of showing to the whole world the entrenched problems in China’s public health sector," says Han Deqiang, professor of politics and management at the Beijing University of Aeronautics.

"Medical care in China, especially in the rural areas, has been weakened greatly. The peasants and the laid-off workers have no place to have their disease checked and treated,” Han explains. ”What is more, they have no money. Families of laid-off workers are having problems feeding themselves, not to speak of putting money aside for health care."

World Health Organisation (WHO) experts contend that the government is drawing lessons from the crisis. "We are really seeing an increased level of cooperation and mobilisation on many levels," says Dr Keiji Fukuda, a WHO expert in Beijing. "I hope this is the beginning of rebuilding of the public health sector in China."

Daniel Chin, the head of WHO’s Beijing team of experts, is even more positive. "I believe Vice Premier and Acting Health Minister Wu Yi sees the SARS outbreak as an opportunity to launch reforms in the health system," he asserts. "One can even say she believes the change in the health care system is her mandate."

The collapse of China’s rural communes in the early 1980s brought to an end the era of free preventive health care and universal medical treatment.

Under the collective system, 90 percent of the rural population had access to free health services. Today only 10 percent of rural residents are insured, leaving some 700 million Chinese having to pay out-of-pocket for all of their health care.

The worst affected by the government’s withdrawal from its role as free provider of medical services in the early 1980s have been public health services such as preventive care, disease surveillance and medical control.

Fiscal decentralisation has meant that poor local governments have less to spend on health than their wealthier counterparts. As a consequence, there has been less investment in hospitals and drugs, and lower pay for medical staff has led to lower standards of health care.

Single-minded economic growth should now cease to be the government’s only priority, argues Mao Shoulong, a professor of public administration at People’s University. In an article in the ‘Nanfengchuan’ magazine, he criticised the government for overlooking the public interest in favour of economic growth and social stability.

This is a harsh accusation against a government that was installed early this year with widely proclaimed goals of building "a well-off society".

Chinese officials had played down SARS outbreak and concealed information about it for months, aiding the spread of the killer virus from southern Guangdong to Beijing and other parts of the country as well as nearly 30 other countries.

Shocked by worldwide criticism of China’s slow response to the crisis, the authorities have promulgated a set of regulations for emergency public measures. They cover outbreaks of infectious diseases, mass food poisoning and other serious threats to public health.

Unveiled by Premier Wen Jiabao in mid-May, the new regulations lay the basis for the establishment of a new Emergency Response Bureau expected to coordinate the country’s efforts in combating new outbreaks.

The new rules require local officials to report epidemics to Beijing immediately, and demand that local governments set up reserve funds to tackle future outbreaks.

The central government has also begun pumping funds and resources into a rural health care system that for decades has been drained of funds.

Beijing has already allocated 1.5 billion yuan (180 million U.S. dollars) for the construction of a nationwide disease prevention and control network and an additional 800 million yuan (96 million dollars) to improve infrastructure.

Officials also said they are extending another 2 billion yuan (241 million dollars) to improve standards for rural medical and health care. "The focus of the funding would be to support the central and western rural regions," says Liu Jian, head of the task force for rural affairs at the National SARS Prevention and Control Headquarters.

Yet there are those who doubt that these new measures amount to a real change of government policy. "Social spending can’t sustain economic growth and the Chinese government is well aware of it," says Robert Ross, a political scientist at Boston College, who was in town recently.

He adds: "China’s strategy so far has been a race – pumping money into infrastructure and hoping to close the gap between rural and urban areas before any serious social crisis erupts. I believe it would stick to this."

Excerpt:

By IPS Correspondents
BEIJING, May 23 2003 (IPS)

The mass resignation of nurses and doctors fighting the SARS outbreak in Taiwan presents a striking contrast to the united front of medical workers that mainland Chinese propaganda is portraying in Beijing’s own battle to contain the epidemic.

More than 150 Taiwanese health workers resigned from their hospitals this week, fearing they are in danger of catching the deadly virus that has made more than 8,000 ill and killed nearly 700 people around the world.

The press in Taiwan took on the government criticising it for failing to provide adequate protection for medical staff. More than 90 percent of all the known infections on the island are among health workers, according to the health ministry of Taiwan, which Beijing considers its province.

"It is not that we are evading our responsibility but we don’t want to return to the sad place where some of our colleagues had died after unknowingly catching the deadly virus from SARS patients," the Taiwanese media quoted one doctor as saying.

Freedom of choice to resign has not been given to medical workers on Chinese mainland, where the government is battling the worst SARS outbreak globally. No such resignations or complaints have been made public in the official Chinese press.

By contrast, the state propaganda has portrayed medical staff fighting the disease in Beijing as "white-coated warriors" on the "front line". Numerous reports have lauded their heroic spirit and extolled the nation to follow their example and join the ‘people’s war’ against SARS.

But the reality behind the slogans has been different, said people who spoke on condition of anonymity.

"Going there (to the SARS frontline) is like getting a life sentence," said one man whose wife, a physician, has been working in a SARS-designated hospital for three weeks now without leave.

"You go in and you don’t know when you are coming out. If there are not many patients, there is hope that she will be back after the month is up. But if there are many cases, she would have to stay. There are simply not enough medical workers,” he said.

China is the nation worst stricken by the SARS epidemic. The country has reported 5,271 infections and 300 deaths as of May 22. The capital Beijing – by far the hardest hit place in the world – accounted for 158 of the deaths along with 2, 456 of the SARS cases. Of the SARS cases, 395 are reported to be among health workers.

After initially playing down the outbreak, the government has resorted to extreme measures since April in its all-out war to fight the SARS epidemic.

Beijing has seen its SARS numbers falling in recent days partly because of a gruelling regime imposed on medical staff, who have been working 18 to 20 hour shifts, without leaving the SARS ‘frontline’ for as long as 40 days.

Authorities have threatened to revoke the medical licenses of those who refuse to join the SARS fight or fled, sources said. Expulsions from the Communist Party have been cited as possible punishment for those party members who waver.

In its efforts to contain the epidemic, the government has exhorted SARS hospitals to achieve the "two decreases" – a decrease in the death rate of SARS patients and a decrease in the infection rates among health workers.

Heeding these instructions, SARS hospitals have given doctors and nurses courses of interferon – an immunity-boosting drug to ward off the virus, said one source. "Patients terminally ill with cancer get interferon but we don’t know what side effects it could have on healthy people," she said.

No dissenting views or refusals to comply with orders by authorities have been allowed. "If my wife or her colleagues refuse to do their job, they would lose their licenses and never get another job," said the physician’s husband. "Only janitors and cleaners have left the SARS hospitals. They have nothing to lose."

In another sign that China is fighting an uncompromising battle to stem the spread of the disease, the government has promulgated a new law on infectious diseases, one that threatens harsh punishment for anyone in any way hindering the prevention or treatment of sudden disease outbreaks.

The harshest punishments are reserved for those caught violating quarantine and spreading the SARS virus intentionally – they will face 10 years to life in prison or the death penalty. But even those spreading rumours, fabricating news or raising false alarms can, under the new law, get prison terms.

The ambitious propaganda campaign launched by China’s government continues to promise people that if "we fight the virus with one heart and one mind, we are sure to defeat it”. In a throwback to the mass mobilisation campaigns of the Maoist era, anti-SARS bulletin boards feature nurses and doctors with clenched fists and exalted expressions.

To those who have survived the waves of numerous political campaigns under the leadership of Mao Zedong (1949-1976), the new revolutionary zeal seems out of place.

"I disagree with the government propaganda saying that SARS can be exterminated and cured because it is not true," said Zhou Xiaozheng, a sociologist from China People’s University. "People will learn that even medical workers are dying, nowadays you can’t keep it secret. You have to tell people the truth and let them get used to it."

Excerpt:

By IPS Correspondents
SINGAPORE, May 20 2003 (IPS)

South-east Asian countries like Singapore have begun to cautiously hope that they have weathered the worst of the SARS outbreak, although it still looms large as a new and deadly health threat.

More than two months after cases began spreading rapidly in the region, Taiwan is still reeling from spikes in the number of cases and deaths related to the Severe Acute Respiratory Syndrome (SARS).

Singapore, which like other countries has been seeing a drop in the number of new infections, was hoping to be declared free of SARS on May 18. But a single new case reset the counter.

The city-state’s health minister, Lim Hng Kiang, advised Singaporeans to "take this in their stride because if you ask yourself what has physically changed – nothing much, because this case has been isolated in our hospital".

But away from the region, new thinking from India is questioning both the reasons for the virulence of SARS and responses to it.

The questions challenge current knowledge about the outbreaks and the relationship between human populations and opportunistic infections. They also seek explanations for why the impact of SARS is mild in certain regions, but far more dangerous than the flu in others, with a fatality rate of 13-15 percent.

These are crucial questions, because the deaths from SARS continue. As of Monday, the World Health Organisation (WHO) reported 7,864 cases of SARS worldwide, and 643 deaths attributed to it. More than 95 percent of these cases and close to the same percentage of deaths recorded from it have taken place in mainland China, Hong Kong, Singapore and Taiwan.

The coronavirus, which has now been confirmed to be the cause of SARS, is not easy to detect. Medical researchers from The Netherlands to Canada have expressed awe at the speed with which the virus has been proven to be the cause of SARS – in comparison, it took nearly two years to confirm HIV as the cause of AIDS.

Yet, as the latest Singapore case demonstrates, it was five days before a diagnosis of atypical pneumonia could be confirmed as the dreaded new coronavirus.

Dr Ling Ai Ee, virologist with the Singapore General Hospital, said that detecting the SARS virus from blood tests was difficult as these are "a little bit less sensitive". As was seen in Hong Kong, the virus is more easily detected in stool samples, but then only in the second week of infection.

Experts from South Asia offer ideas on how the human body’s defences might be strengthened against SARS. It is an old foe of those who live in tropical and developing countries in South and South-east Asia that could provide a glimpse into the methods of the SARS virus and that old foe is malaria.

Medical professionals have said that the endemic presence of infections of falciparum malaria – one of the four life-threatening types of parasitic malarial diseases transmitted by mosquitoes – in some regions in Asia may have contributed to the milder reaction to SARS there.

Dr James da Costa, a pathologist based in Mumbai, India, has been studying falciparum malaria for the last nine years. "It has the highest mutation amongst parasites," he said in an interview, "second only to leishmaniasis, but the pattern has changed in the last few years”.

Leishmaniasis is a parasitic disease transmitted by the bite of some species of sand flies, and more than 90 percent of the world’s cases occur in Bangladesh, Brazil, India, Nepal and Sudan.

"Falciparum has produced symptoms identical to SARS," said da Costa. "Over the last five months I have noticed acute respiratory distress syndrome, as there was during the Surat plague." That took place in 1994, in the western Indian city of Surat in Gujarat state.

More pertinently, da Costa said that malaria has been known to alter the immune response of people.

"It protects against the severe manifestation of other viral infections, by suppressing an over-reaction of the immune system," he said. "It is this immune response of the individual host, and not the presence of the virus alone, which determines the severity of the symptoms."

Indeed, that is one of the aspects of the SARS outbreak that has virologists questioning the speed and spread of the outbreak.

Dr Kalyan Banerjee, virologist and former director of the National Institute of Virology in Pune, India, questions why the virus affects adults far more severely than it does children. "This aspect needs very much more epidemiological work," he said in an interview.

Although the coronavirus that causes SARS is said to be a new type, previously unknown, Banerjee pointed out that the virus "may have been ecologically located in South-east Asian or East Asian countries". He also said that "it is serologically related to other viruses".

Asked about the susceptibility of ethnically diverse populations to the SARS virus, and the public health responses in a populous country like India, Banerjee said much study needs to be done about whether some groups of people may be more prone than others to some diseases.

In India, the number of suspected cases reached 20 before WHO declared the country safe from SARS, but not before scares of an epidemic had shaken the country and its health authorities.

"In the history of infectious diseases, that some ethnic groups are susceptible and others are not is well-known – it is a curious effect," explained Banerjee. However, he cautioned, "Right now it is too premature to make a conclusion about who it affects."

The virologist emphasised that "such a virus cannot be generated sui generis – spontaneously". Banerjee asked: "What was the ancestral virus? If the virus has been fairly benign, and has not been doing much clinical damage, the possibility is that it has been present (in our habitats)."

As da Costa said, "Simple solutions are being missed. The genetic variant of falciparum is being missed."

Excerpt:

By Gustavo Capdevila
GENEVA, May 19 2003 (IPS)

The World Health Assembly got underway in an unexpectedly optimistic climate due to the decision of the United States to withdraw its objections to the first global treaty on tobacco control, paving the way for its approval Wednesday.

But concern about the persistence of the SARS epidemic was a cloud over the events marking the Monday opening of the 10-day sessions of the World Health Organisation (WHO) meeting.

Ministers from the 190 WHO member nations are preparing to sign the Framework Convention on Tobacco Control (FCTC), which establishes limits in many areas, but the most contentious are those related to advertising and promotion of tobacco products, and tobacco companies sponsoring such things as sporting events.

WHO executive director Derek Yach, who since 1998 has been promoting the anti-tobacco initiative, told a meeting of international non-governmental organisations Monday that all member countries will approve the text, the result of four years of tough negotiations.

The draft text, agreed in March by 170 countries, calls for the states party to the treaty to begin to apply the tobacco advertising ban within five years after the treaty enters into force.

During the contentious negotiations of the first multilateral agreement on health issues, the U.S. authorities had objected because the text does not include an opt-out clause for the signatory countries.

In formulating a reform of the measure, a move the United States frequently makes with multilateral treaties, Washington aimed to free up U.S. citizens and companies from potential obligations under the FCTC.

But the situation changed on Sunday, when U.S. Secretary of Health and Human Services, Tommy Thompson, made the surprise announcement that the U.S. delegation to the World Health Assembly would vote in favour of the tobacco treaty as it stood.

Representatives from the NGOs said they were "astonished" by Thompson’s statement, and underscored that the anti-tobacco convention is an "important victory" for public health worldwide and ensures legal obligations for "Big Tobacco".

Akinbode Oluwafemi, of the Nigeria-based Environmental Rights Action, said, "The rejection of the U.S. pressure to re-open the FCTC (to debate during the assembly) is testimony to the commitment of developing countries."

