From SARS to Bird Flu : Public Health and Animal Diseases Between Hong Kong and Guangdong

1. From SARS to Bird Flu :Public Health and Animal Diseases Between Hong Kong and Guangdong Frédéric Keck CNRS French Center for the Study of Contemporary China (CEFC Hong Kong) Conference in Ritsumeikan University (Kyoto) 4 December 2008

2. From SARS to Bird Flu :Public Health and Animal Diseases Between Hong Kong and Guangdong Introduction : - Where I come from - Intellectual references I SARS in Hong Kong : - The facts - The political lessons of SARS II Bird Flu in Hong Kong - The facts - The links between SARS and Bird Flu III Differences between SARS and Bird Flu - The fight against SARS prepares the public health mobilization on Bird Flu - Bird Flu also has an economic aspect, that the SARS precedent leaves aside Conclusion - Where we are going - Anthropological hypothesis

3. Introduction : Where I come from • Two years of ethnographic study at the French Food Safety Agency (AFSSA) • Shift from Mad Cow Disease to Bird Flu as two major sanitary crises in France • Anthropological comparison between different gestions of Bird Flu in the world considered as an animal disease and as a human disease.

4. Intellectual references • Anthropology of human/animal relationships : animals are intellectual tools humans use as ways of articulating social problems (Lévi-Strauss, La pensée sauvage, 1962). Societies trace differently the cut between animals and humans (Descola, Par delà nature et culture, 2005) • Sociology of risks : Risk is the major concept by which modern societies think of themselves as living groups in relation to an environment (Foucault, Sécurité, territoire, population, 1978). Lessons from a sanitary crisis are transposed to another, because they shape the historical experience of a social group (Dodier, Leçons politiques de l’épidémie de sida, 2005)

5. I SARS in Hong Kong : the facts • 21 February 2003 : Dr Liu Jianlun, who has been treating a mysterious disease in Guangzhou, infects travellers from different countries at the Metropole Hotel in Kowloon. The disease is transmitted to Hanoi, Singapore, Toronto. • 10 March 2003 : Doctors and nurses at the Prince of Wales Hospital fall ill after treating the mysterious disease brought by a visitor of Metropole Hotel. • 15 March 2003 : the World Health Organization (WHO) names the disease « Severe Acute Respiratory Syndrome » (SARS) to avoid « Hong Kong Flu ». The Department of Health in Beijing denies the novelty of the disease (talk about atypical pneumonia, feidian xing) and hides the numbers of patients in China. • 31 March 2003 : the inhabitants of Amoy Garden in Kowloon are put into quarantine after an unusual number of cases (contamination by the ventilation system) • 2 April 2003 : the WHO issues an advisory recommanding only essential travel to Hong Kong • 20 April 2003 : Prime Minister Wen Jiabao and President Hu Jintao recognize the importance of the disease and organize the mobilization of the country. Minister of Health Zhang Wenkan and Beijing Mayor Men Xuenong are removed from their posts in sign of « transparency » • 23 June 2003 : Hong Kong is declared free of SARS • 24 June 2003 : Beijing is declared free of SARS • 1 July 2003 : 500 000 persons demonstrate in Hong Kong against amendment of Article 23 of the Basic Law on security • SARS has infected 8446 persons, killing 876, in the world. 1755 infected in Hong Kong 296 dead. Around 2500 infected in Beijing (cases declared to the WHO).

6. The political lessons of SARS • Infectious diseases are not over : new infectious diseases can emerge and kill very rapidly without distinction of class or age. • With modern means of transportation, these diseases can contaminate in a single day the rest of the world. With urban conditions of living, they can kill thousands of people by contact. • A new infectious disease can be rapidly known and controlled thanks to the coordinated efforts of the global community. • Beijing cannot pretend to ignore the rest of the world : public health issues in China concern the global community. • Guangdong is the place where many infectious diseases emerge, because of its climate and dense population, and spread, because of its economic growth. • Hong Kong is a sentinel in the Asian public health system, because of its position next to Guangdong and because of its excellent sanitary condition (Yersin discovered the bubonic plague virus in Hong Kong in 1894). It is also a laboratory for the compatbility of public health measures with the rights of individuals (comparison with Singapore). It has been close to economic bankrupcy during the SARS crisis (13 300 jobs lossed, 4000 companies closed, 14 000 flights canceled). • Emerging infectious diseases force to redraw social relationships in a security-oriented way (use of masks in hospital and in the streets, stigmatization of suspected victims, temperature screens in airports,stockpiling vaccines…)

7. II Bird Flu (Avian Influenza)in Hong Kong : the facts • May 1997 : 5000 chicken in Hong Kong farms die of an H5N1 Influenza virus, a 3-year old boy dies of the same virus. • End of 1997 : 18 people are infected by the same virus, 6 die. The Hong Kong government culls 1.5 million chicken on its territory. • 1999 : two children fall ill with an H9N2 virus. • February 2003 : the H5N1 virus kills a 33 year-old man and his 9-year old son. • February 2004 : the H5N1 appears in Vietnam and Thailand, 31 persons are infected, 22 die (70% mortality rate) • March 2006 : 16 persons infected, 11 dead with an H5N1 virus in China, mostly in Shanghai. The virus spreads to Indonesia, Turkey, Egypt, and Western Europe. • 18 September 2007 : 10 000 ducks die with H5N1 in the Panyu district, Guangdong. 100 000 ducks are culled to avoid spreading the disease and to restore the trust of consumers on the eve of the Moon Festival.

