Friday, June 05, 2009

Containing Novel Influenza (A/H1N1): A Success Story Buried under the Rubble

A rare success story for the beleaguered Aso administration has been its response to the Novel Influenza (A/H1N1). When the news of the virus broke, the authorities quickly set up border checkpoints (it helps that entry points are limited, Japan being an archipelago) and bought time with them while they geared up the domestic response mechanism. When they detected the first domestic human-to-human transmission cases, they quickly wound down border control operations and turned the resource savings over to domestic containment tasks. In the meantime, they did a good job at keeping the public well-informed, giving the latter the public to drop their facemasks almost as quickly as they had put them on*. The trickle of new cases continues (4 June, 15 newly confirmed), but it’s a non-story now—which is probably a problem for Aso. Success in this case is a process leading to normalcy. There are few tangible “kills” to highlight, so the story fades out of the headlines.

Don’t feel too sorry for the Aso administration though; there are big elements of luck to this. For one, there is no doubt that the experience both national and international from the SARS and bird flu outbreaks aided the Japanese authorities enormously in setting up the necessary framework, then forming and executing effective plans to contain the virus. They had in effect dress rehearsals. Moreover, the relative mildness of the symptoms helped maintain public order; there was less urgency, and available resources could be stretched more easily.

This leads me to wonder: How prepared is Japan—any nation, actually—to face an onslaught of a more lethal strain of the virus returning later in the year, which is exactly what happened in 1918 with the Spanish flu? Even if the number of cases will turn out be as limited as they have been in the current outbreak, they will require far more resources for isolation and treatment. They are likely to force more and longer closures of schools and other establishments where they are discovered. The impact will go beyond the pathological, as economic activities world-round take a major hit.

Of course the chances of a lethal mutation are as good as one that works in reverse, making the virus more benign. And nothing guarantees that the virus will come back either. That being said, under the bad-case scenario, a serious flu epidemic will be one of the earliest major political tests, if not the earliest, that the post-election government will face. The danger for a DPJ-led administration is that, coming in to confront large parts of the bureaucracy—the Ministry of Health, Labor and Welfare with it its national pension system troubles has been a particularly popular target of DPJ criticism—it may have difficulties changing gear so that it can take control of the situation, lest it works the other way around.

* The facemask is part our national costume. We’ll whip them out at the slightest sign of a cold, much the way we unfurl our umbrellas at the slightest hint of rain.


Joe said...

I was actually surprised with how well both the national government and local bodies handled the latest flu outbreak. I work at City Hall, and had to translate H1N1-related materials for foreign nationals living in the city. The TV media, on the other hand, seemed to think it was a great idea to spread panic far and wide.


After the fact I found out the measures that had been taken (airplane checks, closing schools, etc.) were based on plans for a bird flu virus with an anticipated 60% fatality rate. Luckily, pig influenza seemed pretty mild even before it hit Japan, but if I were in charge, my plans for a virus that could kill off over half the population in any given area would dispense with canceling field trips and focus instead on locking down the shinkansen, the trains, and the highways.

Janne Morén said...

Joe, actually, while quarantines for infected individuals are a good idea, larger-scale preventative quarantines are known today to be counterproductive.

The problem is that people are perfectly adept at getting around them or traveling ahead of them (and frequently travel when they can simply to avoid being locked down later) and spreading the infection as a result; at the same time those same restrictions also limit the travel of emergency services and other necessary personnel (who, by the way, will also tend to spread the infection as well). Basically, you can lock down a village; you have no chance of locking down a city.

Few nations plan for them as a result. Instead you limit the travel you can (like school trips) and ask companies and organizations to do likewise. Then you rely on people's good sense and their own apprehension to limit travel further. And when people know they could travel to their parents or whomever if they really, really need, they'll be fine refraining when they don't.

Jun, before you get a cramp patting the government on its back (and I do agree the response has been pretty appropriate), Asahi had a piece just recently stating that the earliest cases in Japan probably occurred around or before the travel inspections commenced.

Jun Okumura said...

Joe: thanks for the information and your personal assessment. I side with Janne on your last point though. A couple of more points that I think are relevant to the considerations of the authorities in crafting and implementing a response:
a) I believe that the behavior of the non-symptomatic students of the closed schools would have been different if the virus had been more lethal.
b) There are essential needs (food and water for starters) that cannot be denied for weeks or months on end.

Janne: Your last point has been widely reported here. But it has nothing to do with the medical and social value of the measures that the government took. And it’s a sign of the political times that the media has not bothered to give the authorities any credit for the process—mainly the doings of the bureaucracy. More generally, give the bureaucracy the wrong incentives and it will fuck up; witness the skill with which the National Security Agency messed up the public pension system; give it the right ones and it will actually work. The service at your local prefectural and municipal offices has improved enormously over the last couple of decades. I don’t know what did the trick, but I’m sure that it had nothing to do with a change of heart on the part of civil servants. Same with JAL’s economy class service. The bureaucracy awaits the DPJ with a sense of fatalistic dread; task it, and it will respond positively, blame it, and the machine will grind to a halt. There’s a need to draw a line between demanding accountability and instigating a witch hunt. It is a pretty sure bet that we’ll have the chance to see how the DPJ fares.

Jun Okumura said...

Janne: My virtual claps tire only my fingers.