"Despite the powerful influence of Big Tobacco, the countries of Africa, Southeast Asia, the Middle East and the Pacific and Caribbean Islands stood firm for an FCTC that will protect current and future generations from a preventable epidemic," said Oluwafemi.

According to WHO statistics, tobacco use is the cause of death of 4.9 million people each year. If current trends continue, that figure will double by 2020, with 70 percent of the deaths occurring in developing countries.

Kathryn Mulvey, executive director of the non-governmental corporate watchdog Infact, based in the U.S. city of Boston, pointed out that U.S. administration of George W. Bush "has close ties to the tobacco industry."

"Secretary Thompson, who leads the U.S. delegation to the WHO, maintained an open-door policy to Philip Morris (now known as Altria) and its Kraft subsidiary while serving as governor of the state of Wisconsin," Mulvey said.

The activist added, "The world will be watching to ensure that the U.S. follows through on its pledge to support the FCTC, and does not put the interests of the tobacco industry ahead of public health."

According to a report from the International Labour Organisation (ILO), the tobacco industry has flourished more than any other in recent years.

Philip Morris, the biggest of Big Tobacco, sees annual revenues of 73 billion dollars, reports Infact.

Despite the dramatic statistics associated with tobacco use around the globe, it was clear at the inauguration of the World Health Assembly that the talks will be dominated by SARS (severe acute respiratory syndrome), which has claimed 643 lives and infected 7,800 people since it was first diagnosed in November.

WHO Director General Gro Harlem Brundtland, who will step down from her post in July after having served five years, drew parallels between the SARS threat, which she described as the first epidemic of the 21st century, and HIV/AIDS, the major disease of the 20th century.

It is clear that the battle against SARS is not yet won, said Brundtland, and urged the health ministers gathered in Geneva to remain "vigilant".

The WHO leader warned against complacency, noting that such attitudes had contributed to the spread of other diseases.

AIDS (acquired immunodeficiency syndrome) is today the leading cause of death in Sub-Saharan Africa, is a serious problem in the Caribbean, and is on the rise in Asia and much of Eastern Europe.

There are 42 million people with HIV in the world, and most are in developing countries. Half are under 25.

At the current rate of expansion – 15,000 people infected each day – and without massive efforts to halt the disease, the HIV/AIDS epidemic will have claimed at least 30 million lives.

Among the lessons learned from SARS is the importance of "access to information about diseases outbreaks as soon as they occur," said Brundtland.

Health authorities have criticised China, home to the first SARS case, which appeared in southern Guangdong province, for withholding information about the epidemic until March, when the original cases had been verified in November.

Brundtland called upon governments to share information on SARS in a timely manner, noting that, "since we issued our global alert in mid-March, the disease has still spread to many countries. They have all benefited in their ability to contain and stop the outbreak."

"But we need to ensure this remains the case, so that SARS does not become a burden on countries least able to afford it," she added.

Excerpt:

By Dalia Acosta
HAVANA, May 19 2003 (IPS)

In today’s hard-hit global tourism industry, it is becoming more important to be able to advertise a destination as an area free of problems like the SARS epidemic or terrorism threats than to promote natural and architectural attractions.

The strategy has been working, at any rate, in Cuba and other Caribbean island nations, and the Caribbean may well be the region whose tourism sector best withstands the upsets caused by terrorist attacks, the war on Iraq, and SARS, said the Caribbean Tourism Organisation (CTO).

Not a single case of SARS (Severe Acute Respiratory Syndrome) has been documented in Cuba, Cuban Tourism Minister Ibrahim Ferradaz told the press at the closure of a regional tourism convention held this month in the resort town of Varadero, 140 kms from Havana.

Local health authorities have provided similar reports, giving assurances that all the necessary measures have been taken to detect cases of SARS and prevent an outbreak of the disease which, according to the World Health Organisation (WHO), had killed 643 people worldwide by Monday, out of a total of 7,864 cases.

According to local observers, a centralised government health system like that of socialist Cuba can be especially effective at times like this, because epidemiological measures can be applied at all levels, without depending on the whims of private medicine.

The precautions that have been taken in Cuba are surveillance of passengers for possible SARS symptoms on Cuban aircraft and in airports and all tourism installations, including those owned jointly by the Cuban state and private foreign interests.

Ferradaz said local health and tourism authorities have only had a couple of scares when symptoms similar to those presented in SARS cases cropped up among tourists. But the worries turned out to be unfounded.

After the Sep. 11, 2001 terror attacks in which airliners full of passengers were used as bombs against the World Trade Centre in New York and the Pentagon in Washington, global tourism, already weakened by an international economic slowdown, took a nosedive.

Caribbean islands immediately began to play up the ”safety” aspect, marketing themselves as safe, tranquil destinations free of terrorism and other violence.

But until November of last year, the results of that campaign were still uncertain, noted the secretary-general of the Association of Caribbean States, Norman Girvan.

By the beginning of this year, however, tourism in Cuba, as in neighbouring Caribbean island nations, began to see clear signs of recovery from the post-2001 slump.

By Apr. 30, 767,601 tourists visited Cuba, 19 percent up from the same period in 2002. The main sources of visitors were Canada, Italy, France, Germany, Spain, Britain and Mexico.

Some 250,000 Canadian tourists visited Cuba in the first four months of the year, 42 percent more than in the same period in 2002. There were around 10 flights a week between 15 different Canadian cities and seven Cuban airports.

But the global tourism industry continues to face swings.

The SARS epidemic, the first cases of which appeared last November, has caused more damage to a number of destinations in Asia than the terrorist attack on the Indonesian island of Bali last year, in which 200 people were killed, the secretary-general of the World Tourism Organisation, Francesco Frangialli, said this month.

Arrivals were way down in March in the countries hit hardest by SARS, especially China – where 5,236 probable cases have been reported, including 289 deaths – and its special administrative region of Hong Kong, as well as Taiwan, Singapore and Vietnam.

The disease, which is caused by a highly contagious and deadly virus and is characterised by flu-like symptoms, including high fever and respiratory difficulties, is believed to have originated in the southern Chinese province of Guangdong.

Frangialli added that SARS is having a harsher impact on the airlines than the U.S.-British war on Iraq, which was declared on Mar. 20.

”Moreover, the reality of the epidemic is being compounded by its intense coverage by the media, which has led to a veritable wave of paranoia in certain countries,” Frangialli said in a communique.

He said the paranoia is affecting Asian destinations not seriously infected with SARS, such as India, Indonesia, Malaysia, Cambodia, the Philippines and Thailand, almost as much as heavily- hit areas like China, Hong Kong and Singapore.

Cases have also appeared in Europe, as well as Canada and the United States. In Latin America, the WHO reported two cases detected in Brazil and one in Colombia, both involving travellers who flew in from Asia.

The Caribbean so far has escaped the new scourge and its impact on tourism flows. Countries like Cuba, the Dominican Republic and Puerto Rico have posted statistics that are stronger than or the same as those seen prior to the post-Sep. 11, 2001 crisis, said Fernando Abreu, CTO assistant director of marketing.

As well as those three destinations, the Cayman Islands, the Bahamas, Jamaica and Barbados have continually renovated and updated their tourism campaigns and attractions, a policy that has also had a favourable effect on the subregion, said Abreu.

In addition, Aruba’s tourism sector has posted three to four percent growth since the start of the year, said the country’s Tourism and Transport Minister Edison Briesen.

The CTO is reviewing a marketing plan designed prior to the war on Iraq and to the modifications adopted as the SARS epidemic has spread.

”We are preparing ourselves before the crisis hits,” said Abreu during the Tourism Convention in Varadero, which was held May 5-8.

According to Ferradaz, Cuba’s tourism sector has rallied due to factors like the diversification of attractions and destinations, an increasing array of eco-tourism initiatives, and success in drawing visitors from a wider number of regions, as well as measures like the authorisation of circulation of the euro, the European Union currency, in some tourist centres.

Cuba also aims to attract more travellers from Russia and Scandinavia, as well as from nations like Lebanon, Qatar and the United Arab Emirates, whose citizens may not feel completely comfortable visiting the United States due to closer surveillance of Arabs and Muslims since the Sep. 11, 2001 attacks.

Creating routes between China and Cuba is another challenge faced by Cuba’s Tourism Ministry, since the Asian giant recognised Cuba as an authorised tourism destination this year.

Ferradaz stressed the potential positive impact on the local economy of being able to attract even a tiny proportion of the numbers of Chinese tourists who take pleasure trips every year.

Excerpt:

By IPS Correspondents
MANILA, May 15 2003 (IPS)

Philippine President Gloria Macapagal Arroyo brimmed with pride when the leaders of Singapore and China said at the recent SARS summit that Filipino nurses were performing admirably during the health crisis, but that praise also draws attention to one of the country’s biggest illnesses – the exodus of its best nurses.

Many Filipino nurses, Arroyo was told, had cut short their vacations because they said their host societies needed them given the rising cases of people with the pneumonia-like Severe Acute Respiratory System (SARS).

That Filipino overseas workers or immigrants are appreciated in the more than 100 countries where they work is a refrain often heard in the Philippines, a country of 80 million people said to be the world’s largest organised exporter of human labour.

But the irony is particularly painful in the case of Filipino nurses – of which nearly 14,000, or some say much more – leave each year for better pay and opportunities.

The costs of this migration are being felt in this poor country that needs its best health professionals but spends thousands of dollars training each nurse – only to have them serve the needs of countries like Britain, the United States, Saudi Arabia and Ireland.

"Sadly, this is no longer brain drain, but more appropriately, brain haemorrhage of our nurses," said Dr Jaime Galvez Tan, vice chancellor for research at the University of the Philippines in Manila, and executive director of the National Institutes of Health Philippines. "Very soon, the Philippines will be bled dry of nurses."

Rose Gonzalez is a nursing graduate turned public relations practitioner for seven years, but who is now again a nurse, is leaving soon to work at the Johns Hopkins University Hospital in Maryland in the United States.

She is among the Filipino nurses who find their profession the sure ticket to a better-paying job abroad -and the shortest route to obtaining immigrant status elsewhere.

Government figures report that 2,908 Filipino nurses left for 21 countries in the first quarter of 2002. In the previous year, 13,536 nurses left for 31 countries.

The Philippine Overseas Employment Administration (POEA), which processes the departure of migrant workers, said only 304 nurses left for the United States in 2001. This figure, however, is said to be grossly underreported. The agency also does not handle nurses who leave on immigrant visas.

The Philippines is such a rich recruitment ground for nurses – and increasingly, caregivers too – that U.S.-based hospitals hold nursing job fairs in the country. The International Union of Nurses says close to 10,000 nurses were directly hired in this manner in 2001.

Tan says the annual outflow of Filipino nurses is now three times greater than the annual production of licensed nurses of 6,500 to 7,000 year.

Because of the demand created by the ageing of populations in the industrialised world in the next 10 to 15 years, Tan said: ”It will no longer be the roller coaster demand for foreign graduate nurses seen in the last 35 years. This time, it will be a persistent, chronic need."

The solution for these countries: hire foreign nurses to do the job. The United States has said it would need around 10,000 nurses a year, while Britain, Ireland, the Netherlands and other European countries would need another 10,000 nurses a year.

Austria and Norway have announced their need for foreign nurses this year and Japan, a new market, is expected to open its doors to foreign nurses this year.

Concern is also rising about a shortage of nurses in the Philippines. "In absolute terms, there is no shortage. There are enough warm bodies here, but there is a shortage in terms of quality,” said Dr Marilyn E. Lorenzo, director of the Institute of Health Policy and Development Studies and professor at the University of the Philippines College of Public Health.

The ones who have left are the skilled and experienced nurses. Most of those still here are relatively unskilled and inexperienced, and go overseas after a year or two of gaining experience. Tthis poses serious implications for the quality of health care that they provide.

The government is the single biggest employer of nurses and pays better than private hospitals, but it has not opened new positions and average nurse-to-patient ratios are from ideal – 1:30 to 1:60.

Maria Linda Buhat, president of the Association of Nursing Service Administrators of the Philippines, says nurses go overseas because of the low salary at home, lack of professional opportunities, adventure, family ties, citizenship and health reasons.

Overseas, the monthly pay ranges from 3,000 to 4,000 U.S. dollars a month, compared to the 169 dollar average pay in most cities. In rural areas, nurses receive from 75 to 95 dollars a month.

Lydia Vengzon, who worked as nursing director for years, recalls an exit interview with one of her nurses, who was leaving for Britain to take on a new job for 2,884 dollars a month. "In all my 31 years as nursing director, my salary didn’t even reach a third of that amount."

Virginia Alinsao, director of international nursing recruitment of the Johns Hopkins Health System, recalls how one young nurse applicant she interviewed in Manila in April said her mother had worked as a nursing assistant in Saudi Arabia since she was five years old. "The applicant said she wanted her mother to rest. Working as a nurse here won’t allow her to do that," related Alinsao.

Alinsao herself left the Philippines when she was 22 and has been in the United States for 30 years. From her class batch of 50, only five have worked as nurses in the Philippines. Most of them, like her, have since become U.S. citizens.

She notes with amazement how even Filipino doctors have been studying to become nurses, a reverse human resource development phenomenon that she thinks is found only in this country.

Specialist doctors have also been enrolling in nursing schools to take advantage of immigration visas offered to nurses who apply to work in the United States. Doctors in the Philippines earn an average income of 300 to 800 dollars a month, a pittance compared to the salary of a nurse in the United States or Europe.

Excerpt:

By IPS Correspondents
BEIJING, May 13 2003 (IPS)

China’s all-out war to contain the spread of SARS has spread to cyberspace, showcasing the influence of a young but thriving Internet society in the world’s most populous nation.

Authorities have detained 107 people for spreading rumours about the situation around the Severe Acute Respiratory Syndrome (SARS) over the Internet and through mobile text messaging – a sign that they are worried about social stability in a city that is fighting an uphill battle to contain the illness.

The arrests took place in 17 provinces and cities, including Beijing, Guangdong and Hebei provinces – all areas designated by the World Health Organisation (WHO) as SARS-affected.

