Preventing and controlling the spread of infectious diseases is one of the arguments for strong government institutions. But this argument is undermined if governments address emerging epidemic diseases in a ham-handed way. Concerns over responsibility and reputation all too often take precedence over the real task of saving human lives.
10MERS In South Korea
After the MERS epidemic began in South Korea in 2015, the Park Geun-hye government was accused of mishandling the crisis and possibly making it worse. Experts heavily criticized the official lack of transparency and the practice of shuttling suspected infectees between hospitals before putting them in quarantine, putting medical staff and the wider public at greater risk. Some criticized the government’s failure to create a centralized facility to concentrate care for infected patients, which would be more efficient and less likely to cause further spread of the disease.
Many were angered by the government’s refusal to name the hospitals treating those affected by the disease, greatly increasing public fears and Internet rumors. This was allegedly done to help hospitals avoid losses in revenue if the public was aware they were treating MERS patients. Instead, people on the Internet made up their own lists, and police arrested several people for falsely identifying specific hospitals as MERS treatment centers.
Firebrand journalist Se-Woong Koo believes the mishandling of MERS is representative of a political system perceived by the public as “a crony capitalist state run by corrupt elites who have monopolized power and the national economy, fostering government incompetence and popular distrust of the state.”
9SARS In China
Mao Zedong once bade “Farewell to the God of Plagues,” but the SARS epidemic in China highlighted serious problems with the way the government handles epidemics. Fears that the outbreak would create a bad image for China led to the government restricting information, which led quickly to public anxiety and rumors. Information controls within the official hierarchy itself caused critical delays.
A key report by a team of experts sent to Guangdong by the Ministry of Health early in the crisis was marked top secret, so it took three days to find a provincial health official with the authorization to read it. After it was finally read, the provincial government released a bulletin of information about the disease to hospitals, but this was read by few because many medical personnel were on vacation for Chinese New Year. Meanwhile, Chinese law prevented any public release of information about the disease, classified as state secrets unless “announced by the Ministry of Health or organs authorized by the Ministry.”
As the epidemic was spreading, Public Health Minister Zhang Wenkang still claimed, “China is a safe place to work and live, including to travel.” The WHO complained of government interference in efforts to control the disease, including preventing Taiwan and the WHO from having direct contact as China claims sovereignty over the country.
As the government played down reports of the disease and doctored statistics, wild rumors spread on the Internet. Some believed the outbreak was bird flu or anthrax. A circular appeared in local media outlining preventative measures, such as improving ventilation, using vinegar fumes to disinfect the air, and frequently washing hands.
The epidemic and botched response had a silver lining of sorts. It underscores the limitations of the Chinese system of “fragmented authoritarianism,” particularly when comparing the Chinese response to the more successful responses in Hong Kong and Taiwan.
8Cholera In Zimbabwe
As political tensions between the ruling ZANU-PF and opposition MDC were leading to violence in the streets, an outbreak of cholera erupted in Zimbabwe in 2008. The government initially tried to downplay the spread of the disease, which Robert Mugabe claimed was a part of a Western plot to invade the country and topple his government in a rambling speech where he called US President Bush and UK Prime Minister Brown “crooks . . . guilty of deliberate lies to commit acts of aggression.”
Hours after South Africa declared the border zone with Zimbabwe a disaster area, Mugabe announced the disease was under control, a claim denied by world health officials who complained the president had prevented a team of French specialists from landing in the country. But the country was soon asking for aid, as its beleaguered and declined healthcare industry simply could not cope. Even health minister David Parirenyatwa eventually admitted, “Our central hospitals are literally not functioning.”
In 2013, it was revealed that attempts to cover up the spread of the disease extended to the United Nations, as country chief Agostinho Zacarias had fired Georges Tadonki, the head of the UN’s Office for the Coordination of Humanitarian Affairs in Zimbabwe. Zacarias was closely tied to Mugabe, and Tadonki’s efforts to control the spread of the disease were deemed politically unacceptable to the government.
In a scathing report, a UN tribunal judge later ruled that “the political agenda that RC/HC Zacarias was engaged in with the Government of Zimbabwe far outweighed any humanitarian concerns that (Tadonki’s office) may have had.” In the end, the disease killed more than 4,000 people.
7Nipah Virus In Malaysia
An outbreak of the newly emergent paramyxovirus Nipah in the state of Perak, Malaysia, in September 1998 was initially assumed by the government to be an outbreak of Japanese encephalitis, which is endemic in Malaysia, spread by mosquito, and primarily affects children. The Nipah virus, by contrast, caused severe febrile encephalitis among pig farmers. It had been spread from flying foxes to pigs to humans through bat excretions landing in pig swill, possibly due to the migration of fruit bats to cultivated orchards due to fruiting failure in forests caused by El Nino and human burning efforts.
