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April 10, 2003

Stephen M. Apatow
Director of Research and Development 
Humanitarian Resource Institute Biodefense Reference Library
Eastern USA: (203) 668-0282   Western USA: (775) 884-4680
Internet: http://www.humanitarian.net/biodefense 
Email: s.m.apatow@humanitarian.net

SARS: HONG KONG HEALTH SYSTEM AT BRINK OF COLLAPSE

The progression of the SARS pandemic is unprecedented.  According to a Reuters report "Hong Kong Health System on Brink as SARS Spreads," Thu April 10, 2003 11:48 AM ET,
<http://reuters.com/newsArticle.jhtml?type=worldNews&storyID=2544416>:

·  The deadly SARS virus has pushed Hong Kong's health care system to the brink of collapse, hospital workers said Thursday, as anxiety grew over the spread of the flu-like illness.
·  A quarter of Hong Kong's 1,000 cases of Severe Acute Respiratory Syndrome (SARS) are health workers and another 12 were confirmed with the illness on Thursday.
·  I am afraid that if more hospital staff get infected, the entire health care system would collapse," Peter Wong, a spokesman for three major nurse unions, told a news conference. He said Hong Kong government hospitals were not providing staff with adequate protective gear.
·  "We are facing an unprecedented situation. We are dealing with a serious, unseen threat," Singapore's Minister of Manpower, Lee Boon Yang, said on Thursday.
·  Hong Kong's public health care system, one of the most advanced in Asia, has been overwhelmed by the growing number of SARS patients.
·  The government earlier this week said it was preparing a "worst-case scenario" of an additional 2,000 cases by the end of this month. But isolation wards are already overflowing and essential surgery is being delayed. Trained staff are in short supply.

INTERNATIONAL HEALTH REGULATIONS

The topic of noncompliance to International Health Regulations brings rise to significant issues that now need to be addressed in a crisis responsive environment.  The following is an excerpt from the paper Globalization, International Law, and Emerging Infectious Diseases, David P. Fidler, J.D., Indiana University School of Law, Bloomington, Indiana, USA <http://www.cdc.gov/ncidod/EID/vol2no2/fidler.htm> that is spotlighted on the HRI Legal Resource and Assistance Center <http://www.humanitarian.net/law>:

"The effectiveness of existing international law on infectious disease control has been questioned. A 1975 WHO publication stated that the International Health Regulations have not functioned satisfactorily at times of serious disease outbreaks. More recently, WHO’s efforts with the International Health Regulations have been called a failure, and noncompliance with these regulations has increased in connection with reporting disease outbreaks. The HIV/AIDs crisis dramatically illustrated the weaknesses of the health regulations. Since AIDs was not originally (or subsequently) made subject to the regulations, states had, and continue to have, no notification requirements in connection with this new disease. Further, as HIV/AIDs spread globally, many states adopted exclusionary policies that, according to experts, violated provisions of the health regulations. In relation to one of the biggest disease crises of this century, parts of the International Health Regulations were irrelevant, and other parts were openly violated.

The International Health Regulations <http://www.who.int/csr/ihr/current/en/>* administered by WHO represent the most important set of international legal rules relating to infectious disease control, but the regulations only apply to plague, yellow fever, and cholera. The importance of health is mentioned in international declarations (for example, see the Universal Declaration of Human Rights, art. 25 [1]) and treaties (for example, see the International Covenant on Economic, Social and Cultural Rights, art. 12), leading some legal scholars to argue that international law creates a “right to health” (24); but this “right” does not directly address the control of infectious diseases."

* Reference link provided.

COPING WITH AN INTERNATIONAL PUBLIC HEALTH CHALLENGE

The serious implications of a public health emergency of this magnitude, in the context of globalization, presents a new challenge to the international community. The potential collapse of the health care system in Hong Kong would yield a direct geoeconomic impact illustrated in the ranking statistics from the Humanitarian Resource Institute report "Contingency Planning: Year 2000 Conversion: Global Infrastructure Analysis" <http://www.humanitarian.net/contingency.html> where China was in the Fourth-tier (66% Predictions of Infrastructure Failure) with the following global rankings:

#9 Total World Exports: Hong Kong
#1 Busiest Seaport: Hong Kong
#24 Busiest Airport: Hong Kong (People)
#4 Busiest Airport: Hong Kong (Cargo)
#11 Teledensity: Hong Kong
#10 Total World Exports
#6  Hard Coal  31 Mt  6.3%
#11 Busiest Seaport: Shanghai, China
Enterprises: 8,612 Firms:  Percent of SME's: 99.9: PRC
#3, 24 (Top 25 Banks)