China's risk communication to date about H7N9

by Jody Lanard

April 6 2013

China CDC Candor, Shanghai Health Bureau over-confidence, Xinhua courage

In its communications about the H7N9 outbreak in humans, China has so far been remarkably candid, timely, and not over-reassuring, compared with past Chinese communication during alarming situations.

(These notes were written between April 2 and April 6, 2013.)

(Below: addenda added along the way.)

Unless we learn otherwise, China seems to have reported very early. I hope this means they have learned a tough lesson from past cover-ups and delayed reporting, and are determined to do it right this time.

I was pretty impressed by the China CDC statement on 3/31, which included this line:

"But we cannot rule out the possibility of human-to-human transmission until we know more about the virus characteristics and results from ongoing investigations.”

This sounds so “ordinary,” but is actually highly unusual for China to acknowledge uncertainty like this. It embeds some “anticipatory guidance” that things might get worse. It puts the reassuring information first — no known cases of H-2-H spread -- but ends on a note of caution, as Peter Sandman and I always advise. (“Put the current good news in a subordinate clause, and end on a note of caution,” in uncertain situations that might get worse.)

If these really are the first cases China has found, they deserve kudos for early reporting and non-over-reassurance.

Unfortunately, lower down the bureaucratic chain, the mega-overconfident over-promising has begun re: H7N9.

On April 2, the head of Shanghai’s health bureau stated:

"The health bureau will take effective and powerful measures to prevent and control the disease, to make sure the flu epidemic is effectively guarded against and to safeguard the health of the city's residents."

Such categorical promises!  Why not “try to” or “strive to”?

But at the top level, the China CDC keeps emphasizing its intention to be transparent and timely.

And amazingly, the official government press agency, Xinhua, has been allowed to editorialize about past government misbehavior like delayed reporting and lack of transparency (see link below).

Along with the rapid deposition of sequences in gene databases, these examples strongly suggest that China is officially and strongly pushing open-ness. In subsequent official statements, they have repeatedly told others (and reminded themselves!) that they are doing so. They are inviting the world to hold them to their promise.

I am cautiously very pleased.

Here is a link to the astonishing April 3 Xinhua editorial, "Ten years after SARS, what has China learned?" Especially note the last very punchy line:

"If there is anything that SARS has taught China and its government, it's that one cannot be too careful or too honest when it comes to deadly pandemics. The last 10 years have taught the government a lot, but it is far from enough."

Like the China CDC statement on March 31, the editorial ends on a note of cautious warning.

I never expected to see such a bold critique from Xinhua. I assume this is being done with the blessing of the government. If that is true, it is a very good sign indeed. 

April 7 2013

Influenza Control Theatre: Nat'l Health and Family Planning Commission misleads the public

Did I speak too soon? Woke up today to find the headline China confident it can control bird flu outbreak (Reuters article).

Excerpt:

>"We are confident we can effectively control it (H7N9)," the head of China's National Health and Family Planning Commission Li Bin told Reuters on the sidelines of a World Health Organization-backed event in Beijing.

>Li did not elaborate, but she is the most senior Chinese health official yet to publicly comment on the subject.<

China CDC should push the National Health and Family Planning Commission and Shanghai Health Bureau to stop overpromising! It's bad for credibility, and it motivates undue response measures to "look like you're doing something."

At this point, culling poultry — along with airport temperature monitoring -- is Influenza Control Theatre: misleading and a waste of resources. 

We cannot “control" influenza. We can only try harder to be honest about that reality, and try harder to influence the course of the outbreak. 

***

Full disclosure: I have conducted a leadership seminar (jointly with Peter Sandman) and three workshops (on my own as a WHO consultant) with China CDC officials on about four occasions between 2007 and 2011. Also as a WHO consultant, I participated in a workshop for Shanghai health bureau and other officials in preparation for Shanghai Expo 2010. I don't see any signs yet that I was helpful to Shanghai officials.

Comments

[RK]

I keep reading how WHO says "no proof of H2H spread".
I'd like to see proof of NO H2H spread. Where is the widespread testing of Humans? I see them testing animals and birds... why not people?

Why isn't WHO on the ground in China? So we have to take China's word on this? We know how that worked out in 2003.

When they say contacts show no abnormalities, have they done actual testing on them? Why don't we have results for the 2 suspected patients in Hong Kong?? How long does this test take? Are they waiting for Tamiflu induced negatives before announcing?

[Jody Lanard M.D.]

Thanks for the comment, RK. I'll respond conversationally.

RK: I keep reading how WHO says "no proof of H2H spread". I'd like to see proof of NO H2H spread.

JL: That would be nice. But it's hard to prove a negative. Usually the best you can get is repeated failure to find a positive, after intense searches, by reputable, highly-skilled and trustworthy disease detectives who are given wide-open access.

RK: Where is the widespread testing of Humans? I see them testing animals and birds... why not people?

JL: I just read today that China is starting more widespread human testing, beyond the provinces where confirmed cases have been found. Can't vouch for it myself, obviously.

RK: Why isn't WHO on the ground in China?

JL: I promise you, WHO is DYING to get an international team on the ground. All that fluff in the media about "WHO is considering sending a team" is code for: "When the @#%$#^@ are they gonna let us in?"

RK: So we have to take China's word on this? We know how that worked out in 2003.

JL: You took China's word for it in 2003? Did you notice you were the only one?

RK: When they say contacts show no abnormalities, ... Are they waiting for Tamiflu induced negatives before announcing?

JL: I also cannot prove a negative. But I have seen absolutely no evidence of the "secret Tamiflu blanket" phenomenon described on some blogs that make my skepticism look like naive credulity. I have not met a single expert or insider of any sort who thinks that has been going on -- or that it would be likely to work, if it were tried. And in this case, the horse is long since out of the barn. There's no "remote Thai village" with a small "outbreak" to smother with Tamiflu.