Rumours on the SARS grapevine in Beijing in recent days have ranged from the declaration of martial law in the capital to authoritative “internal data” about the “real numbers” of SARS infections and descriptions of night raids by military planes spraying disinfectants over the city.

China’s Internet crackdown shows the government is serious in its threats against rumourmongers that are spreading SARS hoaxes among an increasingly volatile public in this country of 1.2 billion people.

SARS has killed 252 people in China and infected more than 5,000 as of May 12, accounting for some 65 percent of the world’s cases, according to the World Health Organisation. Worldwide, SARS has affected 7,447 people in some 33 countries, of whom 552 have died.

The number of new cases reported in China appeared to taper off in recent days, with the number falling to below 100 on Monday for the third straight say from up to 150 at one point. “It has been (consecutive) days that we have only a few deaths, but people worry whether the government is telling the truth,” says Dou Youmei, a salesclerk at Aijia furniture shop.

Beijing Health Bureau vice director Liang Wannian said SARS cases in the capital were showing signs of declining, but the World Health Organisation disputed the claim and remains cautious.

“It is too early to tell if (SARS) has peaked or not peaked,” incoming WHO director Yong-Wook Lee said. He added that Beijing still had 1,500 suspected cases, many of which are expected to become confirmed cases. In addition, 18,608 people remain under quarantine.

In Beijing where the authorities at first covered up the epidemic, Internet and mobile messaging had been the public’s secret weapons in getting to grips with what was going on. Rumours were quick to hit the streets about the mysterious virus weeks before the government came clean about the scope of the epidemic on Apr. 27.

Hundreds of folklore tips have been circulated. Word spread that while vinegar made the best disinfectant and that chewing, or wearing cloves of garlic, is the best prevention methods against SARS.

Eating barbecued spare ribs was recommended too, to keep the lungs working when infected with acute respiratory diseases. Drinking ‘Baijiu’ – the local grain spirit brew – and chain smoking were trumpeted as a sure enough way to keep the virus at bay.

”Health experts dismissed all these folk recipes but people were scared,” says Zhao Wei, a doctor of traditional Chinese medicine. “Many thought it was better drinking and smoking that being quarantined and dying.”

The amount of information on SARS exchanged electronically has risen by the day as city dwellers try to avoid face-to-face contacts and work from home. China had 59.1 million Internet users at the end of last year, according to the China Internet Network Information Centre, the world’s second largest Internet population after the United States.

“I got used looking at sina.com (one of China’s most popular Internet portals) three times a day,” says Wang Xuan, a media employee. “I wanted to know the death figures and what places in the cities I had to avoid because of the quarantine.”

In recent days however, a wave of sporadic protests over mushrooming SARS quarantine sites across the country have made the government tighten the flow of information on the subject of SARS . The country operates an extensive “Internet police” network in charge of enforcing a strict control of on-line content.

Some of the rumours asserted that SARS virus was a biological weapon released by the United States to intimidate China and hinder its emergence as a superpower. The reasons cited were that while the United States has detected a couple of scores of SARS cases, no one has died of SARS yet.

“My father is an old Communist Party member and he swears that the Americans have a secret drug to treat SARS,” says Xiong Jiayan, a former chef who operates a private bakery.

The four people detained in Beijing for spreading rumours were tracked down after the Internet rule enforcers intercepted their messages, Xinhua said.

“Using SARS as an excuse, they purposefully spread harmful rumours causing social panic, undermining the fight against the spread of the disease and destroying social order,” the report said. It did not provide details on what crime the detainees would be charged with.

Excerpt:

By IPS Correspondents
OTTAWA, May 13 2003 (IPS)

A new North American agency will provide shock troops for the fight against new viruses like SARS and West Nile, health officials say.

Paul Gully, head of the Canadian health department’s contagious disease department, says the Canada-U.S. agency will be uniquely able to provide "surge capacity" – a large pool of experts trained in handling epidemics who can be quickly mobilised when a crisis like SARS (severe acute respiratory syndrome) erupts.

"What we (want) is a (virus identification and treatment) capacity that we can immediately, easily divert," Gully says.

During April’s SARS outbreak in Toronto, Canadian health workers and epidemiologists found they could not keep up with the disease. One of the city’s top experts on viral infections caught SARS and was hospitalised for a month, and federal officials had to ask for help from the U.S. Centers for Disease Control (CDC).

At the same time, Canadian officials were outraged when the World Health Organization issued a travel advisory for the city. It was lifted five days later, but the tourism industry in the country’s largest city suffered a 40 percent loss and has shown few signs of rebounding prior to the usually peak summer season.

Health officials are discussing the idea of setting up an organisation similar to the Atlanta-based CDC, confirmed James Young, commissioner of public safety in Ontario province, which includes Toronto.

"I think you’ll see permanent changes as a result of SARS because we all realise this is not likely the last (epidemic) we face," he said. In fact, West Nile virus, a mosquito-borne disease that spread through Canada’s southern neighbour the United States in the 1990s, reached parts of this country last summer and is spread to most provinces this year.

The disease, with a five percent mortality rate, causes flu-like symptoms and, in some cases, encephalitis.

CDC Director Julie Gerberding said she has picked up valuable tips from Toronto’s SARS experience that could be used if the United States faces a similar outbreak. The best way to combat the disease is to continue international co-operation, Gerberding told a recent gathering of infectious disease experts in Toronto to discuss the SARS epidemic.

"Along the lines of integration, I’m very pleased to say we have looked at the concept of a strategic national plan for SARS put forward by the Canadian health officials and we think the concept is excellent,” Gerberding added.

"We’d very much like to join in and to share the development of a cohesive strategy for our countries since we have very important issues in common."

The decision on how Canada will work with other jurisdictions to fight new diseases will be made by a federal advisory panel of experts appointed by national health minister, Anne McLellan. Her department faced heavy criticism for being slow to help Toronto cope with the SARS outbreak.

Outbreaks like SARS offer the United States a chance to bolster its reputation and increase its security by strengthening public health in poor countries, said Barry Bloom, dean of the Harvard School of Public Health in Boston.

"With the same intensity we gave to Saddam Hussein, we could be waging war against global infectious disease by training experts in disease surveillance, strengthening laboratories around the world and linking them to the best labs in the United States, and by supporting the WHO (World Health Organization) which is an agency of the United Nations," Bloom wrote in a column in the New York newspaper ‘Newsday’.

Public health, an area long overlooked in North America and Europe, is almost non-existent in many impoverished parts of sub-Saharan Africa and other developing regions, Bloom believes.

Embracing the United Nations and its agencies could also help dispel global anti-Americanism, he added.

"And in a world distrustful of our values in the United States, investing in global health could help to change our image from one of self-interest to human interest," Bloom wrote.

Last week, the Conference Board of Canada, a national economic forecaster, estimated the outbreak of SARS will cost Toronto one billion dollars (720 million U.S. dollars).

More than one-half of the economic damage will hit travel and tourism, with the rest of the economic pain concentrated in the retail sector, according to the report.

It also projects a national economic loss of 1.5 billion dollars, 0.15 percent of Canada’s gross domestic product.

Excerpt:

By IPS Correspondents
BEIJING, May 11 2003 (IPS)

The latest casualties in the panic over SARS in China range from pampered pets that have been beaten to death or abandoned due to fear that they carry the virus, to animosity toward southern Chinese who feast on exotic animals.

People from the north, including from the capital Beijing, are becoming suspicious of people in the south, especially Guangdong where the origin of the virus is believed to have originated.

The World Health Organisation said the total number of Severe Acute Respiratory Syndrome infections in China rose to 4,884 over the weekend, and the death toll reached 235.

Aiming to spread hygiene awareness, China’s state press has been churning out many articles condemning “the taste for wild game”, typical of people in Guangdong where snakes, frogs and fowl are a much sought-after delicacy.

SARS has been described as zoonozis, or an animal disease that has spread to humans, although experts have left room for interpretations what kind of animals could breed the virus.

Still, the suspected involvement of animals in the life of the virus has spelt the end of affection of many Beijing people with their pets and have driven many others react hysterically at the mere sight of dogs walking on the streets.

“I told my employer I’m not going to walk her dog anymore,” declares Xiao Cui, a maid for a foreign family who lives in the Beijing suburbs. ” She might fire me but I’m terrified I can get the disease and be sent to the hospital.”

Xiao Cui is not the only one terrified. ‘Beijing Star Daily’, a popular tabloid, touched a raw nerve when it carried a story of a pet owner in Fengtai district who threw his dog out of a sixth-story window for fear it had caught SARS.

In another well-publicised case, a dog was beaten to death after it sneezed repeatedly while waiting for his owner at an open-air market.

Responding to public pressure, many residential compounds have banned pet owners from walking their dogs within public gardens. Pest extermination patrols are out in force and their work is being aided by informers among the residents who become upset even by the sight of dogs on the streets.

As news spread that the pets of SARS victims would be put down by the authorities in order to avoid spreading the virus, some owners have opted to abandon their dogs.

“We look down at Guangdong people for eating all kinds of flying and crawling creatures but what some Beijing people have done to dogs is worse than killing and eating them,” says Li Aimei, a real estate woman who was pressured by her family to give her pet into a shelter.

In the past, China has launched regular persecution campaigns against household pets, which are seen by communist ideologues as playthings for rich capitalists. Soon after taking control of the city in 1949, the authorities began rounding up and exterminating all dogs including household pets, declaring canines unproductive beasts that ate an undeserved share of the food grown by peasants.

Then in 1983, the anti-spiritual pollution campaign went hand in hand with a another brutal round of city-wide hunts for dogs – those those who refused to cooperate found that their pets mysteriously disappeared.

In the mid-1990s, the state issued fresh regulations authorising citizens to keep certain kinds of dogs provided they were not more than 35 centimetres high – namely the Pekingese, the Shi Tzu, Tibetan Terriers and West Highland White Terrier.

On the other hand, the “people’s war” against SARS is helping somewhat the cause of those campaigning to protect China’s endangered animals from being eaten in up market restaurants.

Some suspect the Cantonese passion for feasting on exotic animals – the rarer, the more valued – is somehow connected to the sudden emergence of this new virus, perhaps a mutation that sprang up when wild and domestic animals came into contact in the markets catering for southern epicures.

The state media is now loudly condemning the practice, which has become ever more popular as living standards rose over the years.

A recent survey by the State Forest Administration conducted in 21 Chinese cities, including Beijing and Shanghai, found out that 46 percent of the surveyed have tried wild game. Some 45 percent believed that eating wild animals could boost one’s energies and replenish the body’s deficiencies.

While Beijing has its own restaurants of exotic cuisine, the SARS epidemic has made people keep away from them and look with disdain at once well-respected Guangdong chefs.

Guangdong, where the SARS virus is believed to have originated in November, has largely succeeded in containing the epidemic reported just 17 new cases on Thursday. In Beijing by contrast, another 94 new cases were reported that day and two deaths.

China reported 85 new probable cases of SARS on Saturday, including 54 new cases in Beijing, and five new deaths.

Excerpt:

By IPS Correspondents
MEXICO CITY, May 8 2003 (IPS)

China’s aggressive presence in local markets has caused headaches for Mexican entrepreneurs, to the point that some say they are relieved by the temporary decline in the Chinese drive resulting from the spread of severe acute respiratory syndrome (SARS) in the Asian giant.

"You can say what you want, but I think SARS – with the deaths and the fear it has generated in China – has brought relief to many Mexican manufacturers and exporters," an entrepreneur in the shoe business, who requested anonymity, told IPS.

SARS was first identified in the southern Chinese province of Guandong in November. And China remains at the centre of the outbreak, with the contagious disease taking its toll on the regional Asian economy and putting the breaks on some Chinese exports.

Of the 7,053 SARS cases and 506 deaths resulting from the disease that were reported by the World Health Organisation (WHO) as of May 8, China had 4,698 people confirmed infected with the virus and 224 fatalities.

The impact of SARS on the Chinese economy could be worse than that of the 1997 Asian financial crisis, says Zhang Zhongliang, head of the Chinese government’s economic monitoring centre.

The World Bank estimates that economic losses related to the SARS epidemic could reach 15 billion dollars in Asia this year.

To date, there have been no SARS cases reported in Mexico, and the country should take advantage of the opportunity to recover clients in the United States and within its own domestic market that were lost to Chinese competitors, says business leader Julio Millán.

There are Chinese companies that can no longer export and others whose workers are under quarantine as a result of the disease, he noted.

Sources from Mexico’s footwear, clothing and glass industries say they are alarmed by the expansion of Chinese imports. Locally- made products have a hard time competing when the prices on the Asian-made goods are as much as 60 percent lower.

The value of Chinese exports to Mexico rose steadily over the past decade from 195 million dollars in 1989 to more than four billion dollars in 2002.

More than two billion dollars should be added to least year’s total to take into account the volume of merchandise reaching Mexican territory as contraband, without customs controls or taxes, according to the calculations of the Mexican Chambers of Industry Confederation.

"SARS today is a blessing for many of us, because we can’t compete with the dumping (disloyal competition) that lies behind low wages, subsidies and widespread pirating," said the shoe manufacturer interviewed by IPS, in reference to products arriving in Mexico from China.

A report by the non-governmental Centre for Private Sector Economic Studies states that the average hourly wage in Mexico’s manufacturing sector is 2.30 dollars, while in China the average is 0.28 dollars.

Luis de la Calle, former deputy secretary of trade negotiations, says Mexico will soon relinquish to China its second- place ranking as supplier of products to the United States. Canada holds the number-one spot.

The U.S. market takes in 90 percent of Mexico’s exports, for an annual total of 160 billion dollars.

China, in contrast, sends just 22 percent of its annual 325.6 billion dollars in exports to the United States.

Mexico strongly opposed China’s admission to the World Trade Organisation (WTO), which was finalised in late 2001 after a long period of negotiations. But the Latin American country ultimately accepted it, due to the vast majority of nations in favour, and to the fact that Beijing promised not to engage in dumping practices.

But China has been a persistent headache for the Mexican business community and for the government of Vicente Fox.

In the 2000-2002 period, Chinese exports rose 14.3 percent, while Mexico’s fell 1.7 percent, a stark contrast to the relative parity of the previous eight years, when Mexico’s sales to other countries grew 17.4 percent, while China’s had risen 14.4 percent.

