Borders to be crossed on health research
When confirmation of the 32-year-old Guangzhou television producer's Sars infection came on Monday, it was the result of work done by two laboratories in Hong Kong. This raises questions about whether the long process of confirming the case could have been shortened had the samples been sent earlier.
The labs that verified that the patient had been infected with a strain of the virus not seen last year were the University of Hong Kong lab at Queen Mary Hospital and the government virus unit at the Department of Health. Both are part of the World Health Organisation's international network for Sars diagnosis. The samples arrived in the city after the Ministry of Health in Beijing had been called to help clarify inconclusive results and after scientists here questioned why Hong Kong had been bypassed.
Similar problems arose last year, when samples were sent to Beijing for testing rather than Hong Kong. It seems the same limitations in the region's scientific and public health co-operation are again hampering efforts to deal with the Sars threat. The consequences then were serious: a delay in understanding and containing the new disease. And they remain serious now, as we face the possibility of a wider outbreak just before the Lunar New Year peak travel period.
There should be scope for more bilateral work and for contacts through the WHO network. On the first level, it does seem that any joint research on Sars undertaken so far has been on an ad hoc basis, and very much dependant on personal ties between the scientists involved, rather than their institutions or because of formal efforts by Guangdong and Hong Kong to foster these links. Such research has been fruitful, including the announcement this week about the similarities between the civet cat strains of Sars and the virus found in the Guangdong case. More would be better, and could provide faster answers to questions that still remain.
The exact origin of Sars and how it is transmitted, for instance, are still in doubt. Guangdong and Hong Kong, as the epicentre of the disease last year, should now be working together to find the answers. Part of the problem appears to be a centralisation of Sars research on the mainland, with the Ministry of Health in Beijing calling the shots. We have argued before that the provincial centres for disease control should be empowered to do more of the laboratory confirmation and outbreak-control work at the local level. There is also a clear argument in favour of allowing them more scope to co-operate across regions, including liaising with researchers in Hong Kong.
The WHO recently called on member countries to help the mainland with its research into Sars. Experienced Sars scientists in Hong Kong, which has a separate WHO membership from the mainland's, are willing to extend such aid. But there are serious questions about whether the mechanisms exist to facilitate this type of scientific exchange.
On the mainland side, there seems to be residual reluctance to share information. The caution is somewhat understandable. False reports or rumours of Sars cases could do untold damage. But the antidote to this is more timely and authoritative information, not less.
The gaps in our understanding of Sars are still glaring - to the detriment of public health all over the world, not just in the Pearl River Delta. And more joint research could help fill in those gaps. What is standing in the way? Obstacles include bureaucracy, complacency and a territorial approach to health information. These attitudes have to change, especially now that millions travel across the border each year. There is little to lose from opening up, and much to gain.
