Published on April 20 , 2005 - Gaining public trust through transparent communication is a vital component to managing a major influenza outbreak. It remains unclear whether the government will make this a priority. This is the second of a three-part series.

It was standard procedure. Last June, an outbreak of a new strain of an existing virus known as Fujian influenza emerged in China and was responsible for deaths in Europe and North America. Finding the virus present in Thailand, Dr Somsong Rugpao, then director-general of the Medical Science Department of the Public Health Ministry, issued an advisory for all those travelling to China, as well as the young and elderly, to obtain vaccinations.

But these were no longer times for standard procedure. The very next day, Somsong was strongly reprimanded by then public health minister Sudarat Keyuraphan.

“She told me that Prime Minister Thaksin had been very upset during the Cabinet meeting and stated that, ‘Every time [Somsong] opens his mouth the stock market goes down’,” Somsong recalls. “Everyone thought I would get fired”.
It was clear to Somsong that in the post-Sars and current bird-flu era, the government was seeking to avoid negative publicity on public health issues.

Somsong retained his job until his retirement last October. However, doctors in epidemiology circles still cite his case as part of an ongoing resistance they feel exists toward issuing influenza warnings. In late 2003, Somsong was also one of the first doctors to internally call attention to avian influenza in Thailand’s poultry industry. It was not until the end of January 2004 that the government actually went public.

Senator Nirand Pitakwatchara, himself a medical doctor, is outraged at the scale of the cover-up. He points to the fact that the government knew as early as January 16th of that year that the first human case of bird flu was suspected, and it was confirmed three days later. Yet on January 20th - the day after it was confirmed - the prime minister and his cabinet staged a chicken lunch for the media to assure the public that bird flu was not a problem in Thailand.

Sources have informed The Nation that lab test records were altered to coincide with the public announcement that eventually came on January 23rd. Nirand believes official lab test records for avian flu in poultry were also “manipulated”.

“Ask any medical student. They can tell you how easy it is to write a lab record the way they want it,” he says. “Even as a senator, I was refused access to those records. How am I supposed to believe there will be transparency next time?”

Somsong stresses that the government still operates in an atmosphere of fear when it comes to disclosing information to the public. Such was again the case last September when the second round of bird flu began to flare up.
After a five-month lull, a new human infection in Prachin Buri province was confirmed.

A rapid surveillance team from the Disease Control Department went to the patient’s village and found infected poultry.
Despite this evidence, the Agriculture Ministry refused to announce that another outbreak had occurred.

“There were infected chickens around his [the patient’s] house; he was infected. How could you deny there was bird flu?” asks Dr Kamnuan Ungchusak, director of the Epidemiology Bureau, who was on the response team. Without conscious resistance to the pattern of denial, Somsong fears there’s little hope that the public will be sufficiently informed when a more serious epidemic or pandemic occurs in Thailand.

“Many doctors are working hard within the system, but nobody is going to stick their necks out like me, so let’s hope that the new minister, who is a doctor, [Dr Suchai Charoenratanakul, recently appointed public health minister] might be able to make some changes.”

Such change would be timely. There is growing concern now because the H5N1 virus has become endemic to much of Southeast Asia. Scientists say the longer it is part of our environment, the greater is the chance a strain will evolve into a form that can spread easily between humans and the resulting global pandemic may kill millions of people.

Suchai, new public health minister, does not concede that there have been disclosure lapses in the past, and insists the public can feel confident it will be informed at the earliest possible time, once there is an influenza outbreak. The ministry is currently developing its capacity to diagnose the disease as quickly as possible, he says.

But merely alerting the public that a pandemic has arrived is too little, too late and sure to generate widespread panic and chaos if left to such a late stage, argues renowned social critic Dr Prawes Wasi, from Siriraj Hospital. He says the public needs as much information as it can get now.

Minister Suchai counters that the ministry should only release information in accordance with professional understanding, and the public will know as soon as necessary.

“We don’t want public panic now,” he says. “In the meantime, we are preparing internally. We also have health volunteers [at village level] who are alert and ready to report influenza cases. Thailand is ready.”

Dr Scott Dowell, director of the US Centres for Disease Control’s Bangkok office, tends to agree. “We have to understand that there is no pandemic now,” he says. “What we try to do is to make preparations. There is no need to create panic. Thailand is doing an excellent job.”

Such opinions appear to counter those of the World Health Organisation, and even the current draft US Pandemic Communication Plan, which outlines specific activities during pre-pandemic periods to increase awareness of pandemic influenza. It also advises preparedness activities including dissemination of information and mobilising the media and non-governmental organisations to aid in pandemic education efforts.

Prawes strongly supports such ideas. “There’s going to be panic and economic impact regardless. We might as well get people educated now so they can be better prepared when the time comes.”

Kamnuan from the Epidemiology Bureau believes there is a way to prepare the public without causing panic.

The ministry has launched a campaign for “desirable” healthcare habits by promoting hand washing to stop disease transmission and encouraging people with colds or flu to show social responsibility by wearing masks. “We want to make people adopt these habits into their daily lives,” he says.

“There is no need to give too much detail about the whole purpose behind our campaign.”

But public health advocates ask: why not more? “Why can’t we have all the information released in the most truthful manner?” asks Virapong Kriengsinyos of the Thai Healthcare Foundation. “It’s okay to scream fire as long as it is followed by good instructions on how to respond.

“If we already know what to do early on, the panic won’t last too long.” Virapong believes the public’s role in getting prepared is just as important - if not more so - than the government getting prepared.

He says the sooner people know a pandemic is imminent, the more eager they will become to know how they should respond, and this is the key to minimising disease transmission when the pandemic arrives.

Nantiya Tangwisutijit
The Nation