In the past three years, faced with the advance of Chinese products, Mexico saw its share of the U.S. market decline in furniture, clothing and telecommunications and recording equipment, reported investment bank Merrill Lynch in December.

China is one of Mexico’s leading rivals for U.S. markets in a dozen industries due to the Asian giant’s low wages and its policies for industrial and trade incentives, according to Merrill Lynch.

While Mexico has the advantage of geographic proximity to the United States, it needs to improve and diversify its production, says the investment bank’s report.

Chinese competition has generated so much concern in Mexico that Trade Secretary Fernando Canales launched some choice words against Beijing last month as he listed what he considers Mexico’s trade advantages.

"Mexico is a democratic country where there is respect for human rights, freedom of the press, alternating powers in government, long-term policies and an efficient banking system," Canales said.

China, however, "is not a democratic country, does not respect human rights and does not have solid financial institutions," he added.

His statements, which subsequently required an apology from the Mexican Foreign Secretariat to Beijing, "demonstrate how far desperation has spread as a result of the trade threat posed by China," said Enrique Quintana, columnist for ‘Reforma’ newspaper.

The headache has been intense for domestic commerce as well. In the past two years, clothing imports from China have carved out a 58-percent share of the Mexican market, says Salomón Presburger, president of the Chamber of Clothing Industries.

Many Mexican shoe manufacturers have either closed up shop or reduced production because the shoes coming from China cost up to 60 percent less than those produced here.

A Mexican-made broom, for example, sells for around five dollars, but brooms imported from China go for 2.5 dollars. Similar price disparities are found in ceramic and glass products and toys, among others.

"It is difficult to confront the competition from China," said the shoe manufacturer, adding, "The government should reinforce border controls and file complaints at the WTO against China for its dumping practices."

According to the WTO, the country with most dumping complaints filed against it in the international organisation’s dispute settlement system is China.

Excerpt:

By Cam McGrath
CAIRO, May 7 2003 (IPS)

Egypt is officially SARS-free, and the government is taking elaborate measures to keep it that way.

SARS (Severe Acute Respiratory Syndrome), which has killed about 460 people and infected 6,600 worldwide, is a new virus that causes flu-like symptoms and severe respiratory problems. There is no known cure for the contagious disease, which has led to death in six per cent of cases.

Egypt, the Arab world’s most populous country, has launched a three-pronged programme to keep the deadly disease out, and to prevent it spreading if it manages to slip through, under-secretary for preventative diseases Dr. El- Sayed Ali Ohn told IPS. The programme includes control measures at ports of entry, enhanced surveillance in hospitals and a public awareness campaign.

Travellers arriving at Egypt’s 31 ports of entry are subject to mandatory medical checks. Quarantine areas have been allocated for passengers who display SARS symptoms such as dizziness, coughing or fever.

Doctors wearing protective masks and latex gloves selectively screen arriving passengers using electronic thermometers and a judicious assessment of information from passengers and crew.

At Cairo International Airport, which handles 60 per cent of air traffic, arriving passengers must clear a medical stand before reaching the immigration hall.

"We have been provided the latest equipment to detect carriers of the disease and it does not carry the infection from one passenger to another," state-owned newspaper Al-Akhbar quoted Dr. Hassan Shaaban, quarantine manager at Cairo airport as saying.

Passengers have been cooperating with airport officials, with some rare exceptions. An Egyptian woman returning from Beirut who refused to let doctors screen her was detained until she complied with procedures.

In another case, two passengers arriving from Tokyo en route to Ghana showed signs of fever. Medical officers quarantined them at the airport until it was established that they were not SARS carriers.

Egyptian authorities are also strengthening surveillance at hospitals to identify SARS patients, says Ohn. Isolation units with hundreds of beds are ready in 110 hospitals. The facilities can be increased.

"We have about 500 mechanical respirators at government hospitals, and there are more at private hospitals," Ohn says, adding that large amounts of the medicines commonly used to treat SARS are in stock.

The health ministry launched an ad campaign last month to explain the dangers of SARS. The ads list symptoms and ask people to report suspected cases to health officials.

More importantly, says Ohn, they urge people to alter social habits and take more care of personal hygiene to prevent any spread of the disease.

Convincing Egyptians to give up deep-rooted social customs may be the biggest challenge to the campaign. Carpenter Hani Youssef says that despite the dangers of transmission of the disease it would be impossible for him forgo the Egyptian tradition of shaking hands with everyone in the room and kissing his male friends on each cheek when greeting them.

"It would offend them if I didn’t do it," he says. "Egyptians would rather put their faith in God than risk offending a friend or relative."

Despite the media campaign, many Egyptians are unaware of the dangers from SARS. Some believe it is spread only through contact with Chinese people, others claim it is a U.S.-manufactured biological weapon.

"The U.S. unleashed it on China to destroy its economy and on Canada because it refused to back Bush in Iraq," says shop clerk Ahmed El-Sayed. No deaths have been reported in the U.S., he said.

Independent observers at the World Health Organisation (WHO) say they are satisfied with the measures Egypt is taking and see no indication of any cover up.

"Egypt is taking this very seriously and is doing even more than WHO guidelines require," says Dr. Nadia Taleb of the WHO’s Department of Communicable Diseases and Epidemics. "Health officials are being very honest. We have our own intelligence network to verify rumours and follow up on any suspected cases."

Excerpt:

By IPS Correspondents
MEXICO CITY, May 6 2003 (IPS)

The presence of people wearing white laboratory coats in Latin American and Caribbean airports is growing as efforts multiply to monitor passengers in order to prevent the entry if severe acute respiratory syndrome (SARS). But the impacts of the disease have already reached the region – and apparently are here to stay.

Experts say it is crucial that control systems function effectively and limit the spread of the virus that produces the disease, also known as atypical pneumonia. But those attempts run into the obstacle of widespread ignorance about SARS.

To date, no Latin American government has launched an intensive information campaign about the virus or how it is spread, report Tierramérica’s correspondents in the region.

And no medication exists yet to treat this infectious disease, which has infected more than 6,700 people in 30 countries, including two in Brazil, the only Latin American country to report cases of SARS, according to the World Health Organisation (WHO) May 6 update.

In Cuba, Guatemala, Peru, Mexico and Venezuela, there were more than 20 suspected cases of SARS by the end of last month, but none proved to be this much-feared disease.

Canada is the only country in the Americas where people have died from SARS: 22 people out of the 148 recorded cases have fallen victim to the disease since the first case was reported in the southern Chinese province of Guandong.

In general, Latin America and the Caribbean are taking appropriate steps to confront SARS, but it can be assured that the disease will crop up in several of the countries in the region, Joaquín Molina, representative in Mexico of the Pan-American Health Organisation (PAHO), said in comments to Tierramérica.

And then SARS will likely remain in the region for a long time, he added.

The illness is caused by a type of coronavirus, related to viruses that cause the common cold and certain gastrointestinal and respiratory diseases in animals, including livestock. It could be three years before a vaccine can be produced, according to scientists.

Pablo Kuri, epidemiology director at Mexico’s Health Secretariat, acknowledged the inevitability that the virus would ultimately reach his country. The challenge will be to isolate it and prevent it from spreading, just as has been done in some European countries, he said.

Most of the measures taken to prevent SARS from entering Latin American and the Caribbean, whose neighbours to the north – Canada and the United States – together report 203 cases, are focused on the airports, though they are limited.

Governments are urging their populations not to travel to areas where there is a high incidence of SARS, particularly China, where there have been 4,409 cases reported and more than 200 deaths as of the WHO’s May 6 update.

Several Latin American countries have set up special rooms in hospitals to quarantine persons infected with SARS, while health authorities are disseminating information among medical workers about the disease, which is easily transmitted through personal interaction with a carrier of the virus.

In Peru, there is a sterile ward with 20 beds at the Daniel Carrión Hospital, the closest to Lima’s international airport.

The government says it has ”a Peruvian model” for preventing SARS from entering the country, but doctors at the Health Ministry and the airport health team said they knew nothing about such a plan.

”There is only minimal awareness” in Peru about the disease, physician Lucrecia Magallanes told Tierramérica.

Guatemala is one of the few countries in Latin America that has implemented strict controls at airports. And travellers are complaining about the questioning and screening procedures.

In comments to Tierramérica, Francisco Ardón, chief of epidemiology at Guatemala’s Health Ministry, played down the complaints and assured that the security and health personnel ”do not do anything that could be construed as harassment.”

But along the Guatemala-Mexico border the flow of people in and out of the country is barely regulated, and there are many undocumented Asians among those who are headed to the United States.

In a world with so great movement of persons it is very difficult to prevent entry of any disease, noted PAHO official Molina.

SARS symptoms include high fever, cough and difficulty in breathing. The main prevention measures include avoiding contact with persons known to be infected, frequent hand washing and using a facemask.

In Brazil, despite its two confirmed cases, the situation is not much different from that of the rest of the region.

Although the government announced measures like distributing questionnaires among airline passengers – to collect data like names, point of origin, flight numbers and address in Brazil – few travellers are handing in the forms.

And even though the WHO reports that two SARS cases were confirmed in Brazil, local doctors maintain that they were probable cases, but not verified.

In Mexico, for the past several weeks there was only one doctor entrusted with distributing pamphlets with SARS information at the Mexico City airport. The authorities recently decided to assign 20 doctors to the task.

At the airport’s customs area, immigration staff have been asked to keep an eye out for arriving passengers who show any indication of respiratory illness.

The Mexican airport has also begun temporary isolation of travellers arriving from Asia, as occurred with a group of sports trainers from China.

Some hotel managers in the capital have refused to provide accommodations to tourists or business travellers coming from Asian countries.

The Mexican government says it has imposed special controls along the borders and at ports, but the medical personnel assigned to those locations, such as along the Guatemalan border, report that the measures are not being fully implemented and complain of lack of state support.

The Venezuelan government has ordered airlines to sanitise all aircraft, and in Cuba the always-strict customs and sanitary controls have been reinforced.

But none of the countries in Latin America or the Caribbean have equipment to detect the illness. As such, several governments from the region have set up agreements with U.S. scientific centres to send blood and urine samples of people suspected to have SARS.

All of these measures are minimal compared to those implemented in Asian and European countries, where some airports have equipment set up to take the passengers’ temperatures.

The World Bank estimates that SARS will cost Asia 15 billion dollars just this year, while OPEC (Organisation of Petroleum Exporting Countries) reports that the Asian region’s demand for crude has already dropped 300,000 barrels a day due to the sharp decline in air travel.

Even though Latin America is far from the epicentre of the disease, the economic effects are beginning to be felt.

Mexico’s business dealings with Asian countries have been disrupted to the point that executives have suspended direct contact with their counterparts and cancelled trips to trade shows.

Furthermore, Mexican officials have decided that negotiations for a free trade accord with Japan will continue in the coming months, but not in person. Talks will take place via electronic communications, such as Internet conferences.

Brazil, too, has postponed official travel to Asia for trade or economic negotiations, and the country’s chicken exports have been hit as its sales to Asia have dropped off markedly.

Chile is suffering the indirect effects of SARS as the price of copper, which it exports to Asia, has fallen.

”SARS will be with us for a long time,” and there is much left to be done to eradicate it, says Henk Bekedam, WHO representative in China.

The Latin American and Caribbean region, although with precautions only partially implemented, is already on the frontline in combating the disease.

(Diego Cevallos is an IPS correspondent. Mario Osava/Brazil, Humberto Márquez/ Venezuela, Dalia Acosta/Cuba, Abraham Lama/Peru and Jorge Alberto Grochembake/Guatemala contributed to this report.)

* The original version of this article was published May 3 in Spanish by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme and the United Nations Environment Programme: www.tierramerica.net

Excerpt:

By IPS Correspondents
BEIJING, May 2 2003 (IPS)

In a throwback to its patriotic sanitation campaigns of the 1950s, China’s Communist Party is now waging a ”People’s War” on curbing the spread of deadly Severe Acute Respiratory Syndrome (SARS) here in the capital and the rest of the country.

Chinese leaders have deployed 1,200 military medical staff to help Beijing authorities fight the escalating outbreak of the virus, which is believed to have originated from China and has now sickened more than 3,500 people in some 30 countries.

Beijing’s neighbourhood committees, which are Communist Party-run groups, and the police have been enlisted to keep watch over some 12,000 people being held under quarantine.

The state-run media is in full gear, recycling stock propaganda phrases that hail the heroism of the top leadership, the selfless devotion of the ”warriors in white coats” and the decisive contribution of the People ‘s Liberation Army, especially its research laboratories.

The epidemic has now spread to 26 of China’s 31 provinces and autonomous regions, prompting the government to launch a mass mobilisation campaign calling on everyone in this country of 1.2 billion people to take part in the ”SARS battle”.

The Communist Party was undoubtedly successful at 1950s sanitation campaigns that almost wiped out syphilis and leprosy and inoculation drives against smallpox, typhoid, diphtheria, infantile paralysis, whooping cough and measles.

But with strict quarantine measures in place, stock trading suspended and entertainment and recreation curtailed, the Chinese capital is beginning to count not just the economic fallout but also the emotional cost of its draconian measures to curb the SARS outbreak.

Economic pundits have been busy revising their growth forecasts for China’s miracle economy, which posted a Gross Domestic Product growth of 8 percent last year. China closed its two stock exchanges in Shanghai and Shenzhen from May 1 to May 9 as the government tries to keep SARS out of crowded dealing rooms.

The Guangdong Fair, China’s biggest, ended a day ahead of schedule, with orders worth only 4.42 billion U.S. dollars, just a quarter of the 16.8 billion dollars booked last year.

A group of academics at Beijing University now predicts that SARS will cut between one and two percentage points from China’s economic growth in 2003.

Beijing University’s China Centre for Economic Research also estimates that the country’s tourism – both domestic and foreign – will lose about 140 billion yuan (16.8 billion dollars).

With the spread of SARS threatening to spin out of control, the government earlier shortened the seven-day-long May Day holiday to five days and advised people against travelling. Last year, 87 million Chinese spent 33 billion yuan (3.9 billion dollars) shopping and touring during the traditional May Day Golden Week.

By contrast, May Day this year is a holiday spent at home. Shopping centres in Beijing are forbidden from holding sales promotions. Public gatherings are discouraged and some health experts have advised newlywed couples to postpone having babies.

