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Speech by PSHWF at Hong Kong SARS Forum


Following is the speech (English only) by the Permanent Secretary for Health, Welfare and Food, Mrs Carrie Yau, at the Hong Kong SARS Forum today (May 10):

Distinguished guests, ladies and gentlemen,

Thank you for the opportunity to speak with you today on this very important subject.

Fourteen months ago we were faced with a virulent new disease about which we knew nothing. SARS (Severe Acute Respiratory Syndrome) began killing before it was even given a name, and it brought much tragedy.

The first epidemic of the 21st century showed us the attributes of an emerging disease in the modern world: the spread was swift, the virus was deadly, and the threat was global. If we can learn the lessons of this epidemic and gear up our efforts, in terms of both research and government emergency preparedness, we can get our healthcare system more ready to meet future public health challenges.

This forum gives us an opportunity to meet with health care experts from all over the world to share knowledge on different aspects of SARS. I would like to share with you what the government learnt from last year's experience, so we can take a proactive, city-wide approach to managing public health crises. Three of the lessons we are taking very seriously are the effective use of IT, the importance of risk communication, and the strategic role of a command structure for emergency response.

The contribution of IT to containing the spread of SARS in Hong Kong was remarkable. We could never have controlled the epidemic as well as we did without employing a computerised information and communication systems to process the data we had as the virus was spreading quickly through our densely populated city.

During last year's outbreak, it became clear that to contain the spread of SARS in the community, we needed to locate and isolate people who may have contracted the disease - and we needed to do it quickly. The conventional methods - interviewing and paperwork - were too slow and cumbersome. But we had no time to build a new system.

So we turned to the police. The Department of Health and the Hospital Authority had set up databases, which we hooked up with the police department's Major Incident Investigation and Disaster Support System - or MIIDSS for short. MIIDSS is mainly used to track down criminals, but in this case the criminal was a virus.

We employed it for location alerts and mass contact tracing. Using the system's artificial intelligence and link analysis, we could pull together clues, determine common traits, and identify clusters of people exposed to SARS, and the precise buildings where the virus lurked.

Without this system, we could not have identified most of the 26,000 contacts of suspected and confirmed SARS victims within the peak period of April last year. Such timely identification followed by swift isolation action was key to controlling the outbreak. This collaboration between the health authorities and police quickly turned the tide in the outbreak.

At this juncture, I would like to again thank the Police Force, as well as our health informatics experts in HA who developed the eSARS system in a matter of days when SARS was at its peak. The effectiveness of the combination of databases has been recognised by the international community, including the WHO. Hong Kong's IT collaboration scheme, which we will use to combat the disease in the future if necessary, is one of 16 finalists in the health and quality of life category at this year's Stockholm Challenge awards.

Another key to successful public health crisis management lies in effective risk communication with the public.

When "perception becomes reality", and rumours spread like a hill fire, it is necessary to address not just the facts, but also people's concerns. The appearance of a credible, knowledgeable and authoritative person in public, displaying sympathy, concern and competence, is often the most important contribution to stabilising public sentiment.

So we attached great importance to our communication with the media. From the onset of the outbreak, the government gave daily briefings to the Hong Kong and international media. We stepped up our communication efforts further by conducting these briefings in a manner: same time, same place, same spokespersons, welcomed by our media and community at large.

This dedicated approach on external communication proved very effective in enhancing public awareness of the disease. Moreover, we were able to dispel speculation and clarify public misconceptions. We fostered a close relationship with the media, which in turn helped enlist the support of the public as they received accurate health messages and pitched in to take positive steps themselves.

The lessons we learnt about the importance of IT and risk communications should not be relegated to a few lines of history in our annual reports. We must put this valuable experience into practice. That's why we're setting up relevant branches in the new Centre for Health Protection (CHP) to look after these matters.

We have been pressing ahead with the extremely important initiative of setting up the CHP endorsed by SARS Expert Committee. Thanks to the advice and contributions of all concerned, the CHP has moved from concept to reality in a matter of months.

Emergency response will be a new icon within the CHP. The Emergency Response and Information Branch is taking shape, with staff seconded from the Police and the Department of Health to co-ordinate contingency planning. I'm glad to see that two of the six major functional branches, the Surveillance and Epidemiology Branch and the Infection Control Branch, are now well in place.

On the international front, the CHP will seek to reach bilateral arrangements with overseas health agencies where there is a joint commitment to develop substantive collaboration arrangements. Some of you may have witnessed the signing of a memorandum of understanding between the CHP and the Health Protection Agency of England and Wales last Friday. All these collaborative modalities will empower the CHP with the surge capacity and expertise for more effective control of public health crises.

