From Inter-Governmental Conflicts To Administrative And Political Incompetence: A Summary Report Of The Streptococcus Suis Outbreak In Sichuan, People Republic Of China
T Lee. From Inter-Governmental Conflicts To Administrative And Political Incompetence: A Summary Report Of The Streptococcus Suis Outbreak In Sichuan, People Republic Of China. The Internet Journal of Healthcare Administration. 2005 Volume 4 Number 1.
This article examines the recent outbreak of
The recent outbreak of
As far as the sources are concerned, this report relies on newspapers, news bulletins and periodicals in both Chinese and English languages, collected between the period of July 25 (when the Chinese officials first notified the media) and August 10 (until times when no more new case was reported). Because the Chinese government has not released all the reports about the
Beginning with a chronological account of the
The Outbreak Of In Sichuan (June 24–August 5, 2005)
On June 24, 2005, the local hospital in Ziyang city in Sichuan received 20 patients showing symptoms associated with severe infection, meningitis and Toxic Shock Syndrome (9,12,13). There were 9 deaths and the rest were hospitalized throughout the summer (1,9,29). Some patients died as soon as 19 hours after the first identified symptom (14). All the patients were either pig farm workers or worked closely with pigs. They all had wounds on their bodies at the time of admission (1,9,29). However it was until July 21 that the outbreak of
– A Common Pathogen For Pigs
The pathogenesis of
Human infection with
The Chinese Government's Responses To The Outbreak
Shortly after the
Compared with the previous experience of dealing with the SARS and avian influenza, the central government was more determined and efficient this time (27,). It sent a team of medical experts to Sichuan and delivered large amounts of vaccines and drugs to the affected areas with desperate effort to control the epidemic (21,27,). It also implemented immediate control measures such as stamping out, quarantine, screening, control of human movement in the countryside, and zoning (28,). Other provinces also banned and recalled all the Sichuan produced pork products from the market as precautious measure (23,25,). These effective measures helped contain the outbreak and there was no reported case of infection in early August. After the crisis, two provincial and four regional/rural government officials were sacked for their administrative failure (3,26,).
The Hong Kong Government's Responses To The Outbreak
By comparison, the Hong Kong government failed to come to grips with the
The local public felt rather frustrated with the insensitivity and incompetence of the Hong Kong government officials. The mass media and the local politicians severely criticized the Health, Welfare and Food Bureau for its failure to impose a ban on pork products from Sichuan and overly relying on the central government to lay out strategic intervention (18,22,23,24,25). What made the situation worse was that the Hong Kong government previously banned all the beef products importation from the whole countries of Japan and the United States after hearing the outbreaks of mad cow disease, but it did not dare to apply the same policy to China due to political pressure. (18,19). It was only until the Chinese central government banned the export of pork products from Sichuan to Hong Kong and abroad on July 28 that the Hong Kong government survived yet another political crisis (22,23,34,35).
A Closer Look At The Outbreak In China
In the recent outbreak, Sichuan provincial and rural government must take the blame for its failure to handle the crisis immediately. Government officials' lack of responsibility, poor attention to work and low awareness to urgency were blamed the most by public and media for causing the recent devastating outbreak and heartbreaking lives-losses (20,21,22,). In the past, whenever a widespread infectious disease or food poisoning outbreak occurred and dead were resulted, officials were often being sacked from their positions by seniors in the central governments consequently. For the sake of protecting their positions, many provincial officials often prefer to ignore whatever matters that may held them accountable rather than appealing to the central government for help, as shown in this recent outbreak (21,33,). This policy of denial reflected a culture of collective irresponsibility in the Chinese official bureaucracy. It was only when the national media reported the outbreak that the central government had to step in and implementing strategic interventions to prevent the further escalation of the disease outbreak.
Absence of effective public health surveillance and failure to implement an efficient properly–prepared public health infrastructure to deal with immediate epidemic threat may have also contributed to the recent
On the other hand, medical service in China often requires the user to pay for the service, many farmers are just simply too poor to afford medical treatment (30,). Therefore, it is not surprising to see many people in rural China would often retrieve to self-treatment via buying drugs over the counter and choose to wait until time when medical treatment becomes an absolute necessity before actually seeking for medical assistant (36,). Prolonged suffering may be the primary result of delaying medical attention; it may also mean increasing mortality and enhancing further spread and transformation of diseases (30,36,38,).
