Effective and acceptable strategies for the control of SARS and new emerging infections in China and Europe
The epidemic of Severe Acute Respiratory Syndrome (SARS) showed that new infections transmitted through close contact are able to spread rapidly across international borders resulting in significant morbidity. They can even cause widespread public alarm and economic loss in unaffected countries. It is therefore crucial to assess the likelihood of similar occurrences and their possible impact on public health, economic performance and public concern.
SARSControl aims to improve the public health response to emerging infections, such as SARS and influenza, through better knowledge of the spread of these viruses, improved risk assessment, mathematical modelling, and economic analysis and risk communication strategies. All of these activities will be performed in conjunction with policymakers and key stakeholders in Europe, thus helping to improve the quality of decision-making. A database with all SARS cases from mainland China, in conjunction with World Health Organization (WHO) data, will be used to help develop models for the local and geographical spread of SARS.
A toolbox of models will be developed covering the range of alternative approaches. By standardising epidemiological and control parameters, a consensus view on model-based policy recommendations will be derived. These model results will be combined with analyses of the micro- and macroeconomic consequences of SARS-like infections to evaluate the potential economic impact of different control options.
Because the acceptance of interventions depends on social, cultural and psychological factors, SARS-related risk perceptions and precautionary practices will be studied along with the risk communication strategies adopted during the outbreak to help improve future strategies for communicating with the public. Vulnerable communities, such as the Chinese in Europe, will receive particular attention. SARSControl is therefore an integrated multidisciplinary project to aid European policy on emerging infections.[+] Read More
New infections transmitted through close contact are able to spread rapidly across international borders resulting in significant morbidity. The public health response to such emerging infections (pandemic preparedness) needs to be improved.
SARSControl aims at improving:
Risk assessment models
Risk assessment models were developed based on international travel, and they assess the risk of introduction of new infectious diseases like SARS and influenza. To achieve this, data sources of international travel were identified and analysed. Different risk assessment scenarios were developed to estimate the risk of importation of infections by air travel under different scenarios.
Chinese data analysis
An optimally complete database with nearly all epidemiological data on the 2002/03 SARS outbreak in mainland China was developed to estimate key parameters in the spread and control of SARS, as well as to assess the (economic) impact of interventions used in the control of SARS in China and to additionally develop protocols for standardised recording of epidemiological data.
A range of transmission dynamic models of SARS and pandemic influenza was developed, capable of simulating both the local and global spread. They can also model the impact of various interventions identified in other Work Packages (WPs) of the project and estimate their effectiveness. This was achieved by a series of stochastic models for assessing the community transmission of influenza within countries and by evaluating the effectiveness of local control measures and travel restrictions to impede global spread.
Risk perceptions were analysed in relation to SARS, influenza and other infectious diseases in Europe and Asia. This was achieved with a survey questionnaire developed to measure risk perceptions, precautionary actions, sources of information used, etc. In addition, focus group interviews of Chinese communities in two European countries were conducted to explore the reactions to risk communications and the impact of SARS on vulnerable communities living in unaffected regions. Finally, strategies were developed for effective risk communication directed at realistic risk perceptions and precautionary actions in the populations.
Risk communication strategies used by affected Asian countries and other professional bodies like the WHO and EU during the SARS outbreak were developed and the media response was analysed. The institutional structures within which government communication occurred were analysed, as well as the content and timeliness of communication from governments and public health authorities to the public. In addition, critical ethical issues were identified in the communication of risks and it was determined whether discrimination or stigmatisation of groups identified as a special risk source played a role, in both the Asian and European context.
The partners analysed the macro- and microeconomic impact of the SARS outbreak of 2003 and of potential scenarios of pandemic influenza and future SARS outbreaks on European countries. In addition, an economic analysis of strategies to control and prevent new and emerging communicable diseases, such as SARS and pandemic influenza, was undertaken.
The research objectives were achieved by the preparation of an inventory of the main SARS control strategies implemented by European and non-EU countries, including China and Canada, during the 2002/03 SARS epidemic and the identification of critical ethical issues associated with the implementation of such measures. It also included the application of the Hazard Analysis and Critical Control Points (HACCP) Model to identify critical control points in pandemic management and a qualitative Delphi analysis with questionnaire rounds and face-to-face meetings to assess the current preparedness situation and feasibility of intervention strategies.
Multidisciplinary workshops and seminars provided additional insight for generating and appraising scientific advice. Finally, the results from the policy evaluation analysis, along with the outcomes generated from research in the other WPs of SARSControl, the experiences gained from the 2002/03 SARS outbreak and information gained at SARSControl meetings and workshop have been compiled in this policy evaluation report.
Pandemic preparedness plans in Europe and elsewhere.