Outings in the surrounding countryside of Beijing have also been banned for fear that visitors from the capital might spread the disease in the impoverished rural parts of the country. ”Even swimming pools have been closed,” fumed Zhang Shengyun, a businessman who wondered how to kill the holiday time.

At least three psychological counselling hotlines have been set up to help nervous Beijing residents deal with what specialists term the ”SARS – fear” syndrome.

”I received twenty phone calls in the last hour,” said a staffer for the hotline set up by the Psychological Health Institute who gave her name as Liu. ”To quarantined people who call, I tried to explain that isolation was not something aimed at them personally but a measure taken against the spread of the disease.”

More than 42 percent of capital residents feel increasingly terrified by the unabated spread of the disease, according to an official survey conducted by the Chinese Socio-economic Survey and Information Research Institute.

One of Beijing’s biggest problems is that public confidence in the health system has sunk to the lowest point. Many residents avoid going to hospitals, fearing that being held in quarantine with other suspected cases runs a greater risk of getting infected.

More than 100 SARS-treatment medical institutions have been cordoned off in Beijing as acting mayor Wang Qishan admitted that they were epicentres of epidemic.

Another 13.4 percent of people surveyed by the government think tank said they were unsure whether they approved of the strict authoritarian measures deployed to control the epidemic.

On Thursday, the Geneva-based World Health Organisation (WHO) said China might need extra help for hospitals in the country’s poorer western and northern provinces, including facilities to isolate and treat SARS patients.

Beyond ensuring social stability in a disease-stricken capital, Beijing leaders might also have reasons to worry for their own health. A front-page article in Friday’s Guangzhou-based ‘Southern Weekend’ newspaper revealed that SARS had infiltrated the Central Party School, where 1,600 party officials are trained for top positions inside the government and the Communist Party.

Quoting an unidentified professor at the school, the paper said a librarian had been confirmed as SARS-infected and areas and people inside the school have been placed under quarantine.

China reported 11 new SARS deaths and 187 new cases by Thursday morning, the Health Ministry said. Seven of the new deaths were in Beijing. The capital also accounted for 122 of the new cases.

”The next few months will prove crucial in the attempt to contain SARS worldwide, which now greatly depends on whether the disease can be controlled in China,” a WHO update said on Thursday.

Excerpt:

By Jim Lobe
WASHINGTON, May 2 2003 (IPS)

The U.S. House of Representatives’ approval Thursday of a five-year, 15 billion dollar package to fight HIV/AIDS in 14 African and Caribbean nations is a key victory for President George W Bush and anti-AIDS activists, but the concrete test of this commitment lies ahead.

The bill, which would provide three billion dollars each year beginning in 2004 to some of the world’s worst-affected countries, provides that up to one billion dollars in each annual installment should go the cash-strapped Global Fund to Fight AIDS, TB, and Malaria.

That was five times the amount that Bush originally proposed for the Global Fund when he first requested the 15 billion dollar package in his State of the Union address late January.

Bush, however, went along with the higher amount for the Fund, which is chaired by his Health and Human Services Secretary, Tommy Thompson, after lobbying by the right-wing chairman of the House International Relations Committee, Henry Hyde, who crafted the final version of the bill.

While claiming a significant victory in Thursday’s vote, activists cautioned against early celebration, stressing that the money contained in the bill still faces a number of obstacles before it can actually be disbursed, even if, as expected, the Senate passes the same or a similar version as early as next week.

That is because the bill passed Thursday merely ”authorises” the money. For the funds actually to be spent, they must be included in a separate appropriations bill likely to be taken up later this year.

”Similar (authorisation) bills have been ignored in the past, even when approved by the full House”, said Paul Zeitz, director of the Global AIDS Alliance. ”We call on the president and House leadership to make sure this bill is not yet another empty promise”.

”The real test of the president’s commitment will be whether he works hard to persuade members of the Appropriations Committees to turn these funding levels into a reality,” Zeitz added.

The point was echoed by Salih Booker, director of Africa Action, a grassroots group that has lobbied for Washington to provide as much as 3.5 billion dollars a year to the Global Fund, a multilateral agency that coordinates funding for anti-AIDS projects around the world.

”This is just the authorisation”, he said, ”so it’s an easy vote. The question is whether Congress is prepared to break the budget limits and really appropriate the money”.

Still, activists, including Booker, conceded that the House bill is a far better product than what Bush had originally proposed in January.

In addition to providing only 200 million dollars a year to the Global Fund, Bush’s original proposal also called for starting disbursements much more slowly over the five-year period, with only 1.6 billion dollars to be spent in fiscal 2004, which begins Oct. 1.

The administration also considered placing anti-abortion-related conditions on the money that would have made it far more difficult for grassroots groups to become a recipient.

But Hyde, a long-time anti-abortion leader himself, helped persuade Bush and a number of right-wing Republicans that tough curbs on spending the money would alienate Democrats, and that, to ensure strong bipartisan support, both sides would have to compromise on the final bill.

Bush, who intends to travel to Africa later this year, went along in spite of opposition from some Christian Right leaders who objected to providing money for encouraging the use of condoms to prevent transmission of HIV and to the lack of U.S. control over the Global Fund’s funding policies.

”The bill, in its present form, would throw taxpayer money at condom handout schemes in Africa,” said Ken Conner, director of the right-wing Family Research Council (FRC) earlier this week. ”By signaling that President Bush will sign the bill ‘as is,’ the White House probably has made it much more difficult to pass amendments which would focus U.S. efforts on abstinence and monogamy, or which would limit funding to the U.N.’s disastrous Global AIDS Fund and other anti-family organisations.”

But Bush, while indicating sympathy with concerns like Conner’s, bowed to Hyde. ”Time is not on our side,” he declared Tuesday at a White House ceremony that included 13 ambassadors from sub-Saharan Africa where AIDS has hit hardest, claiming more than 5,000 lives in the region each day. ”So I ask Congress to move forward with the speed this crisis requires.”

In the end, Hyde himself went along with two right-wing amendments to the package regarding the bill’s endorsement of the so-called ”ABC” strategy (abstinence, being faithful, and condoms) prevention strategy.

One permits funding to go to religious groups that do not provide information about condoms out of ”moral or religious objection”. The other requires that one third of all the money in the bill targeted at prevention be used to encourage sexual abstinence.

Some groups strongly objected to these amendments, suggesting that they would discourage the use of condoms. ”A lopsided emphasis on abstinence is irresponsible”, said Sally Ethelston of Population Action International. ”Efforts to prioritise the ‘A’ or ‘B’ to the exclusion of the ‘C’ will only make condoms less accessible to those who need them most’.

Overall, however, anti-AIDS groups said they were pleased about the House’s strong approval of the bill. ”This is a remarkable and historic day in the fight against AIDS”, said Nils Daulaire, president of the Global Health Council (GHC). ”The United States is now showing its global leadership on this issue”.

Activists are hoping that, if the money is actually appropriated, it will significantly boost the Global Fund, designed act swiftly on funding proposals and reduce the administrative burden on recipients caused by the reporting requirement of multiple donors.

The Fund’s management has estimated that it will need at least 7 billion dollars over the next two years just to keep pace with demand.

Booker said after the vote that his group and others will still push for more U.S. contributions to the Fund, as well as other measures that would strengthen the ability of African governments to contain the disease.

”Africa’s illegitimate debts should be cancelled, enabling governments to spend money on health care instead of debt repayments,” he said. ”And the White House must break with the pharmaceutical industry and support African countries’ access to cheaper, generic anti-retroviral drugs.”

In addition, he said, Bush’s own remarks about the urgent nature of the disease should justify providing more money already in this fiscal year to the Global Fund and the anti-AIDS fight. ”After all, the Bush administration secured 79 billion dollars in a supplemental (appropriation) for war in Iraq.”

He cited Powell’s interview in this week’s edition of ‘U.S. News and World Report’ magazine in which he said, ”The greatest weapon of mass destruction today on the face of the Earth is HIV, and it is a destroyer of people, families, nations, societies, and hopes in the poorest parts of the world, and it is spreading.”

”The White House is still failing to match rhetoric with resources,” Booker said.

Excerpt:

By A. D. McKenzie
SINGAPORE, Apr 29 2003 (IPS)

The Severe Acute Respiratory Syndrome (SARS)-linked closure of the largest wholesale vegetable market in Singapore has cast the spotlight on a little known industry in this modern island state: farming.

When the Pasir Panjang Wholesale Centre, which deals with 70 percent of Singapore’s fresh-produce sales, was closed on Apr. 20 because three workers there had come into contact with the potentially deadly disease, retailers experienced a shortage in vegetables -and many of them suddenly descended on the nation’s 55 farms.

These farms, located in a secluded corner of the city state, far away from the shiny malls and office buildings for which Singapore is famous, normally provide only 5 percent of the country’s daily requirement of 1,000 tonnes of vegetables.

But the shutdown of the wholesale centre resulted in an instant surge in demand, causing farmers to work overtime. The crisis also made residents aware of this low-key industry, as SARS has prompted many to turn to healthier food.

"I didn’t even know Singapore had farms," said Dori Boyce, a U.S. national who has been living here for three years. "When you go into the supermarkets, all you notice is produce from elsewhere."

Singapore, a country of 4 million people, imports most of its fruits and vegetables from Malaysia, Australia, Thailand and the United States, with European countries also providing many items.

But the government, which leases land to farmers, would like to see local enterprises meeting 20 percent of the demand in five years. SARS, and the panic buying of produce over the past week, has given a new impetus to that goal.

The Pasir Panjang Wholesale Centre was due to reopen Wednesday, but the Ministry of Health has extended the closure for five more days, to ensure that none of the wholesalers and workers returns to work with SARS.

Health authorities have identified 10 SARS cases linked to the centre. Meanwhile, more than 1,900 people who frequented the market and may have come into contact with the virus are under home quarantine, according to a Ministry of Health statement.

The extension means that local farms will continue to see consumers at their gates, although other wholesale facilities have taken over some of the closed centre’s operations, and additional produce is being brought in from Malaysia.

”We’ve definitely had more walk-in visitors since the crisis started," said Jerry Sim, the marketing manager of Aero-Green Technology. "They come because they know it’s another avenue for them to buy fresh greens. But of course we have to take our own protection measures, and the staff is told to look out for people who seem unwell."

Aero-Green Technology is Singapore’s most high-tech farm, using a method known as aeroponics, in which vegetables are grown without soil. The technology could represent the future of the farming industry, not only in Singapore but in other countries with a shortage of arable land.

Visitors to Aero-Green are treated to the rare sight of vegetables growing suspended in air, under the cover of greenhouses. The roots, meanwhile, are placed in soil-free troughs and sprayed with a mist containing essential nutrients. The technology allows temperate produce such as romaine lettuce to be grown year-round in equatorial Singapore.

Developed by Lee Sing Kong, a professor at the National Institute of Education, this high-technology method has earned Aero-Green several awards, including the U.N. Urban Agriculture Award in 2000, and the Asian Innovation Award in 1998 given by the ‘Far Eastern Economic Review’ magazine. Aero-Green is owned by an international group based in Malaysia.

At least two other farms here are considered high-technology as well, using a method known as hydroponics in which plants are also grown without soil, their roots in a nutrient-rich solution. These farms, too, have been experiencing increased demand for their products.

Nanda Kumar, a farmer at Agrotech Hydroponics Farm Centre, said, "My volume has increased a lot, especially with orders coming via the Internet." He said consumers have been surfing the web to find alternative sources of vegetables – and as a result, he is now constantly busy making deliveries.

Perhaps the sector of the farming industry that will feel the greatest impact, however, is organic farming.

In the past two years, more consumers have been turning to organic produce here, and the SARS epidemic is boosting this trend as people try to strengthen their immune systems by eating healthier food.

Lim Tian Soo, a former financial consultant who left his job to start an organic farm with his wife, said the SARS crisis has made Singaporeans increasingly aware of biological produce – grown without pesticides or artificial fertilisers.

Lim’s farm, Green Circle, supplies vegetables to one of Singapore’s most "chic" organic stores, SuperNature, which normally has organic produce flown in just once a week from Australia as well.

But last week, after the closure of the Pasir Panjang Wholesale Centre, all the store’s fruits and vegetables were sold out in a day. This week, SuperNature is having organic produce flown in twice to meet increased demand.

"There has definitely been an increase in people coming to the shop," a spokeswoman said. "SARS has made more people willing to spend money for organic food because they realise the importance of staying healthy."

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Apr 29 2003 (IPS)

In a sign of regional solidarity, leaders of South-east Asian nations and China pledged at special summit here Tuesday to use unity, shared resources and openness to combat the Severe Acute Respiratory Syndrome (SARS).

For one, the leaders agreed that their countries would stop people suspected to have SARS from travelling abroad – going further than the initial measures limited to preventing those suspected to have the virus from coming into a country.

At the same time, the leaders of China and the 10-member Association of South-east Asian Nations (ASEAN) agreed to keep the borders they share open, rather than face further economic consequences from closing borders as a protective measure.

”ASEAN will be taking coordinated efforts to control SARS, including screening all those going on international travel,” Thai Prime Minister Thaksin Shinawatra said at a press conference Tuesday evening at the end of the special summit on SARS.

A call by Chinese Prime Minister Wen Jiabao to set up a special fund to pursue research on SARS in the region was also endorsed by the leaders of ASEAN.

Together, China and ASEAN have been the hardest hit by the spread of SARS, whether it is because of the physical toll of the illness or its economic effects. Apart from China and its Hong Kong Special Administrative Region, ASEAN members Singapore and Vietnam have been the worst hit by SARS. Others, from Thailand and across East Asia, have been hurt by major drops in tourism.

China’s Wen offered 10 million yuan (1.2 million U.S. dollars) as an initial contribution toward the China-ASEAN Special Fund. Thaksin offered 250,000 U.S. dollars from the Thai government and Cambodian Prime Minister Hun Sen, 100,000 dollars.

China’s presence at the meeting demonstrates further that it is ”committed to the ASEAN region,” added Thaksin. ”We welcome the Chinese proposal to set up the special fund.”

