In the early hours of March 15, 2003, I was awakened by a telephone call at my home in Geneva from the infectious disease duty officer of the World Health Organization, who had just received a call from the health authorities in Singapore.
He said that a doctor in the city-state who had been treating patients with the unusual respiratory disease that we were monitoring had become ill with the same symptoms while flying back from a medical conference in New York. His plane was due to stop in Frankfurt.
Our first step was to alert the German health authorities and advise them to consider taking the doctor off the plane to reduce exposure to other passengers, and to put him under immediate medical supervision.
What followed marked a turning point in the history of public health as the W.H.O. issued an international appeal that galvanized global cooperation in an unprecedented effort to contain the dangerous disease.
As the chief of the United Nations health agency’s infectious disease section, I called together the W.H.O.’s outbreak alert and response team. Within two hours we were urgently reassessing the evidence surrounding this unknown illness.
More than 85 suspected cases — the majority of them among health care workers — had already been reported in Canada, Hong Kong, Vietnam and Singapore, with many of those infected needing assisted breathing. Now there was a possibility that the disease may have spread to the United States.
Later that morning, we presented a summary of our findings to the director general of the W.H.O., Gro Harlem Brundtland: An apparently new and untreatable respiratory disease was rapidly spreading around the globe.
The facts behind the threat — the cause, how far it had already spread, and its final ramifications — remained uncertain. Could it become a disease like H.I.V.-AIDS, which had entered the human population via exposure to infected animals and had become firmly entrenched around the world?
Brundtland and our team carefully weighed what was known and what was not, and named the disease SARS, for severe acute respiratory syndrome. Quickly comprehending the urgency, Brundtland that morning issued an unambiguous call for health authorities worldwide to work together to stop the disease in its tracks.
Her announcement declared SARS to be a rapidly spreading threat, described how to recognize signs of the disease and offered guidance to travellers and airlines on what to do if someone exhibited symptoms.
In 2003, March 15 fell on a Saturday. Because that is not a working day for much of the world, and because of the urgency of the threat, the announcement was made simultaneously to the media and to health authorities without any opportunity to ease the way politically.
Brundtland understood that some countries might not agree with her decision to sound the alarm so precipitously. She also knew that officials of some governments might refuse to join in a global effort because of fear of spreading panic, concern about dire economic consequences, or injured national pride for not being the first to issue warnings to their people.
This was the first of several bold decisions Brundtland would make over the coming months — bold because they were made purely on the basis of rapidly accumulating scientific evidence, because they put concerns for public health first and foremost, and because they were made despite concerns about potential political pressures.
The SARS outbreak was the first major international health emergency in which the W.H.O. was able to take full advantage of the Internet age. It was detected early because of recently established Web-based systems trawling for unusual health events. It occurred at a time when health authorities around the world — experienced in earlier collaborative efforts to halt the spread of meningitis, yellow fever, polio and the Ebola virus — were on the alert and ready to respond.
The information technology at our disposal allowed us to instantaneously adapt our response as the outbreak unfolded. Virus experts from around the world worked together virtually — by phone, videoconference and through the Web — to share information and report progress.
Within a month, they identified the virus responsible for SARS. Epidemiologists soon confirmed that health workers were at greatest risk and that air travel was spreading the disease. Doctors shared their knowledge about what treatments worked and what did not. The media provided clear information that captured the world’s attention.
The outbreak occurred at a time when countries were hesitant to report the outbreak of infectious disease to the W.H.O., in large part because of potential damage to national economies. In the early 1990s, for example, the spread of cholera in Peru — the first report of the disease in Latin America in 100 years — cost the country more than $770 million in lost trade and tourism. That same decade, India reported a loss of more than $1 billion in travel and tourism revenues after plague struck a small area of the vast country. In Europe, health authorities were at first reluctant to publicly discuss mad cow disease.
Nevertheless, most countries were forthright in reporting incidents of SARS. One country remained reticent — the country where the outbreak appeared to have begun, and whose cooperation was key to tracing how the disease emerged. Brundtland spoke openly about China’s reluctance to publicly discuss the duration, scale and evolution of SARS within its borders and successfully encouraged Chinese officials to air the details and to work with the rest of the world to stop the outbreak.
The disease spread around the globe over a period of about eight months, with the outbreak peaking in April and May. By July 5, we were able to declare that all chains of person-to-person transmission had been broken and that the outbreak had been contained.
An estimated 774 people died of the disease, but another 7,322 people who were known to be infected eventually recovered, including the Singaporean doctor whose case prompted the March 15 worldwide alert.
History will determine the final impact on global health security of the decisions made 10 years ago. The evidence so far is good: SARS was contained, and countries now freely report suspected threats like avian influenza or Ebola and cull their animals accordingly.
When it comes to controlling global outbreaks such as these we must continue to let evidence speak louder than politics.
David L. Heymann, former executive director of communicable diseases at the World Health Organization, is senior fellow and head of global health security at Chatham House.