The Malaysian government’s initial attempts to control what it thought was Japanese encephalitis through fogging and mass vaccination had no effect on the spread of the disease. When cases were reported in abattoirs in Singapore in March 1999, the country banned the import of Malaysian pigs and controlled their small outbreak.
The outbreak of the disease in Malaysia was finally controlled with the culling of over one million pigs, while people were advised to conduct preventative measures such as using protection like masks, hand-washing after handling infected animals and pigsties, and washing down cages and vehicles for transporting animals with soap and water.
The disease wreaked havoc on the billion-dollar Malaysian pig industry, and a group of pig farmers tried to sue the government for their mishandling of the case. The farmers were angry to have engaged in fruitless efforts to control the misidentified virus, which led to more deaths and the destruction of many livelihoods.
6Plague In India
When an outbreak of the plague erupted in the city of Surat in the western Indian state of Gujarat, the response of the government was confused at best. There were mixed signals, with one government press release confirming the plague, while the chief minister of Gujarat denied it and said it must be pneumonia. The mixed signals led to panic among the population.
People wore masks and covered their faces with handkerchiefs in affected areas (which was ineffective at preventing infection), and in larger cities like Mumbai and New Delhi, many schools and public entertainment places were closed as residents chose to stay indoors. People in the neighboring state of Rajasthan killed rats to prevent the spread of the disease (which may have caused affected fleas to jump to new human hosts, spreading the plague further).
The correct diagnosis of the disease was limited by the medical equipment available, and the government tried to initially cover up the outbreak. It would take heavy pressure from nearby trade partners such as Bahrain and the United Arab Emirates to compel them to allow the World Health Organization to render assistance.
Even then, some in the WHO complained of Indian government delays and pointless squabbling over sharing of samples. The WHO intervention was controversial in the national press, and one member of the WHO team complained that the government was encouraging “science by the press.” Some refused to admit the plague originated in India, and rumors spread of genetically engineered bioweapons from hostile South Asian neighbors.
5AIDS In The United States
Some lay the blame for the 1980s AIDS epidemic in the United States squarely with President Ronald Reagan. When the first cases emerged in 1981, it became clear to health authorities that a real crisis situation was developing. But a slow response from the federal government led to delays in vital HIV/AIDS research due to lack of funding and little to no efforts made to develop an outreach program to control or prevent infection.
This is very likely because the initial victims were gay men, who suffered a great deal of hostile attention as the disease spread. Reverend Jerry Falwell said, “AIDS is the wrath of God upon homosexuals,” while Reagan’s communications director Pat Buchanan called the epidemic “nature’s revenge on gay men.”
It took until 1987 before Reagan publicly spoke about the AIDS epidemic, after 59,572 AIDS cases had been reported and 27,909 people had died. In the meantime, discrimination against homosexuals prevented serious work being done. Senator Jesse Helms of North Carolina amended a federal appropriations bill to prohibit AIDS education programs that “encourage or promote homosexual activity,” to prevent gay men from being taught how to have safe sex.
Some have argued Reagan’s political decisions were rarely influenced by religion and that his silence and inaction were calculated to avoid offending his base, largely made up of conservative Christians who saw the disease as a just punishment for sexual deviants and drug abusers. The cynicism and ignorance ultimately cost the lives of tens of thousands of people.
4BSE In Britain
The epidemic of bovine spongiform encephalopathy, or mad cow disease, began with the death of a single cow in West Sussex. While it first appeared in the 1970s, it had largely gone unnoticed but would eventually jump to humans. Controlling the outbreak involved the culling of millions of livestock, and the disease killed 176 British and 50 others around the world. The outbreak caused severe doubts in the reliability and honesty of UK governments in handling such outbreaks.
At first, the government denied any link between BSE and the human variant, Creutzfeldt-Jakob disease (CJD). Agriculture Minister John Gummer criticized schools that had taken beef products from their menus over the rising fears. At a political event in 1990, he tried to prove properly cooked British beef safe by feeding a hamburger to his daughter. She refused, so he took a bite himself and called it “absolutely delicious.”