Besides the failure of the government officials in handling crisis, farming malpractice was also thought to be one of the factors attributing to the
The increasing overpopulation of farming animals creates a favourable environment for the pathogens. As there is a huge demand for pork products in China and abroad, Chinese pig farmers have to increase the supply by introducing foreign species for mating and using steroid (21,). However, the ever-expanding pig population was not accompanied by the increase of physical space in the farms. Therefore, suboptimal conditions of poor housing with inadequate ventilation and hygiene created an “optimal breeding ground” for the bacteria to harbour and develop, enhancing the possible development of animal epidemic. Inadequate housing also forced farmers to live closely with farming animals under a poor and unhygienic environment and thus increase the likelihood of animal pathogens transmission from livestock to human as well (4,12,33,38,). On the other hand, the abuse use of steroid may also cause suppression of pigs' immune system, making them vulnerable to many different pathogens. Hence, also increase the likelihood of animal diseases pandemic among farming animals (21,33,).
Another form of farming malpractice blamed for the cause of the epidemic was the inappropriate use of human antibiotics. Farmers in rural China often have little to no access in acquiring basic health related knowledge and skills to protect themselves and their livestock against various diseases (29,). The misuse of human antibiotics and steroid by pig farmers in Sichuan is just one of the examples (32,33,). Many farmers often know nothing about disease transmission and preventive medicine; they often assume antibiotics to be an “omnipotent super-wonder-drug” for curing diseases and steroid to be the “amazing meat boosting agent” used to fastening growth and maturation for their livestock (21,33,). However, the cost associated with the use of appropriate veterinary medicine is just too high for many farmers who are already living under poverty in rural China to afford. Therefore, many use expired human antibiotics, a cheaper alternative available almost everywhere in rural China, to treat sick animals as well as to prevent animals from getting sick (21,). As a result, besides being useless in curing sick farming animals, human antibiotic-resistant bacteria were also created, making treatment for animal-pathogenic infection in humans increasingly difficult as well (14,33,). This may also partly explain the reason behind the failure of multiple-antibiotic treatment among some patients as experienced by medical staffs during the recent outbreak (14,).
The persisting poverty problem in the rural agricultural districts is often the very underlying factors of causing many widespread uncontrollable epidemic outbreaks in the past (30,), and it is especially noticeable in the recent
On the other hand, the earning of farmers is often under the mercy of business sectors that acquire their products in extremely low cost whilst distribute their products for a very luscious profit. Since many farmers are often poorly educated with little knowledge of marketing mechanism, they simply have less bargaining power against unfair trade deal, besides contributing to the poor farming practice and neglect of self-care as aforementioned earlier. As a result, allowing the continuation and intensification of poverty problem in the rural China. It is also because the poverty problem that, for many farmers, livestock is their valuable asset and investment and killing sick animal is simply not an option (33,). By fastening the growth and maturation of pig via the use of steroid in this case, farmers could sell the pigs before they fall ill or died from their illness. However, for those dead pigs that do not live up to the time of maturation, farmers often choose to eat the dead animals themselves and fall ill consequently as indicated by some of the infection cases in this outbreak scenario (21,33,). Some farmers may go as far as selling the dead animals through illegal channel as well (33,).
The Impacts Of The Outbreak On Hong Kong
In Hong Kong, the lack of response to the
Second, most of the Hong Kong officials are not familiar with the form of governance in China. Nor do they have experience of dealing with their Mainland Chinese counterparts over public health issues. Whenever there is an epidemic or food poisoning outbreak in China, the Hong Kong government is always passive and incapable of implementing any immediate crisis management policies (24,). It is especially truth when these crisis management policies may affect the economical interest and reputation in all level of the Chinese government.
Further evidence of this ambiguous relationship between the Hong Kong and Mainland Chinese governments can be found in the management of the heavily polluted and toxic water imported from the East River (
As China is embracing the stronger economical growth while integrating itself into the global economy, there is an increasing flow of people and goods from China to the rest of the world. This highly globalized and mobilized environment also facilitates the spread of diseases and troubled food products. Although the Chinese central government is aware of this issue, it is still beyond its ability to implement an effective public health system at the national and regional levels. As the 2008 Olympic Game is approaching, the Chinese government has yet to find a comprehensive solution to the frequent outbreaks of epidemics. Otherwise, China will not be a safe environment for its citizens as well as for athletes and tourists from around the world (36,). To build a nationwide public health surveillance system and to implement an independent food monitoring system may be the good steps in the right direction towards creating a healthy society. This should be followed by the improvement of educational and medical facilities in the countryside, the increase of public and private investments in remote areas (30,36,), and the development of an independent and critical mass media.
Hong Kong, claiming to be China's gate to the world and the world's gate to China, must be assertive in defending its public health system and making a correct political decision based on available scientific information even at the risk of being criticized by the central and provincial officials (31,). Otherwise, the so-called “one country, two systems” formula is only an illusion and Hong Kong would become the gate of Chinese epidemics to the world as seen in the spread of SARS from China to Southeast Asia, Europe and Americas in 2003.
I would like to thank Prof. Joseph Tse-Hei Lee of Pace University for his comments and help with editing of the paper. I would also like to show my sincere appreciation to Mr. David J. Padula from South Australia Research and Development Institute (SARDI) for his many insightful ideas for the project.