”We briefed the governments on the measures China has taken to combat SARS,” said Wen, whose government came into office a month ago and just this month stepped in to stop the hiding of the extent of the SARS problem there. ”China is in a time of difficulty, but the measure taken by China are there for everyone to see.”

Wen also said the World Health Organisation (WHO) could ”visit any area they want and inspect any hospital of their choice” in China.

In the meeting with ASEAN leaders, he made a case for more information sharing on SARS – and the special fund that was proposed arose from these discussions.

In their joint declaration, the East Asian leaders said their countries would cooperate in research and training efforts on SARS and throw their weight behind an international seminar on control and treatment of the disease to be held in China.

In addition, a joint statement by the leaders of ASEAN identified over 10 measures the countries will pursue to stall the spread of SARS, including the creation of a regional SARS information network.

The 10 members of ASEAN, South-east Asia’s main regional grouping, are Brunei, Burma, Cambodia, Indonesia, Laos, Malaysia, Singapore, Thailand, the Philippines and Vietnam.

Besides China and Hong Kong, the other ASEAN countries with high SARS cases are Singapore and Vietnam. On Monday, the WHO removed Vietnam from the list of countries where SARS is transmitted locally.

It also said SARS appears to have peaked in the countries worst hit by the disease, such as Singapore and Hong Kong, and is stabilising there.

However, this has yet to happen in China. Currently, China has over 2,900 cases of which 131 people have died, while Hong Kong has 1,543 cases of which 133 people have died. Singapore has 189 cases, of which 21 people have died and Vietnam has had 63 cases, with five deaths.

The other ASEAN countries, according to the WHO, have had markedly low incidents of the atypical pneumonia. Indonesia, for instance, has two cases in a country of 220 million people. Malaysia has nine cases, the Philippines four, and Thailand, nine.

If Vietnam can stop local transmission of SARS, so can Singapore, Hong Kong and China with ”will, resources and organisation”, Singapore Prime Minister Goh Chok Tong said Tuesday. ”We achieved our first objective (at this summit), learning from each other.”

Wen said that this exchange of information did not result in any criticism toward China, given that the SARS virus is said to have originated in a southern province of the country in November last year and Beijing had not been forthcoming with information until very recently.

”No one is pointing an accusing finger at anyone,” said Wen, adding that Beijing has called for ”truthful reporting” of SARS incidents from all local authorities across the country.

On Monday, a WHO expert identified China as the key element that will determine victory or failure over SARS. ”China will make or break this disease,” David Heymann, executive director at the U.N. health agency’s communicable diseases cluster, told the media.

The WHO expert also told ASEAN leaders that there is a wide gap between the public perception of the disease and its actual impact – an issue that governments need to address. ”The public perceives the risk to be far greater than the risk actually is,” he added.

At the same time, the WHO welcomed a decision by the health ministers of ASEAN countries, who met ahead in Malaysia over the weekend, to support the poorer countries in the region in establishing public health surveillance systems.

Countries that are already short of doctors and nursing staff will be faced with added burdens if they have find staff to monitor diseases like SARS, says Raj Kumar, head of the research division at the Bangkok-based U.N. Economic and Social Commission for Asia and the Pacific (ESCAP).

”There is a need for more aid for these countries,” he adds. ”It should be seen as an international public good, strengthening public health surveillance.”

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Apr 29 2003 (IPS)

Vietnam’s success at curbing the spread of the deadly Severe Acute Respiratory Syndrome (SARS) is fuelling optimism among international health experts that the latest killer disease can be put under control.

Vietnam has shown that the SARS outbreak can be contained by ”detection and protection,” David Heymann, an expert on communicable diseases at the Geneva-World Health Organisation (WHO) said here.

”We believe that SARS has stopped spreading in Vietnam,” he told media. ”And it has the capacity to detect if SARS occurs again and to stop it from spreading.”

Heymann’s comments came in the wake of the WHO’s removal of Vietnam Monday from the list of countries with local transmission of the atypical pneumonia, which has killed 318 people from 26 countries and infected over 5,000 people across the world.

The U.N. health agency declared that Vietnam is the first country to stall the local transmission of SARS, which is said to have surfaced in November in China’s southern province of Guangdong.

According to the WHO, Vietnam’s new classification is ”significant,” given that it was one of the four countries initially identified on Mar. 15 as having local transmission of the deadly virus. The other places in the region named at the time were Singapore, China and Hong Kong.

As of Apr. 8, Vietnam had reported a total of 63 cases and five deaths, according to a WHO statement. But since then ”there have been no new cases” or ”no cases of spread to other countries”.

The 20-day period of no reported cases of new SARS infections is ”twice the maximum incubation period for this disease,” said Heymann, the executive director at the WHO’s Communicable Diseases Cluster.

This South-east Asian country’s success has been attributed to a series of measures that health officials and workers pursued no sooner than when the alarm bells went off about the emergence of the atypical pneumonia.

These measures included the immediate identification of infected people, including who they had met and where they had moved, isolating SARS patients in hospitals and those believed to have SARS, and providing protective gear to health workers treating the patients, states the WHO.

In addition, the Vietnamese authorities screened international travellers leaving the country and had ”timely and accurate reporting and sharing of information with other authorities and governments,” the WHO adds.

”With the WHO’s assistance and the tenacity of the health workers in the hospital (in Hanoi), they pursued very effective control and prevention measures,” says Mark Salter, a medical officer at the WHO’s department of communicable disease surveillance and control.

”This stopped the spread of the virus within its borders,” he adds. ”The virus dies out, because there was no more people it could infect. But that does not mean we can sit back.”

Vietnam was hit by the disease when a Chinese-American businessmen with a high temperature was admitted to the privately-run French Hospital in Hanoi on Feb. 26. The patient had flown in from Hong Kong.

Subsequently, health workers who had treated the patient at this hospital fell ill with the same the same flu-like symptoms, which were subsequently identified as SARS. The businessmen and four health workers died as a result of the new virus.

”It’s difficult to describe the pain and tiredness of SARS. I had a terrible stomach ache and my head felt like it would split open,” Nguyen Thi Men, a nurse at the French Hospital, wrote in the Apr. 18 issue of ‘Vietnam News,’ an English-language daily. She is the only health worker of the first five of the hospital’s staff who were infected to survive.

In addition to the WHO and domestic efforts, several donor organisations ”moved in very quickly to set up a system that helped overcome the spread of SARS,” says Bjorn Melgaard, the WHO’s representative in Thailand.

The French government, for instance, announced in early April that it would grant over 100,000 U.S. dollars to help sterilise the French Hospital, the epicentre of the killer virus in Vietnam.

Another hospital designated to handle SARS patients was the state-run Bach Mai hospital. Patients from the northern province of Ninh Binh have been admitted to this government facility.

Vietnam’s ability to control SARS, even though its health system is unlike the more advanced city state of Singapore or Hong Kong, stems from the fact that it was infected by just one case at the outset, the Chinese-American businessman.

On the other hand, Singapore, which was designated as a SARS-affected area at about the same time as Vietnam, has had to battle with the disease spreading from three infected women who arrived from Hong Kong.

”That multiplied the problem, unlike Vietnam,” says Melgaard.

Nevertheless, the WHO is convinced that Hong Kong and Singapore, with their advanced health systems, are on the verge of putting SARS under control. ”We believe that the outbreak has stabilised in Hong Kong and Singapore since April 11,” said Heymann. ”These countries are on the way to decreasing the epidemic.”

Excerpt:

By IPS Correspondents
GEORGETOWN, Apr 25 2003 (IPS)

Until this week, many Caribbean governments were concerned that if they were seen taking steps to combat SARS (severe acute respiratory syndrome) the moves could cause undue alarm about an outbreak.

But with reports of several new cases in the Far East and North America – Canada in particular – many nations have moved in the past week to deal with the outbreak, taking steps ranging from banning nationals from those countries from crossing their borders to restricting their own citizens from visiting states on the list of affected.

In the 15-nation Caribbean Community, which includes countries from the Bahamas to Belize in Central America to Suriname on the South American mainland, Belize has taken the most drastic steps by imposing an outright temporary ban on visitors from Mainland China, Hong Kong, Singapore, Vietnam, India and Canada.

”No entry visas or entry permits will be issued to persons from these countries for the time being. Entry to Belize may also be refused to any suspected cases of SARS from any other country,” Home Affairs Minister Ralph Fonseca said as the administration issued the advisory to diplomatic missions, airlines and immigration departments around the globe. Belizeans have also been advised not to travel to countries on the list.

Other nations, including St. Lucia, Barbados and Trinidad, have urged their travelling citizens to avoid what officials termed as non-essential travel to countries with confirmed cases

Since the outbreak started, this tourist-dependent region has been treading lightly on the issue, hoping it would simply go away or that cases would be restricted to the Far East and areas that traditionally do not send many tourists to the Caribbean.

But officials say they are beginning to accept that the pneumonia-like illness will be around for a while and to deal with the issue.

They might have jumped to the task after health authorities in St Lucia had to deal with local media reports in the past week about a SARS case on the island, stemming from a hospitality worker who took ill and was transferred from a private to a state-run facility for treatment.

It turned out that the alleged victim was suffering from a regular flu, but St. Lucian authorities say the scare is proof of how an outbreak could devastate the social systems and fragile economies of small states.

Of particular worry to the region is the situation in Canada, an important source of visitors to the Caribbean, because the World Health Organization (WHO) on Wednesday issued a hotly disputed travel advisory urging people to postpone unnecessary travel to the country’s largest city Toronto.

Many thousands of people from the Caribbean and a similar number from the diaspora in the United Kingdom and the United States travel to Toronto each summer for the annual Caribana carnival street festival. Many also spend time with relatives on both sides of the Atlantic in the summer months.

Caribana spokesman Eric Delfish said that costume bandleaders are going ahead with registration of revellers while at the same time monitoring the spread of the disease and the reaction of authorities.

While City of Toronto officials have in recent years acknowledged the importance of the festival to the economy and tourism industry, the board of directors of the festival is planning to meet over the weekend to discuss the event’s immediate future.

Among regional airlines flying to Canada, Trinidad and Tobago’s BWIA announced this week that it has no plans to abandon seven weekly flights to Toronto, but it did say that flight crews and passengers were being told how to react if a passenger takes ill on a flight or at an airport.

In Barbados, staff at the state-run Queen Elizabeth Hospital (QEH) are busy preparing special facilities to treat any outbreak, given the hundreds of people who alight there from cruise ships or disembark from airlines each week.

”We are not taking any chances and are going out to ensure things are handled properly,” said Andrew Watson, the hospital’s acting director.

”It is important we do not panic out front. We deal with fact and not fiction and rumour. We need to be open with staff on the process,” he added.

In nearby St. Lucia, the health ministry has already identified isolation rooms at its two main airports and at the main seaport, while ambulance and other staff have been trained to handle infected persons.

Excerpt:

By IPS Correspondents
OTTAWA, Apr 25 2003 (IPS)

Furious lobbying by Canadian politicians against a World Health Organization (WHO) advisory to avoid the City of Toronto because of the SARS outbreak appeared to pay off Friday when Ontario Premier Ernie Eves said the global body would review its decision.

Earlier, Prime Minister Jean Chretien had promised to keep pressure on WHO chief Gro Harlem Brundtland to revoke the advisory issued because of the outbreak in Canada’s largest city of the virus that causes SARS (severe acute respiratory syndrome).

Political leaders here have lambasted the WHO for including Toronto on a list of regions that have lost control of the virus. Hong Kong, Beijing, China’s Shanxi province and Guangdong province – believed to be the source of the outbreak – are also listed.

It was feared the decision would further devastate the economy of greater Toronto, which acts as the country’s economic engine.

Wednesday’s travel advisory, along with warnings to British citizens by their government and other negative publicity, is expected to cost Toronto billions of dollars in lost tourism revenue. Already, conventions that were to bring more than 60,000 visitors to the city this spring and summer have been cancelled.

Hotel bookings have dropped drastically, and local officials say the hospitality sector had already lost about 30 per cent of its business before the WHO advisory was issued.

Amateur sports teams travelling to the United States have been turned back at the border and Major League Baseball has warned players visiting Toronto to play against the Toronto Blue Jays not to sign autographs, mingle with fans or visit hospitals.

But Eves, leader of the central Canadian province that includes Toronto, said Friday, "I’m pleased to announce they are going to present the updated facts to the (WHO) director next Tuesday morning and Tuesday there will be a decision to make whether to lift the travel ban on Toronto or not”.

WHO did not confirm the review.

Chretien has already called Brundtland, and said Friday he would speak to her again next week. His cabinet, which normally meets in Ottawa, will hold a rare out-of-town meeting in Toronto on Tuesday, and Chretien says his wife Aline will keep a promise to visit the city next Thursday.

Canadian doctors say no new cases of SARS have been diagnosed in Toronto in the past 19 days. But two more victims died Friday, bringing the total dead in the country to 19.

A WHO official denied Friday that politics had anything to do with the warning.

"We do not like making travel advisory recommendations," said David Heymann, speaking by telephone from WHO headquarters in Geneva to Canadian reporters. ”We’re trying to stop the spread of this disease internationally, and if we see a chance to eliminate it, to drive it back into the box à we do that."

Heymann noted that the WHO issued the advisory after at least one incident in which SARS was carried to a developing country from Toronto – a nurse carried the virus from a Toronto hospital to the Philippines. As well, is has spread from Toronto to the United States and Australia, says the WHO.

Heymann warned that the disease, if it spreads into the general population of an undeveloped country, could have devastating results. Some SARS-stricken countries have a death rate of more than 10 per cent, depending on the quality of their health care system and the age of victims.

Toronto had 257 suspected or probable SARS cases on Thursday, down 10 from the day before. Chretien’s call to Brundtland came a day after the WHO chief told Health Minister Anne McLellan the travel warning will stay until Canada proves it has the disease under control.

Canadian medical officials have also been lobbying their counterparts at the WHO to lift the ban. Donald Low, a Toronto microbiologist who leads the Canadian SARS effort, discussed the advisory Thursday with WHO executives. He says the global body issued the notice without discussing the SARS outbreak with officials in the Canadian or Toronto governments.

The decision was not scientifically sound, he added. "I think we’re the scapegoat."

”Our impression is they are not thinking seriously about lifting their advisory," Health Canada spokesman Paul Gully told a news conference in Ottawa on Thursday. He said the incidents of SARS being exported ”happened long enough ago to be irrelevant”.

