Can a Disease Outbreak Help a Country?

When public health expert Harris Pastides was in Kenya in the 1980s, he couldn't believe how brazenly the government was lying about its health crisis.

At any health-care facility, he said, "you could physically point to the ones who were HIV-positive and stumbled into the hospital to die."

The hospitals were "overflowing" with AIDS patients, he said — yet the Kenyan government continued to insist that it did not have a problem.

Two decades later, the country still hasn't drawn much attention to the problem, and at least 10 percent of its population is HIV-positive, threatening an even graver crisis.

Pastides' experiences in Kenya seem familiar today, as information emerges that China had been covering up its troubles with the infectious disease SARS, or severe acute respiratory syndrome.

Since the revelations, however, Beijing has dealt with the crisis far more publicly, revising its estimate of SARS patients sharply upward, and getting rid of the capital's mayor and the national health minister in perhaps the most public sackings of public officials since the Communist Party took over in 1949.

Beijing's actions have impressed a number of observers because the Chinese government is known to be one of the most secretive and insular in the world.

But public health officials like Pastides, the dean of the school of public health at the University of South Carolina, say transparency is simply in a country's best interests — as Kenya's case shows.

General transparency is something desired by the world community, and as one of the largest countries in the world — in both size and population — China's attempts at transparency are especially heralded.

There has been some speculation SARS may be the tear through which sunlight penetrates China. If so, disease might not only be a negative thing, but a positive thing, too.

Self-Interest at Heart

Throughout history, human beings have continually faced epidemics of new pathogens: the bubonic plague centuries ago, cholera one century ago, HIV this century. "SARS is only the most current example," Pastides said.

Each time a community has been faced with an epidemic, it has been human nature to play down the situation. There's the natural inclination toward optimism, and there's the inclination to look at an epidemic in relative terms.

But the primary reason for concealment is self-interest, according to Robert Blendon, professor of health policy and political analysis at Harvard University's Kennedy School of Government.

"Cover-ups are all related to the same thing: People are afraid of the economic impact," he said.

Much has been made of SARS' economic impact in the age of easy global transportation, but epidemics have been part of free trade as long as the concept has existed.

Port cities were typically the first places to be struck by epidemics, and at the time, public health authorities weighed the same decision they do today: alarm the populace and save lives, or anger and jeopardize the merchants' businesses with word of an outbreak.

This relationship between public health and commerce was so close that public health authorities wielded considerable power, Blendon said. They had the authority to shut down ports, confiscate shipments and burn them as they thought necessary.

Best Advice: Ask for Help

Ironically, the natural instinct for self-interest is not well-served by the natural instinct to cover up. "In retrospect, almost every regime understands that being honest up front is the safest route," Blendon said.

Thailand provides a good counterpoint, experts said. When HIV first emerged, the country was thrown into crisis, in part because of its large population of commercial sex workers.

But it has been more open than many countries about its health problems. Public authorities brought condoms to Thai brothels and bars and engaged in programs of public education.

With such measures, "you'd think 'Oh my God, who wants to go to a place with such disease?' But tourism has come back," said Pastides.

There is also a clear economic gain from admitting your health issues as well, he added: The international aid community won't give you any money if you don't admit you have a problem.

Experts were careful to note that the issue of HIV is an inexact comparison to SARS, because ignorance and cover-ups of sexually transmitted diseases are not only motivated by economic interests but moral stigma.

"There's [also] some fundamental difference because the mode of spread is so different," said Dr. Kenneth Mayer, a professor of medicine and community health at Brown University Medical School in Providence, R.I. But in general, he said, "there's some parallel here."

The Philippines, Taiwan and Vietnam have all been open about their SARS problems to some degree, Pastides said, and this week the World Health Organization proclaimed Vietnam the first country to contain SARS.

However, experts acknowledged that sometimes full disclosure can be dangerous. In 1976, President Ford was convinced that swine flu boded terrible things for the nation, and put into effect a number of measures, including vaccines and quarantines. But in the end, Blendon said, "more people died from the vaccine than the disease."

Now, in the computer age, when news of an outbreak can be relayed to millions of people around the world in an instant, public health officials face a greater challenge.

"I think with a public health epidemic, transparency at the outset is a double-edged sword," said Mayer.

"People only remember the economic loss; they're not grateful to you for preventing a thing that never happened," Blendon said.

A Unique Circumstance

While the lessons of disease might encourage openness, some political and business observers cautioned that China might be a unique example.

SARS' effect on politics in China will depend on the extent of its impact, said Nao Matsukata, an international trade expert at Hunton & Williams, one of the world's largest law firms. "They're not going to learn the lessons unless they get whacked economically from this."

While cities like Toronto and countries like Vietnam early declared their SARS problems, and have since been deemed clear; China continues to struggle.

It has closed most public venues, shut down several stock exchanges and even shortened its annual weeklong May Day celebration. The government has discouraged travel, causing major carriers to cancel a vast number of flights.

But even that might not be enough. Those who work with China in general have accepted Beijing's opaqueness as a cost of doing business, Matsukata said.

There's a "frontier mentality" about China, he said. Businesses working with China see it as a sort of marketing and merchandising gold mine by virtue of its size, he said, and are unlikely to be scared off by a disease outbreak.

Matsukata agreed with the idea that disease outbreaks in other countries might cause more transparency, but not in China.

"In an already open economy, the responsibility creates more transparency and efficiency, but in this case, I'm not sure we're going to see that," he said.

Kenneth Lieberthal, a China expert at the University of Michigan, also said it was too early to tell what kind of impact SARS would have in China.

Like Matsukata, he sees SARS playing out in a unique fashion in China. However, he is more optimistic.

"It's worth keeping in mind that [the Chinese leadership] had before SARS outlined goals for the system to have more transparency than there had been," Liebenthal said. "SARS plays into and reinforces that goal."

Leaders in the business community and the legal community hope China reaches that goal, but perhaps the most urgently concerned are those in the medical community.

"New diseases are constantly emerging," Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, told ABCNEWS in statement. "We must always be prepared for the unexpected."

Diseases like SARS require global awareness and collaboration, she said: "U.S. health and global health is inextricably linked."