Ministry of Health Official—Beijing
Li Tao was born in Tianjin in 1945. He moved to Beijing in 1976, becoming a Party member and joining the civil service. After a distinguished career in the Ministry of Civil Affairs in which he rose from a low-level bureaucrat to the provincial head for Sichuan Province, Mr. Tao transferred to the Ministry of Health in 1999, about 3 years before the SARS outbreak.
. When did you first learn of the SARS outbreak?
To be clear, we didn’t know the outbreak was SARS at first; the genome was new and hadn’t been identified yet. We didn’t know what it was at first. In the beginning, we didn’t know it was anything unusual; we just heard reports of a few cases of severe lung infections that resembled pneumonia. We first learned of these reports in early November 2002, during the normal flu season in Guangdong province. Some of the symptoms were a little unusual, and it was obviously more severe than other strains of influenza, but we didn’t know for certain that it was anything out of the ordinary until later.
. Why wasn’t the outbreak reported to the WHO sooner?
When the first cases of atypical flu were reported in Guangdong province, we didn’t see any reason to report this to the WHO because the pneumonia we were dealing with was not on the list of diseases for which notification was required. The WHO’s 1969 International Health Regulations specify the diseases which need to be reported. The symptoms for this disease had not been seen before, and were not on the list of illnesses to report. Again, it was a brand-new disease, and it took some time to figure out what we were dealing with.
. What are the regulations describing China’s interaction with the WHO?
In China, regulations were rewritten in 1991 making the Ministry of Health the only organization with the authority to report outbreaks to the WHO. We respect the work of the WHO and are happy to work in cooperation with them, but at the same time we have great doctors in China and wanted to see what we had on our hands before reporting it to them. Sensitive information like this needs to pass through the Ministry of Health before being communicated to the rest of the world, and rightfully so. With this being a new disease, that process took time because we weren’t sure at first what we were dealing with.
. When did the Ministry begin working with the WHO?
We were first contacted by the WHO on December 5th and on the 12th we reported to them the information we had uncovered up to that point. At that point, we only had about 20 reported cases of the atypical flu, and we weren’t absolutely sure it was anything unusual from what we normally see during the flu season.
. Why were inter-lab transfers of specimens of the atypical flu barred by the Chinese government?
Inter-lab transfers of an unknown disease pose serious safety risks to the public. Keep in mind, we didn’t know how contagious or severe the disease was. What if a sample being transported to a lab in Beijing or Shanghai had ruptured? Then we would have an outbreak ten times worse to deal with. The safest course of action is always to limit the number of available samples and keep them contained in one area as much as possible, so that the risk of escape is minimized to as great an extent as possible.
. Why was the WHO team sent to China denied entrance to Guangdong province?
At the time, around mid-February, we did not feel there was any need for international assistance in Guangdong. We have very good doctors, scientists, and health professionals in China and they were working hard to identify and isolate the cases of atypical flu. We felt the presence of a WHO team may have impeded their progress and there was no need for the WHO to do a job our Chinese health professionals were capable of doing themselves. The presence of a WHO team would have created exactly the kind of public hysteria we were trying to avoid, and besides the WHO team was sent to investigate cases of avian flu, of which there were none in Guangdong province. Reports of a cover-up or of China trying to conceal the outbreak are preposterous. We simply did not think the situation warranted asking for outside assistance, we didn’t have even a single case of avian flu in Guangdong.