The U.S. Centers for Disease Control says it will not issue a similar advisory. "We understand the patterns of transmission in Toronto," said spokeswoman Julie Gerberding in Atlanta. "They make sense, the epidemiological picture is complete, and there’s no suggestion that a traveller going to Toronto is inadvertently coming into contact with a SARS patient."

But the damage may already have been done. Two huge conventions, of cancer researchers and librarians, which were to draw some 50,000 visitors to Toronto, have already been cancelled. Residents of Canada’s largest city are being denied tickets on cruise ship lines, and Belize has banned visitors from this country.

At Toronto City Hall, Councillor Brad Duguid reacted harshly to rumours that the city’s garbage shipments to Michigan were to be slowed by a law forcing both drivers and trucks to be inspected for possible SARS contamination.

"That would be in very poor taste, and any politician who would do that is not worth anything," he said.

Excerpt:

By IPS Correspondents
BEIJING, Apr 25 2003 (IPS)

Long sheltered from bad news by their image-obsessed government, the residents of the Chinese capital are undergoing a test of maturity in the current crisis over the spread of atypical pneumonia.

Over the past week, the sudden deluge of information about the Severe Acute Respiratory Syndrome (SARS) here has driven the capital of nine million people to the brink of hysteria.

Like a city stricken by the plague, Beijing is gripped by fear, panic and rumours about a full quarantine from the outside world. Thousands of people are trying to flee and others are frantically stocking up on groceries.

"It is impossible to live like this," complained Ding Shuhui, who had stood in a queue for hours to buy soya sauce, cooking oil and rice. "They (the government) advised us to buy in bulk to avoid shopping everyday but when we set on doing that, the shelves are either empty or one has to queue."

Beijing recorded 89 new cases and four deaths on Thursday, pushing the total to 774 cases and 39 deaths, according to figures released by the Ministry of Health. The death toll from mainland China rose by 125, but there were no deaths reported outside Beijing.

The accumulated number of SARS cases in China stood at 2,422 with 110 dead.

A third hospital in Beijing was sealed off Friday as fears mounted that SARS patients there had infected many medical staff. Ditan hospital, designated as one of the infectious diseases institutions fit to deal with SARS patients, was quarantined following the closure of People s Hospital of Beijing University and the 302 military hospital earlier on.

Many queued at railway stations and airports, trying to leave before the government banned all travel in or out of a city where the death toll has kept rising. Officials are concerned by the number of migrant workers leaving Beijing and possibly carrying the virus back to their home provinces.

"Migrant workers and student are forbidden to leave and outsiders are already being stopped from entering the city," explained Zhao Wenren, a taxi driver. "Now you can still leave but later people say you won’t be allowed back in."

People could be seen around the city emptying supermarket shelves and carting home as much as they could before the start of a three-day holiday on May first.

Some feared that soon, peasants would be excluded from delivering supplies of fresh vegetables, meat and fish. Others said it was because they had heard that all shops would be closed and disinfected.

Around the city, the police are operating roadblocks to stop outsiders from coming in. Across the city, squads of sanitation workers in masks and rubber gloves were spraying disinfectant as the new mayor, Wang Qishan, placed Beijing on an emergency footing after his predecessor Meng Xuenong was fired Sunday.

Wang Qishan ordered 1,000 hospital beds to be prepared and is buying 1,000 artificial respirators, 30 more ambulances and 500,000 protective medical suits for confirmed SARS patients, an indication that medical authorities are preparing for the worst.

Many people have stopped coming to work, claiming sickness or the need to look after their children who were discharged from school on Thursday for a two-week holiday.

"I was trying to get a document notarised at the Municipal Notary Office today but they told me they had only half of their employees, and were not able to process any documents," complained lawyer Zhang Xin.

The normally crowded four-storey IKEA store was almost entirely empty of customers, and so was the neighbouring big Dazhong supermarket. With occupancy down to as low as 20 percent, the city’s luxury hotels have begun renting out just a few floors of rooms while sterilising the others on a rotation basis, the ‘Beijing Youth Daily’ reported

Just about everyone in the city centre is now wearing surgical masks, and shop assistants complain if people are not wearing one. Even the once-overcrowded buses have few passengers. Instead, the sales of bicycles have risen.

Indeed, Beijing and its nine million people have overtaken Hong Kong as the SARS hot zone. Until last week, officials had admitted to only 37 infections in the city, but now there are 39 known deaths and over 700 known cases.

Most of the foreign community is evacuating after the foreign schools suddenly announced that they were closing until May 8. There are 135 reported SARS cases in 84 different Beijing schools, including 69 university students and 30 staff.

Still, it is still widely believed that the true picture of epidemic has not emerged in China.

Staff at one of Beijing s largest hospitals, the People’s Hospital of Beijing University, believe that officials have continued to understate numbers, particularly among medical workers. According to official data, 541 medical workers are infected across China.

The 1,200-bed hospital was closed, with staff saying that at least 60 doctors and nurses have caught the SARS virus after they worked in a makeshift isolation ward. Without proper facilities to accommodate the growing numbers of suspected patients, these and confirmed cases have been mingled together and some have infected each other.

As the capital increasingly feels like a city under siege, the government has announced it is setting up a national task force to combat SARS and has established a national fund of two billion yuan (241 million U.S. dollars) for the prevention and control of the disease.

Officials have called on medical workers and others to show "greater understanding and compassion" for SARS patients, whom the media describes as feeling "isolated and depressed" and prone to lose their tempers with medical workers.

Morale is a major problem and the government has given the job of leading the campaign to China’s ‘Iron lady’, Vice Premier Wu Yi, the only woman in the 25- member Politburo of the Communist Party. She will oversee an emergency programme to set up a China Centre of Disease Control and Prevention to coordinate reporting from around the country.

Wu Yi said every citizen must join the campaign against SARS and improve public hygiene. She called for "tough action" against rumourmongers and business people who are exploiting the crisis by hoarding goods.

Excerpt:

By Julio Godoy
PARIS, Apr 24 2003 (IPS)

The French government has ordered immediate hospitalisation of anyone showing SARS symptoms even though the condition is not considered a major health risk within France.

"Given the exceptional and urgent nature of the disease, the government has decided to decree the immediate and forced hospitalisation of all persons showing its symptoms," says Health Minister Jean-Francois Mattei.

French authorities have so far examined 359 persons showing SARS-like symptoms, which include fever and a dry cough. Five of them are suspected to be suffering from SARS (Severe Acute Respiratory Syndrome).

The government ordered forced hospitalisation of suspect patients after a patient secured release from a hospital and maintained contact with relatives and other people for several hours.

"Such a situation is distressing," Mattei said. "Therefore we have decided that forced hospitalisation of people with grave infectious risks like SARS is necessary."

The condition arose in China, which has seen also the highest incidence of the disease. Chinese authorities have reported more than 2,000 SARS cases with more than 100 deaths. About 490 cases have been reported in Beijing. The Chinese government has closed all schools in Beijing for two weeks to avoid further spread of the disease, also referred to as atypical pneumonia.

The government shortened Prime Minister Jean-Pierre Rafarin’s visit to China this week. Rafarin is expected to be in Beijing from Thursday until Saturday. Rafarin and a delegation of 120 will be in Beijing only some 30 hours. A visit to Shanghai has been cancelled.

Members of the delegation have been given alcoholic gels to wash their hands regularly during the trip. A specialist in respiratory diseases travelled with the delegation.

Members of the delegation were also given masks and disinfecting devices.. But they were asked not to show masks in public to avoid conveying "a negative image" to China.

It was significant that the visit was not cancelled. The government argued that Rafarin’s visit was important from the diplomatic and commercial points of view. "There are several contracts to sign," said a government source. The French are looking for power generation contracts and for orders for Airbus aircraft.

But Rafarin’s visit has been criticised by many physicians and politicians. Some company executives are said to have opted out of the visit.

"The government must explain why its warnings are valid for the normal citizens but do not stop the Prime Minister going to Beijing," said Jean-Marie Leguen, spokesperson for the opposition Socialist Party on health issues.

Specialists in respiratory and contagious diseases say the situation in China is worse than officially admitted. "You have to multiply the Chinese figures by ten to arrive at a better estimation of the dimensions of the disease," says Alain Fisch, a French epidemiologist investigating the atypical pneumonia.

Fisch says there are no medical services to detect the disease in many of the poorer areas within China. Measures against SARS have come too late to check the epidemic, "and now it has spread to the rest of South East Asia," he added.

Several steps are being taken against SARS within France. People returning from South East Asia and Canada are required to face tests to establish that they do not carry the SARS virus.

At airports and at international railway stations, many people have been wearing masks, or avoiding travellers who cough or show symptoms of respiratory diseases.

SARS usually begins with a fever. Other symptoms may include headache, a feeling of discomfort, and body aches. Some people also experience mild respiratory symptoms. After two to seven days, SARS patients may develop a dry cough and have trouble breathing.

The primary way SARS appears to spread is by close person-to-person contact. Most cases of SARS involve people who have cared for or lived with someone with SARS, or had direct contact with infectious material such as respiratory secretions.

SARS can spread by touching the skin of people, or objects contaminated with infectious droplets, and then touching one’s own eyes, nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets on to themselves, other people, or nearby surfaces.

Excerpt:

By Stephen Leahy
TORONTO, Apr 23 2003 (IPS)

With reports that SARS (severe acute respiratory syndrome) can survive for up to 24 hours on inanimate surfaces, turning any object into a potential transmission source, it looks like the virus might indeed be the global pandemic suggested by health experts. But what exactly does that mean?

David Heymann, executive director of the communicable diseases section at the World Health Organization (WHO), says SARS could pose a more serious global health threat than any other new disease in the past 20 years, with the sole exception of HIV, which causes AIDS.

The epidemic had infected 4,000 people and killed at least 228 in 25 countries as of Apr. 22, according to WHO. Roughly 90 percent of the cases were in China and Hong Kong and overall numbers were expected to continue to rise. Thousands of people are currently in quarantine worldwide, and that number could grow dramatically as China struggles with the disease.

In 1918 a new influenza virus killed at least 20 million people before it disappeared. While the worst human epidemic on record, that flu virus was not particularly lethal, killing only three to five percent of those infected. The SARS death rate is estimated at four percent. The Ebola virus is much more deadly, killing half its victims, while HIV kills virtually everyone infected.

In an unprecedented world-wide collaboration, scientists earlier this month identified SARS as a new Coronavirus. ”It took three years to find the cause of AIDS and HIV," said WHO spokesman Dick Thompson. ”It took eight days to find the cause of this disease.”

On the other hand, SARS is operating in a much more fast-paced, interlinked world than that which spawned HIV, Heymann pointed out. Its apparent incubation period of two to 10 days is long enough for infected people who are asymptomatic to travel ”from one city in the world to any other city having an international airport”.

SARS can also be spread via droplets, excreted when we sneeze or cough, and the initial symptoms – dry cough, headache, fever – are non-specific and common, he noted.

The global cost of the disease is already estimated at 30 billion U.S. dollars, Heymann said.

The family of Coronaviruses, so named because of the distinctive crown that encircles the viral particle, cause 20 to 30 percent of common colds in humans as well as diseases in many domestic animals, including pigs, cats, dogs, cattle, chickens, turkeys, rats and mice.

Viruses are simply small packages of genetic material – DNA or RNA – plus a few enzymes surrounded by a protective coat of protein or fat. On their own, they are relatively inert – unable to move, grow or reproduce.

But what viruses do exceedingly well is hijack the machinery of living cells they come into contact with to make more viruses. Chemicals in their ”coat” act as a key to open the protective lock of a cell membrane, giving the virus access to the genetic material.

Once inside, the virus takes over the cell so it can make copies of itself. As soon as enough are created, the new viruses either leak out through the cell membrane or cause the cell to self-destruct, bursting open to release the viral progeny that move on to colonize other cells.

Viruses easily swap genetic information with other viruses or host cells. The constant reshuffling enables them to jump from one species to another. HIV, for example, is believed to have transferred from wild animals in Africa to humans.

Animals are hosts to many kinds of viruses, most of them benign, but a single gene change can make them highly dangerous to other animals or humans. Many flu viruses start in pigs or chickens, undergo mutation and start infecting humans. The SARS virus may be another example.

Controlling a highly contagious virus is much more difficult without a diagnostic test. One that would identify SARS in a person’s blood or saliva could be just weeks away after Canada’s Michael Smith Genome Sciences Centre in Vancouver recently announced the virus’s genetic sequence.

Drug companies ”are madly testing all of their drugs that work against AIDS and hepatitis C right now to see if they work on the Coronavirus,” said Kathryn Holmes, a Coronavirus expert at the University of Colorado Health Sciences Center in Denver.

But Heymann cautioned that companies’ eagerness to develop a vaccine will hinge on how likely it is that SARS will be here for the long-term. The ability to recoup research costs and make a profit will drive their decisions.

"Can we prevent a global pandemic of SARS?" asked U.S. Centres for Disease Control Director Julie Gerberding writing in the Apr. 2 issue of the ‘New England Journal of Medicine’.

If civilization is lucky, she said, diagnostic tests and treatment will be found to curtail the epidemic. A seasonal pattern will evolve, allowing scientists to contain infections within regions, and the infection rate will slow.

But if the virus escapes the noose of public health control strategies, the world will be in for a long, difficult struggle, she concluded.

Excerpt:

By IPS Correspondents
BEIJING, Apr 21 2003 (IPS)

Shock and disbelief, as well fast-rising worries, greeted the weekend disclosure of dramatically higher figures for atypical pneumonia in Beijing and the sacking of top officials over the handling of the health crisis.

But beyond that, some observers are speculating that the new leadership under President Hu Jintao could use the crisis to push for ‘glasnost’ in the same way then Soviet President Mikhail Gorbachev exploited the Chernobyl nuclear accident in 1986 to introduce political reforms in the former Soviet Union.

China fired its health minister and the mayor of Beijing on Sunday and also cancelled a weeklong May Day holiday, after admitting new figures up to 10 times the previously disclosed statistics for Severe Acute Respiratory Syndrome (SARS) cases in the capital.

