Rate of flu spread normal : Witthaya

Q : Did the Public Health Ministry make any mistakes regarding measures to prevent the type-A (H1N1) influenza?

A : Preventive measures by the state will never succeed without cooperation from the public. The 2009 flu spreads from human to human. The government may limit part or all travel but that measure has never proved successful. For example, Mexico closed the country for seven days and the spread of the flu was still very severe.

I think Mexico may need to close the country for the second time. Shutting the country does not create immunity. You can create immunities in two ways - for individuals and for the entire world through vaccination.

When there are no vaccines, everybody must protect themselves so that they won't catch the flu. Preventive measures by most countries of the world have proved ineffective.

At present Japan has the best measures. Its people wear face masks, stay at home and wash their hands frequently.

Q : Does that mean the measures set by the Public Health Ministry are failing because people don't cooperate?

A : It is a pandemic, and not a failure. It's something you can't avoid. We tried to put off the start of the outbreak in Thailand. But when it arrived in the country, we found measures to tackle it. We are not only the Public Health Ministry but also the advisory committee on public health strategies, whose members consist mostly of experts on influenza from outside the ministry. We have never strayed off the path.

Epidemiologists predicted the outbreak and what the Public Health Ministry can do is to prevent an influx of patients into hospitals. Our policy is to ensure flu patients going to hospitals are at a controllable level.

Q : It seems the epidemic is expanding faster.

A : Not rapid, it's normal. But the expansion globally started from Mexico in March. Up to now the flu has been found in 110 countries all over the world due to the ease of transport.

Q : Compared to other Asian countries, Thailand appears to have seen a faster spread.

A : Thailand is a hub of air transport so the flu certainly arrives here earlier than in Laos, Cambodia and Burma. More than 30,000 passengers disembark at the Suvarnabhumi Airport every day. Many people say Laos, Cambodia and Burma are less advanced than Thailand but there are fewer deaths in those countries.

We may also wonder why the United States, which is more advanced than Thailand, sees more deaths than our country. The US is adjacent to Mexico. Logically speaking, we are talking about something we have never known before. It is a new flu and even the World Health Organisation did not know it.

Q : What has been your major concern dealing with the influenza over the past three months?

A : Everything is new, for both the Public Health Ministry and the general public. The ministry may have made some inaccurate estimation because this is new for us. I asked experts from the Bureau of Epidemiology and the advisory committee whether the ministry made any policy mistakes, or whether the measures were too strong or too weak, and all the institutes insisted we did right.

Q : Why did Chuan Leekpai [former Democrat Party leader and its current chief adviser] oversee the measures himself if they were successful?

A : He offered me comments every week and I called to consult with him from the beginning. He suggests that the Public Health Ministry has to speak the truth and I stick to that advice. Whatever the ministry knows, the people must know.

Q : In your view, what message caused misunderstanding about the outbreak?

A : I think it was the message in the initial period that the flu was not severe and that 90 per cent of patients would be cured while the remaining 10 per cent were among the risk group. I thought the risk group referred to people in risk of contracting the flu.

But according to the medical reports presented worldwide, the risk group refers to people with a risk of serious illness or death. People initially had had expectations because we prevented the flu from entering the country for 40 days.

On the 46th day, the flu entered the country and people became disappointed. And they lost their confidence with te first death. People thought there should be no deaths.

According to medical and public health statistics, about 10 per cent of patients require treatment. But people expected Thailand would have no deaths, which is impossible.

Q : What to be done to restore the confidence?

We must speak the truth. We spoke the truth incompletely; for example, we talked about the risk group and people found that patients included people with good health. In fact, we intended to say that the risk group referred to people in risk of death.

Everyone on this planet has an equal risk of contracting the flu because it is new and nobody has the immunity. Closure of schools and the country, as well as suspension of activities in public places can just slow down the spread but it does not create immunity for everyone.

Whenever the activities resume, the virus will be back.

Q : Is there any timeframe for the pandemic to stop?

A : In theory, it will stay with us for a long time. Experts around the world have no ideas when the spread will stop. To restore public confidence, we must let people know the facts.

Thailand is not isolated and the flu does not spread only in Thailand. Reports from each country depend on the efficiency of case reporting. I discussed with the World Health Organisation as to why our country's figures went so high in this region.The WHO's answer was that it depended on the efficiency of reporting. Effective reporting led to the high numbers.

Q : Is there any assessment about public reaction to the weekly reporting of deaths?

A : The Department of Mental Health found that the mental health of people improved because they no longer were pressured by the daily increase in deaths. I think this is a major shift in wellness behaviour for Thai people and a great awareness for humanity.

Humans must prepare for new diseases and unexpected natural disasters. This has been said for a long time but when it happens, everybody can't cope and they are all affected.

Q : Is the rise in figures going to affect the government's stability?

The Public Health Ministry is sorry every time there is a death. In my position, I am aware the fatality figures point to a decline in public confidence towards us. \

So what we should do is to regard every patient as an important person. Every morning when I wake up I make calls to check where there are many patients and those being hospitalised. I must offer encouragement to the doctors and I don't make calls to scold them. It won't make the doctors treat their patients better to take them to task.

Q : As the public health minister, what are you going to do in taking responsibility when the epidemic gets worse?

A : The problem is how worse should I take the responsibility. Up until now, it must be determined if the Public Health Ministry did anything wrong.

If you talk about political responsibility, it is easy for me because I paid nothing to get this position. Throughout my life I have never worked so hard as I do these days.

Q : Does the public health minister know the 2009 flu better now?

It is not over yet. I am learning more and more.

A : That may imply you don't know well enough.

Thailand is not the only country to look into the 2009 flu. My question is whether the World Health Organisation knows enough about the 2009 flu. Are we better than they are? And do they know everything yet?

They just said last week that pregnant women are among the risk groups. We talked about it one week earlier. People who act as if they know a lot may know nothing.

Q : Opposition attacks say the wrong signal in the beginning led to deaths.

A : I asked epidemiologists and they said 90 per cent of people who catch the flu can be cured when they have paracetamol. Some people don't even need medicine and get cured. We have found 8,000 patients but there are 400,000 to 500,000 who catch the flu. The question is if it is serious for everyone to be admitted to hospital.

Today there are only 30 in-patients even though there are many others who are examined at hospitals. But most of them can go home shortly. We said the situation was not serious but we did not mean there would be no deaths.

I admit the ministry made some communication mistakes but we did nothing wrong involving the principles. Misunderstanding was caused when compared to the avian flu. But the spread of the avian flu was limited because the birds could be culled.

Q : What is your highest concern in dealing with this matter?

A : I am worried about the high number of deaths. I want to see the deaths decrease. In my position, I can't scold any doctors or they will resign to work at private hospitals instead. It is no fun to say how we can reduce the fatality rate when there is a shortage of doctors.