Censorship Doesn’t Just Stifle Speech — It Can Spread Disease

In October, Saudi Arabia will host millions of travelers on the hajj, the annual pilgrimage to Islam’s holy sites. The hajj carries deep meaning for those observant Muslims who undertake it, but it also carries risks that make epidemiologists blanch. Pilgrims sleep in shared tents and approach the crowded sites on foot, in debilitating heat. They come from all over the world, and whatever pathogens they encounter on the hajj will travel back with them to their home countries. In past seasons, the hajj has been shown to foster disease, from stomach flus to tuberculosis or meningitis.
The Saudi Arabian government has traditionally taken this threat quite seriously. Each year it builds a vast network of field hospitals to give aid to pilgrims. It refuses visas to travelers who have not had required vaccinations and makes public the outbreaks it learns about. This year, though, the Saudis have been strangely opaque about one particular risk—and it’s a risk that has disease experts and public-health agencies looking to October with a great deal of concern. They wonder if this year’s hajj might actually breed the next pandemic.
The reason is MERS: Middle East respiratory syndrome, a disease that has been simmering in the region for months. The virus is new, recorded in humans for the first time in mid-2012. It is dire, having killed more than half of those who contracted it. And it is mysterious, far more so than it should be—because Saudi Arabia, where the majority of cases have clustered, has been tight-lipped about the disease’s spread, responding slowly to requests for information and preventing outside researchers from publishing their findings about the syndrome.
Even in the Internet age, when data sources like Twitter posts and Google search queries are supposed to tip us off to outbreaks as they happen, one restrictive government can still put the whole world in danger by clamming up.
That’s because the most important factor in controlling epidemics isn’t the quality of our medicine. It’s the quality of our information.

The Wall of Silence

To understand why MERS is so troubling, look back to the beginning of 2003. For several months, public-health observers heard rumors of a serious respiratory illness in southern China. But when officials from the World Health Organization asked the Chinese government about it, they were told that the countryside was simply experiencing an outbreak of pneumonia.
The wall of silence around what came to be known as SARS (severe acute respiratory syndrome) cracked only by chance. An anonymous man in a chat room, describing himself as a teacher in Guangdong Province, made the acquaintance of a teacher in California. On February 9, 2003, he asked her if she had heard of the illness ravaging his city. She forwarded his message to an epidemiologist she knew, and on February 10 he posted it to ProMED, a listserv that disease experts use as an informal surveillance system.
That email was the world’s only warning for what was to come.
By mid-March there were already 150 cases of the new disease in seven countries. SARS wound up sickening more than 8,000 people and killing almost 800 in just nine months. Luckily, the disease was quelled in China and Canada (where travelers from Hong Kong touched off an outbreak in Toronto) before it had a chance to evolve into a more efficiently spreading strain. Many experts believe that given time to mutate in humans, SARS might have become a deadly pandemic.

By Maryn McKenna
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