Beijing now has over 700 confirmed and suspected cases, making it the third-hardest hit community in the world after southern Guangdong province and Hong Kong.

"I can’t believe what is happening," said Chi Lihua, a saleswoman in a supermarket in Beijing. "For weeks they assured us it was all under control. But to cancel the May 1 holiday it means it must be really serious!"

"I don’t trust them even now," said Liu Guotang, a teacher at Beijing Economics and Trade University. "I’m sure even these figures are not the real ones. The university closed today and we have been told to go on a long holiday. If it wasn’t really bad, they wouldn’t have done that."

The Chinese government’s actions come after an emergency meeting of the Communist Party’s Politburo on Thursday last week, ending weeks of lies and evasions by top officials who tried to deceive visiting World Health Organisation experts who had been struggling to contain the outbreak of the mysterious new disease.

Health Minister Zhang Wenkang and Beijing Deputy Party Secretary Meng Xuenong repeatedly issued statements saying that the situation was under control, and that it was safe to travel and live in China.

But in a news conference Sunday, China’s Vice Health Minister Gao Qiang said an investigation ordered by top leaders on Apr. 15 had revealed 339 infections, 18 deaths and 402 suspected cases of SARS in Beijing. These are vastly higher than the 37 cases and four deaths reported earlier.

"The way China behaved has come as a shock to many investors who thought things had changed here," said one foreign diplomat in Beijing, who predicted that "This could be China’s Chernobyl."

He was referring to how Soviet leader Mikhail Gorbachev used the nuclear meltdown in the Ukraine, which Moscow had tried to keep the lid until abnormally high radiation levels were detected in Sweden, to drive his ‘glasnost’ policy, and to discredit the old system at work in the Soviet Union.

Here too, the Chinese government at first issued false statements to the public and even to the WHO – and is only now relenting because the secrecy is damaging the economy and confidence in China.

News of the first SARS case in Beijing was held back for a month for fears it might ruin the March annual session of the National People’s Congress, China’s legislature, when a major leadership transition was afoot. Upon the conclusion of the legislative meeting, only a few cases were admitted at first.

Until now, political reforms have not been overtly on the agenda of President Hu Jintao, who last week used a public appearance at a military research institute in Beijing to say he is confident about China’s ability to find the methods to combat SARS using high technology.

He termed the battle against SARS "a major task" affecting the health and safety of all Chinese and endangering the country’s development and stability.

No explanation for the dismissal of officials has been given but President Hu and his premier Wen Jiabao, who took office two months ago, are now facing the first test of their rule – and appear to have had to deal with a dangerous split in the leadership.

Health Minister Zhang Wenkang had close ties to senior leader Jiang Zemin. Meng Xuenong, who took office as Beijing mayor only recently, had been highly touted as a "man of the people" and fit the new profile of the Chinese leadership as one that cares for the poor and underprivileged.

Such public sackings are extremely rare in Chinese politics, where the principle of collective responsibility is normally applied.

"Of course we are shocked by the figures, but the fact that they sacked these people gives me hope that things are turning for the better," said Hollis He, an employee at a foreign bank in Beijing. "One doesn’t see this happen everyday."

"Someone had to be held accountable," said a Chinese government source, explaining that the dismissals are designed to be a warning to ensure that other provincial leaders now act promptly and cooperate in addressing the SARS virus.

Still, there are grave doubts whether all the figures in China have been revealed. Some experts wonder how many cases in China’s provinces are being kept secret by local leaders fearful of jeopardising the local economy.

At least eight of China’s poorer provinces, including Shanxi, Inner Mongolia and Ningxia, have reported SARS cases. Officials said hospitals in those areas might not be able to cope with the contagion and the influx of patients.

The week-long May Day holiday has been suddenly cancelled to discourage people from travelling and further spreading the disease around the country. The so-called ‘Golden Week’ was introduced five years ago to boost consumer spending in the wake of Asian financial crisis.

Most people have already called off travel plans. Schools and universities are closing down as panic spreads across the country – and there is now the risk of a serious economic slowdown.

Excerpt:

By Marwaan Macan-Markar
BANGKOK, Apr 18 2003 (IPS)

The special summit to be held by South-east Asian leaders this month to deal with the economic consequences of the Severe Acute Respiratory Syndrome (SARS) amplifies the rising tide of panic over the deadly illness in the region.

This crisis meeting on Apr. 29 was called for by Singaporean Prime Minister Goh Chok Tong during a telephone conversation with Thai Prime Minister Thaksin Shinawatra this week.

The summit will provide leaders from the 10-member Association of South-east Asian Nations (ASEAN) to ”discuss experiences and formulate economic rescue measures,” Thai Public Health Minister Sudarat Keyuraphan was quoted in Friday’s ‘Bangkok Post’ newspaper.

The gravity of this meeting is evident, judging from the compelling issues that have forced ASEAN leaders into special summits in the past. In 1978, the leaders met this way after Vietnamese troops invaded Cambodia, stated the English-language ‘Nation’ newspaper on Friday.

ASEAN, South-east Asia’s main regional grouping, includes Brunei, Burma, Cambodia, Laos, Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam.

Of these countries, Singapore and Vietnam have been the worst hit by SARS, an atypical form of pneumonia. Since the disease gained global attention in early March, 162 people have been detected with SARS in Singapore, of which 13 people have dies and 85 have recovered.

In Vietnam, 63 cases have been detected, of which five people died and 46 have recovered.

By comparison, the infection rate in the rest of ASEAN is relatively low – Thailand has reported eight cases, Malaysia, five cases, and the Philippines, one case.

But beyond the health sphere, experts fear that SARS increasingly threatens to sap the economic health of ASEAN and undercut its competitive edges including as hubs for tourism and regional finance two sectors most affected by fears of travel and limits on physical mobility.

”Over the short and medium term, the sector most vulnerable to SARS are those related to consumer spending, lie retail sales, restaurant services, tourism and travel-related sectors such as hotel occupancy and transportation” says Pradumna Rana, director of the regional economic monitoring unit at the Manila-based Asian Development Bank (AsDB).

Likewise, foreign business people and expatriates are staying away from Hong Kong and Singapore. Media reports say many have in fact sent their families away from Hong Kong, if they have not left themselves.

”The contagious nature of SARS discourages international travel and, thereby, affects travel-related spending,” he adds.

Three countries feeling the pinch most are Vietnam, Singapore and Thailand. During a recent regional tourism meeting held in the Vietnamese capital Hanoi, authorities admitted that SARS had led to almost half the expected number of tourists cancelling their bookings.

Singapore Airlines, the city-state’s national carrier, is reporting that it has cut 199 flights per week due to the drop in air travel over the last weeks. Authorities also say that tourist arrivals have dropped to 50 percent in April when compared with the numbers during this period last year.

In Thailand, hotel authorities have confirmed to the media that occupancy rates in hotels had dropped to between 30 to 40 percent.

The travel and tourism sector is a central pillar of the ASEAN economies, which, according to the World Bank, accounts for four to five percent of the region’s Gross Domestic Product (GDP). Thailand alone gets 10 million tourists a year.

Little wonder why the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP), among other international institutions, was compelled to cut its estimates of projected growth in the region due to the impact of SARS and the war in Iraq.

All the major engines of growth in the region will feel the pinch, ESCAP officials stated Thursday after the launch of the ‘Economic and Social Survey of Asia and the Pacific 2003’.

Singapore’s estimated GDP growth for 2003 will drop to 3 percent from the previously forecast 4.2 percent for this year, while Malaysia’s growth will drop to 4.5 percent from the forecast 6.3 percent, according to ESCAP.

Thailand, on the other hand, will see its GDP growth drop to 4.2 percent from the forecast 4.5 percent for 2003 and Vietnam’s growth will drop to 7 percent from the forecast 7.5 percent.

”We had to revise our projections for 2003,” Kim Hak-su, ESCAP’s executive secretary, said at the launch of the annual report of the economic performance across Asia and the Pacific. ”We need to watch out how SARS can develop.”

Still for all, the ESCAP report revealed the Asia-Pacific region had performed well last year against the global economic averages and the potential of repeating that achievement this year was plausible.

In 2002, the ESCAP region countries collectively registered a growth of 5.1 percent as opposed to the world average of 1.7 percent. The U.S. economy, by contrast, had only grown by 2.4 percent in the same year.

And in 2003, after making the cuts for the impact of SARS and the conflict in Iraq, the ESCAP countries were expected to achieve a 5 percent growth rate as opposed to the world average of 2.3 percent. The U.S. economy, according to ESCAP, was expected to grow by 2.2 percent this year.

China’s economy played a lead role to achieve these salutary numbers. In 2002, the Chinese economy registered a 7.9 percent growth rate and this year, even after accounting for SARS, it is expected to achieve 7.5 percent growth, according to ESCAP.

Consequently, economic experts say it is premature to make parallels between the economic shocks being felt in South-east Asia due to SARS and the economic flu that swept through the region in 1997.

”The 1997 financial crisis was a very serious crisis – a currency crisis, led to a banking crisis and eventually to a full economic and social crisis,” says the AsDB’s Rana, adding that to draw comparison is to ”exaggerate” the reality.

”The threat of SARS to the economy will only become very serious if it becomes uncontrollable and starts affecting the supply side of the economy,” he adds. ”At this time, I don’t think such an event will occur.”

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By IPS Correspondents
BEIJING, Apr 18 2003 (IPS)

When China’s newly inaugurated leaders pledged last month to devote their energy to helping the poor and downtrodden, little did they know that they would run straight into a challenge that would test this commitment.

This is because of the fast-spreading atypical pneumonia, called Severe Acute Respiratory Syndrome (SARS), which is not only active in China and in many countries around the world, but is suspected to have originated in the country.

But beyond the growing worries about what some fear may have the potential to be a global pandemic, SARS has brought to public attention one carefully concealed failure of China’s development over the past two decades – the regression of its rural health care, largely overshadowed by the glare of the country’s remarkable economic achievements.

In truth, this boom has left hundreds of millions of peasants in the Chinese countryside without even basic preventive care – something they enjoyed in the old days of socialism.

After the government withdrew from the role of being the free provider of medical services in the early 1980s, when its market-opening measures were stepped up, the worst affected by this shift have been public health services – preventive care, disease surveillance and medical control.

In rural China, the collapse of public health care has been a disaster waiting to happen.

The current health crisis might well turn out to be a time bomb that would inflame dormant social tensions in the long-neglected countryside.

SARS has officially killed at least 65 people and infected 1,445 people in China, which now has nearly half of the world’s cases. Outside of Guangdong, Beijing and Shanghai, SARS already has spread to southern Guangxi and Hunan provinces, to Sichuan in the west and Shanxi in the north.

Two more far-flung provinces, Inner Mongolia and Ningxia, reported this week that they too had an outbreak.

A visiting team of World Health Organisation (WHO) experts that did their investigations in Guangdong, southern China, where the first case emerged in November, reported that it had "found an urgent need to improve surveillance in the countryside to head off new outbreak in rural areas”.

"The team observed that many of China’s poorer provinces may not have adequate resources, facilities, an equipment to cope with outbreaks of SARS, and underscored that Guangdong’s capacity was (actually) exceptional among China’s provinces," the report said.

Hospitals in Guangdong, one of China’s wealthiest coastal provinces, are among the most modern in the country, but have nevertheless came under enormous strain due to the outbreak.

WHO experts admit they have scant information about the level of preparedness and scope of the epidemic in most of China. "We do not know what is going on outside Guangdong," said David Heymann, WHO’s head of communicable diseases.

Experts fear that far away from central government control, hospitals in some regions might turn away patients with SARS who are unable to pay for their treatment. "No hospital should refuse treatment to people infected with SARS," read the headline on front page of ‘Beijing Youth Daily’ newspaper this week.

Echoing fears about how well poor provinces could handle a full-fledged health crisis, Communist Party chief Hu Jintao warned that if mishandled, the SARS epidemic could jeopardise not only social stability but also China’s overall economic development.

The emergency meeting of the Standing Committee of the Communist Party’s Politburo, held on Thursday, follows two other SARS-related meetings convened by Premier Wen Jiabao.

A matter that has been taboo for months, SARS and its impact on China’s future has become the most formidable challenge the country’s leaders, who assumed their positions in the last months, are facing as they try to seek legitimacy for their rule.

There are plenty of reasons to worry. Rural residents account for more than 70 percent of China’s 1.3 billion population, but receive just 20 percent of public spending on health. Urban residents also enjoy disproportionate access to hospital beds and trained medical personnel.

This week Beijing, earmarked 18 more hospitals to those three already designated as infectious-disease hospitals to deal with SARS patients. It was not clear why so many hospitals were needed when official statistics claim only 37 people in Beijing have been affected by SARS, and only four have died.

But even if Beijing has grossly underreported the scope of epidemic, as feared by many specialists here, the capital’s preparedness for emergency situations mirrors a growing disparity in health care between the developed coastal and urban areas and poorer inland regions.

The collapse of China’s rural communes in the late 1970s and early 1980s brought to an end an era of free preventive health care and universal medical treatment.

Under the collective system, 90 percent of the rural population was provided with free health services. Today only 10 percent of rural residents are insured, leaving some 700 million Chinese having to pay out-of-pocket for all of their health expenses.

The Chinese government has effectively relinquished all responsibility for health care in rural areas, leaving local governments to fend for themselves. Many regions in China’s poorest and under-developed regions have been unable to finance public health programmes on their own.

As a routine, financing for rural clinics come partly from local governments and partly from their own revenues. To increase revenues, clinics are charging fees for injections, antibiotics and intravenous drips, disregarding less costly treatment.

As a consequence, the neglect of preventive care in favour of more profitable curative treatments has led to a precipitous rise in infectious diseases and epidemics. Tuberculosis and neo-natal tetanus kill more than 200,000 children in China every year, and hepatitis, tuberculosis and AIDS are spreading rapidly.

SARS is only the newest health threat to befall China’s neglected countryside.

And even as Premier Wen Jiabao says that the situation is now "grave", the "golden week" labour holiday on May 1 – which would see millions of Chinese head for trains, planes and cars to visit their families and tour regional resorts remains on schedule.

The government is still encouraging people to travel and spend, and live up to the country’s growth targets, although this will also ensure a greater risk of the disease spreading throughout China.

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