8. The link between SARS and Bird Flu • The authorities who were in charge of fighting SARS in Hong Kong in 2003 now fight against Bird Flu at the world level (Margaret Chan, head of the HK Department of Health, is now director of the WHO in Geneva) • The microbiologists who were working on Bird Flu at the University of Hong Kong (trained by Robert Webster, Kenneth Shortridge and KY Yuen) identified the causal agent of SARS as a coronavirus (Mali Peiris, 21 April 2003) and traced its animal origins in the wild markets of Guangdong (Guan Yi, 23 May 2003) • Administrations and scientists delayed the identification and eradication of the SARS agent for two weeks because they first thought it was H5N1. • Vaccines against SARS are produced with the same techniques as vaccins against Bird Flu (evolutive vaccines using reverse genetics) • The lesson of Bird Flu : new viruses emerge because they get mutated and reassorted in the animal population

9. Differences between SARS and Bird Flu • SARS is due to a virus whose ecology and mutations are now well-known (from the bat to the civet to the human). Bird Flu is due to a virus whose possibilities of mutation and reassortment are much wider (combination of a bird flu with a human flu would be catastrophic) • SARS has mutated to an inter-human form, Bird Flu is for the moment mostly an animal-to-animal, and sometimes an animal-to-human, disease. • The mobilization against SARS lasted 6 months, the mobilization against H5N1 has lasted for 10 years.

10. The fight against SARS makes people prepared to the mobilization on Bird Flu in Hong Kong • Airport companies have organized urgency plans for a pandemic in the next two years. • Hospitals have allocated 1000 beds for the cure of bird flu patients. • Microbiologists follow the mutations of the virus in the world, and particularly in Guangdong, through computer networks.

11. Bird Flu also has an economic aspect, that the SARS precedent leaves aside • Cost of culling, indemnisations for poultry farmers. • Inflation caused by the closure of some poultry commercial lines (compare with blue-ear for swine) • Biosecurity measures in farms and transportation system : Hong Kong is considered as a model • The poultry farms system in Hong Kong has been designed to produce poultry in better sanitary conditions than Guangdong, despite its higher cost (first industrial farms in the 30’s, supply for US and Japan in the 50’s) • In 2001, 100 million people crossed the border between Hong Kong and Guangdong, for commerce or leisure. Reversal of the two-centry trend : humans go from Hong Kong to Guangdong, poultry go from Guangdong to Hong-Kong. Can this border be controled and closed in case of an inter-human form of H5N1 emerging ? • SARS produced emergency measures to save a threatened economy. Can the economy be built on the preparation of a threat that has not appeared yet ? Problem of the economy of preparedness.

12. Conclusion : Where we are going • Extrapolating from the precedent of the Spanish Flu in 1918, the WHO estimates that an H5N1 pandemic could cause 60 million dead. • Scientists are surprised that H5N1 has not mutated yet to an inter-human form. Others say it will never mutate. The mutation is a low probability-high consequences risk. • The question is not : when will the pandemic happen ? But : are societies prepared for it ? • Companies and governments have plans saying what they should do in case of a pandemic - not only H5N1 - and identify critical activities that need to be sustained. • The SARS has reconfigured the economy in Asia (2004) and in the rest of the world (2005) around the preparation of a pandemic. • There are almost no more poultry farms in Hong Kong. They have become biodiversity reserves.

13. Anthropological hypothesis • Why have sanitary crises in animal diseases (SARS, Bird Flu, Mad Cow Disease, Foot-and-Mouth disease, Blue-tongue, Blue ear) become so numerous in the last twenty years ? • One hypothesis : 9/11 has opened a new era of bioterrorism and biosecurity. Chickens have become « virus bombs » and China is ready to explode. • My hypothesis : sanitary crises in animal diseases are due to a contradiction in the same representation (or cognitive dissonance) between two views of the animal, as good to eat and as a dangerous living being. Humans have always been wary that the animals they have domesticated would revenge against them (J. Diamond : viruses are « the lethal gift of livestock »).But this cognitive contradiction, expressed as an emotion of fear, has become more important in urban societies, where the animal is not present as a living being but onlyas a food ready to consume. • The role of social sciences is to redraw the spectrum of actors implicated in a sanitary crisis and to make public their controversies, so as to give these crises their critical rationality, and explain why they are formative of modern individuals.

14. Actors implied in sanitary crises concerning animal diseases (SARS) Bat civets Merchants Microbiologists Agriculture Dept (H5N1) Wild birds poultry Farmers Veterinarians Media Consumer Food industry Physicians Health Authorities Bird Watchers Religious Authorities Representation of the animal Representation of the animal as a living beingas food