It took until 1996, after several human cases had already been reported, before the government was willing to admit the danger posed by BSE. A 2000 report lauded government efforts to control the outbreak but admitted denialism and delays hampering the process. Poor communication and foot-dragging by civil servants, bureaucratic hurdles, and poor enforcement also made things worse. One key failure was the 1987 decision not to ban mechanically recovered meat from carcasses, considered risky, which then entered burgers and meat pies.
3Spanish Flu In Samoa
In 1918, Samoa was under the administration of New Zealand, and many blame administrator Lieutenant-Colonel Robert Logan for an outbreak of Spanish flu that killed 22 percent of the population.
The disease was brought aboard New Zealand passenger and cargo ship Talune arriving at Apia from Auckland on November 7, 1918. The ship had been quarantined when making a stopover in Fiji, but no precautions were made in Samoa. Sick passengers disembarked, and the disease was soon spreading throughout the main island of Upolu and to the neighboring island of Savai’i, overwhelming Samoa’s rudimentary medical facilities.
The governor of American Samoa offered assistance, as he had a staff of medical officers and assistants at the ready having recently controlled their own outbreak. Logan ignored the message, later claiming he assumed it was referring to his wife. He also broke off radio communication with the American Samoan capital of Pago Pago, apparently in revenge for a policy of quarantining Western Samoan mail. Samoa therefore received no medical assistance until an Australian ship arrived carrying four doctors and 20 medical orderlies.
Logan was inexperienced with administration and believed he needed to wait for instructions from Wellington before doing anything, so little was done to curb the epidemic. Plantation interests opposed a quarantine, and so much of the population was soon sick that there were food shortages. Many became more sick as they were weak from a lack of food.
A 1947 United Nations report would call it “one of the most disastrous epidemics recorded anywhere in the world during the present century, so far as the proportion of deaths to the population is concerned.” Logan left Samoa in early 1919, writing of the crisis in a report: “[It is] temporary and, like children, [the Samoans] will get over it provided they are handled with care . . . They will later on remember all that has been done for them in the previous four years.”
2Meningitis In Zambia
After an outbreak of meningococcal meningitis at Kabompo Secondary School in North-Western Province, Zambia, in June 2015, three students died and another three were admitted into the hospital. The slow reaction by the government to spread accurate information led to hysteria, as some students claimed the disease was caused by witchcraft. In a riot involving students and members of the local community on July 4, school property was damaged, and parents withdrew their children, who were claiming the school needed to be “cleansed.”
Conflicting statements from the Ministries of Health and Education soon suggested miscommunication was a factor in the chaos. On July 8, Health Minister Joseph Kasonde told reporters the school had been closed for two weeks, but Ministry of Education spokesperson Hillary Chipango said the school hadn’t been closed, merely that students were refusing to attend.
Critics of the government have blamed the lack of communication and coordination between the Ministries for the lack of accurate information about the disease, which can be treated with antibiotics and easily prevented. The information could have helped to prevent the spread of witchcraft rumors.
1AIDS In South Africa
South Africa had spent 15 years steadily fighting the spread of HIV, until the election of Thabo Mbeki. The new president had fallen under the sway of a group of scientific rebels led by Berkeley’s Peter Duesberg who deny that AIDS is caused by the AIDS virus and instead blame pathogenic factors such as drug use, promiscuous homosexual activity, blood transfusions, parasitic infections, and malnutrition.
Though their claims went against the vast weight of scientific evidence, Mbeki was convinced. Part of it may have been the cost of drug treatments, and AIDS denialism put pressure on international drug makers to lower their prices to be more affordable to ordinary Africans. Part of it was due to him believing the claims HIV was sexually transmitted was only a representation of traditional racist ideas about Africans being promiscuous.
The disease wasn’t caused by a virus, he believed, but general ill health and malnutrition. The solution wasn’t simply buying medicine from the West but improving the African standard of living.
Mbeki appointed a group of scientists who declared there were alternative treatments to combat AIDS. Until late 2003, the Ministry of Health refused to provide treatment to HIV-infected individuals. Health Minister Manto Tshabalala-Msimang declared in 2006 that AIDS could be cured by eating healthy foods like olive oil, beetroot, lemon, and garlic. She even presented a South African government display of fruits and vegetables at a Toronto AIDS conference. The following year, deputy health minister Nozizwe Madlala-Routledge was dismissed, ostensibly for corruption but in reality likely due to her outspoken views on the relationship between HIV and AIDS.
South Africa ended its official culture of denialism with the election of Jacob Zuma in 2009. A Harvard study found that Mbeki’s belief in quack science likely led to the deaths of over 300,000 people.
David Tormsen is your own personal patient zero. Email him at [email protected].