Introduction

In February 2003, the Beijing office of the World Health Organization (WHO) received an unconfirmed report that a virulent strain of a pneumonia-like disease had broken out in Guangdong province. Chinese health authorities confirmed the news but assured WHO that the outbreak was under control. However, over the next two months the world panicked as cases with similar symptoms emerged in Hong Kong, Vietnam, the US, Canada, Singapore and Taiwan; a number of patients died. Economies faltered and global travel plummeted as international health professionals rushed to determine whether this was a new disease and, if so, what caused it, how it spread, and how to stop it.

The world community turned to WHO for answers. The UN agency charged with managing global disease alerts and outbreak response mobilized infectious disease experts to analyze the illness, name it, identify its cause, contain it and find a treatment. On March 15, WHO headquarters announced that it was a new disease and dubbed it SARS (Severe Acute Respiratory Syndrome). The WHO office in Beijing was, in many ways, the epicenter of the crisis. The disease had possibly started in China, and determining its origins would help to combat its spread.

Yet the Chinese government remained chary with crucial information. Only on March 27 did it acknowledge that the disease had spread to Beijing, and on March 28 that the outbreak was SARS. Suspicions ran high that the Beijing city government was grossly under-reporting the number of cases, allowing it to spread unmonitored. The WHO-Beijing office had emerged as a reliable source of information on SARS, willing to say what it knew and, as crucially, what it did not know. WHO-Beijing Director Henk Bekedam had scheduled regular press conferences, and briefed the diplomatic community. The office also hosted successive WHO missions—teams of scientists from around the globe who came to China to try to find answers to the epidemiological questions. 

On April 16, WHO held a press conference to report on the latest mission—which had visited Beijing, including secretive military hospitals. By then, SARS had spread to 19 countries with 3,293 reported probable cases and 159 deaths.[1] Bekedam listened as the mission members took media questions. A key concern was the number of SARS cases in the capital—the Chinese had announced 37, but rumors put the number much higher. To the dismay of Bekedam and his No. 2, Alan Schnur, a mission member replied that Chinese officials had asked them to keep what they learned at two military hospitals confidential. A murmur of anger rose from the press corps.

The senior WHO-Beijing officials had seen the syndrome before—outsiders seduced by Chinese hospitality into acceptance of Chinese restrictions on information. Bekedam knew the global media would not accept the answer—and that such evasiveness could cost WHO the credibility it had so carefully built over a painful two months. Schnur, who had been a member of the Beijing mission, had a more accurate estimate. At the same time, to publicly contradict a mission member could be seen as unacceptable, not only by WHO leadership but by the Chinese government. Bekedam had built a reputation as reliable with both groups. Did he want to risk that by publicly contradicting the mission? Should he speak up now? To say what? Could he wait to correct the record until after the press conference ended? He had only seconds to deliberate.


[1] For a breakdown in the number of cases per country, please see: http://www.who.int/csr/sarscountry/2003_04_16/en/