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