I want now to share with you what I think is the most important philosophy of modern crisis management: think big and act strategically.

In times of crisis, situation dictates strategy. As architects of contingency plans, we have to start by mapping out deployment of resources at a territory-wide level so we can see how we can push the frontiers of feasible options.

Take, for example, last year's isolation measure. You have observed how we evacuated all residents of Block E of Amoy Garden on April 1 given a lead-time of a few hours from the point of decision made at the top level. We, in fact, prepared not just holiday camps but secured well in advance high-rise housing estates in case the outbreak continued to affect hundreds or thousands of people.

Thank God that did not happen, and the reserved accommodation was turned to good use when we offered them as quarters for doctors and nurses who opted for voluntary isolation to protect their families.

The SARS crisis also demonstrated that we not only have this "hardware"; the civic-mindedness that lies in the blood of Hong Kong people had given us the much desired "software" during the time of the crisis.

It is clear to everybody that our world-class, dedicated and selfless frontline healthcare workers are the key fighters in the SARS crisis. Among those who also deserve our respect are members of the civil service, whom we can always count on at times of emergencies. This was especially the case for SARS given its wide impact to virtually every sector of the community.

Just to quote a notable example: a crisis management team was set up on an inter-disciplinary basis, drawing on expertise in building ventilation, drainage systems, and environmental contamination, to conduct vital disinfection exercises following the investigation and management of the SARS outbreak at Amoy Gardens.

Also, Hong Kong is blessed to have the well-trained reserved army of the Auxiliary Medical Service and the Civil Aid Service, who can be mobilised at short notice to provide invaluable assistance throughout the epidemic, particularly in relation to quarantine arrangements and health check measures implemented at the boundary control points, to complement the work of full-time professionals.

While it may demand a creative mind to sort out how the "hardware" can be utilised during a crisis, it seems to me that it may call for even more skills to have the "software" in place to discharge emergency duties.

I chaired an interdepartmental committee involving 20 government departments and four policy bureaux during the SARS crisis. Each morning during the peak of the outbreak, the committee was convened to agree on the details of measures to be put in place that day. Action checklists for the day were then sent to the officers-in-charge to ensure that all the measures were implemented without delay. With the concerted efforts of all parties, the tasks were successfully completed.

What I have learnt is that clear lines of command, smooth staff deployment and supply of necessary gear and equipment are crucial agenda items for any war cabinet tasked to fight and manage public health crisis. And after all, there must be a sound command structure for emergency responses.

What are then the principles underpinning a "sound" command structure?

I would say "clarity" and "responsiveness".

In the light of experience, we have established an overall contingency mechanism to set out a clear command structure for making decisions. Central to this contingency mechanism is a three-level response system to ensure expeditious and effective interventions for various SARS emergencies, through clear lines of command. They are now clearly set out in the "Checklist of Measures". This booklet which we compiled last year details the work and responsibilities of parties concerned when SARS comes back.

The mechanism is underpinned by about 40 detailed contingency plans for individual bureaux, departments and agencies, and we have conducted 40 drills in hospital settings to assess the workability for these plans. The CHP's Emergency Response Branch, which I mentioned earlier, will take the lead to build contingency plans for other public health crises.

In a nutshell, the keys to success for managing a crisis are effective deployment of human resources and decisiveness in giving clear orders that in turn simplify work procedures. This style of management not only relieves colleagues of unnecessary pressure, it can also win their respect and loyalty. Only then can they put aside their personal and family worries and give their best.

Finally, let me say that contingency planning is necessarily a never-ending exercise requiring continual updating and investment. It is not adequate to write up an emergency response plan only to see it locked in the bookshelves. We need to ensure it is fully read and well understood by all the emergency responders. We need to ensure it can be carried out in practice.

As with all manuals and procedures, crisis management plans may go out of date. In view of the emergence of new infectious diseases and other health hazards, sustained efforts are required to review and update the plans to ensure their continued applicability and conformance with international best practices.

A contingency plan also needs regular exercises to ensure its workability. Only when it is put to rigorous test can we identify the possible gaps and inadequacies in the chunk of papers. We will be organising a major drill exercise this Autumn. This time around, we will invite observers from overseas health protection agencies to offer more objective appraisals on the adequacy of our plans, systems, procedures and personal practices.

Ladies and gentlemen, thanks to the efforts of many, we are much better prepared today. Let's continue our teamwork in the never-ending battle against emerging diseases, so that we can safeguard the public health of Hong Kong.

Thank you very much.

Ends/Monday, May 10, 2004


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