The Case of H5N1 in Hong Kong 2010: Raising the Alarm

Last week, Hong Kong recorded its first positive case of H5N1 (avian influenza) in seven years in a 59-year-old woman who had recently travelled to China. The Hong Kong government then raised Hong Kong’s bird flu alert to “serious”, meaning there was a “high risk” of contracting the disease.

These events prompted fears of a new wave of pandemic avian influenza across Southeast Asia, and a host of other countries in the region released reports that they were H5N1-free. Some took it one step further: the Philippines declared that their airport authorities were on high alert, Malaysian health authorities announced that their existing mitigation systems to cope with H1N1 were in place and being reinforced, and Taiwanese authorities also declared that they were on high alert. The Indonesian Health Ministry’s director general for disease control and environmental health said that in spite of Indonesia’s two H5N1 fatalities earlier this year, there was “no cause for panic”.

This reaction appears to err on the side of caution if one considers that in the past seven years, H5N1 has killed 302 people worldwide – a stark contrast to the estimated 250,000 to 500,000 who succumb to regular cycles of influenza annually. The disease was expected to be a major threat, with some experts predicting it might kill between 150 and 500 million.

Several days after issuing the high-risk alert, Hong Kong officials then stated that the H5N1 case they discovered was an isolated one and that she could therefore be treated with existing vaccines. Although the authorities’ promptness in diagnosing the case and their transparency in reporting it are admirable, Hong Kong’s methods of dealing with pandemics, evident in its strict containment policies when dealing with H1N1 last year, have been largely shaped by its difficult experience with SARS in 2003.

While H5N1 may cause more than one influenza pandemic as it is expected to continue mutating in birds regardless of whether humans develop herd immunity to a future pandemic strain, the isolated nature of the Hong Kong case raises significant questions of whether the initial response of raising their alert phase was a measured one.  Imperative as it may be that authorities recognise the risks posed by newly discovered infections of potential pandemic viruses, it is just as important to consider the hidden costs of over-caution, among them damage to confidence in public health authorities, unwarranted expenditure on drugs, vaccines and other medical services, and misconceptions of both the disease and the level of threat it poses.

Although pandemics – in particularly influenza strains such as H5N1 and H1N1 – remain a health security cause for concern for many Asian countries, it is vital that the social and political dimensions and consequences of knee-jerk reactions in the event of new diagnoses need to be continually considered in the management of public health situations in the region.