Securitization of Health: The Case of Avian Influenza in Hong Kong

March 9, 2009

The avian flu has become endemic in poultry in most part of East Asia since 2003 after the first human case appeared in Hong Kong in 1997.  Until now, effective vaccination for prevention is still not available.   If mutation of this virus enabled human to human transmission, the impact could be catastrophic.

The fear of a possible global pandemic has lead the Hong Kong government to “securitize” the threat of bird flu. In responding to outbreaks of bird flu, the Hong Kong government has formulated various policies to reduce risk of human infection.  When another H5N1 case was found in a Yuen Long farm in December 2008, immediate actions were taken, including temporary suspension of chicken import for 21 days and also culling 90 thousand chickens in the infected area and in the Cheung Sha Wan Wholesale Poultry market.

The positive consequence  of the securitization policy is obvious. There has been no major spread of the avian flu virus in Hong Kong since the government’s adoption of the above policies.  Besides, the people’s awareness of preserving personal hygiene has been greatly enhanced due to educative effects from government’s measures.

Yet, securitizaton does involve trade-offs.  As close contact with poultry is thought to be the main reason for human infection, centralized slaughtering replacing live poultry retailing in wet markets is believed to be the most effective way in preventing the threats of bird flu. However, the plan of centralized slaughtering has been delayed for quite a long time because the  government needs to balance the interests of the poultry traders and that of public health. A poultry license buyout would mean losses of jobs among those poultry traders.  In order to compensate these traders, a buyout scheme was estimated to cost HKD 1.23 billion. Yet, even with this compensation package, retailers were reluctant to hand in the license as they thought the amount was not enough.  If, as estimated, only 75% of retailers were willing to return their licenses, how effective would the scheme be?

Another problem we find in securitizing infectious disease is the potential misallocation of health resources.   For example, cancer alone contributes to 33.0% of all deaths in Hong Kong, but it seems more attention and significant resources have put into fighting against this relatively new avian flu.  Is this a correct allocation of resources?

Moreover, it remains ambiguous as to whether securitization is an effective method to avoid a H5N1 outbreak in Hong Kong.  In case of an outbreak in the Mainland (where most of Hong Kong’s live chickens come from), the current protective measure (e.g. temporary suspension of chicken import) can efficiently help to protect Hong Kong from serious infection.  But if human mutation was found in avian flu (human-human infection), Hong Kong would still experience enormous economic loss,  even if it effectively minimized infections within Hong Kong, given Hong Kong’s close link with China.

We believe that the current health securitization policies have been the most feasible policies to protect human health for Hong Kong people. Nevertheless,  Hong Kong cannot stand alone with the globalization of infectious diseases. To better protect human health in the region, cooperation in securitization policies have to be extended across the region. Unfortunately, problems arise with resources again and also with the political will to cooperate.   How can health issues compete for resources with other traditional security issues?

Reference:
Maclean, S.J. (2008). “Microbes, Mad Cows and Militaries: Exploring the Links Between Health and Security”. Security Dialogue 39(5), pp.475-494.

– Pinky and Katrina

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9 Responses to “Securitization of Health: The Case of Avian Influenza in Hong Kong”

  1. magso Says:

    Pinky and Katrina,

    Very interesting article!

    I agree that securitising avian flu in Hong Kong would be the potential misallocation of health resources. Unfortunately in this case, I think that Hong Kong has no choice but to securitize avian flu at the expense of other diseases.

    Firstly, Hong Kong’s geography puts her at a disadvantage because of its linkage with China by sea. As you have said, in the event of an outbreak on the Mainland, Hong Kong can simply suspend imports of chicken. However, I must disagree with you as I do not think that it can efficiently protect Hong Kong because just last month, dead poultry has been found washed up on Hong Kong beaches.

    Recalling the fact that the SARS outbreak in Hong Kong was traced to one person who introduced the disease when he traveled into the territory; it would be very difficult to contain the avian flu virus if human to human transmission becomes possible. Hence securitizing avian flu as a priority at this earlier stage is crucial.

    Secondly, Hong Kong relies on tourism and finance as its main industries, thus maintaining her international reputation is crucial to her survival. During the SARS epidemic I remember going to the cinema, and even at $30 a ticket ($4-5 US) there were less than 10 people in the cinema. If even locals feared leaving the house during those times, then surely tourists would chose not to come to Hong Kong. Thus, even if Hong Kong fails to prevent an outbreak, she must at least convey the impression of having a clear and strong mechanism to control the situation, salvage her international reputation and prevent a “disease ridden city” label.

    Maggie

    References:
    Parry, Hazel. “Deadly tide of birds in HK fuels fears of H5N1 cover-up” The China Post, 9 February 2009 http://www.chinapost.com.tw/china/local-news/hong-kong/2009/02/09/195302/Deadly-tide.htm

    “Hong Kong hotel is eliminating memories of SARS” Taipei Times, 23 February 2004 http://www.taipeitimes.com/News/world/archives/2004/02/23/2003099824

  2. rosanneleung Says:

    Dear Pinky and Katrina,

    Thank you for your post.

    Linking health crises like bird flu and SARS to security has no doubt raised government’s policy priority and public awareness during outbreaks. I agree that securitization was indeed needed in light of the serious risks involved.

    In addition to our close link with China, we are among the most densely populated places in the world. If bird flu/ SARS were to become an uncontrollable pandemic in Hong Kong, the result would have been catastrophic. As Maggie said, our heavily-relied-on tourism and financial industries would be seriously harmed. It is widely accepted that good health is a precondition for economic growth and development. (Maclean, p. 487) With economic security at stake, it is understandable that government had to adopt the securitization policy.

    On the other hand, I can see your concerns in relation to conflicting interests and resource misallocation. Nonetheless, I am of the view that securitization policy should still be adopted. While acknowledging that the poultry traders’ legitimate interests to make a living, public health should be given priority. The traders’ loss can at least be quantified and compensated, but the harm brought by the infectious diseases and the resulting deaths cannot.

    Compared with cancer which is non-infectious and curable to a certain extent, avian flu deserved the attention owing to its ability to spread in the community, the possibility of human-to-human transmission, as well as the high mortality rate of 62% worldwide. (WHO website) We should not take that risk. If government had not adopted the securitization measures, there might have been a lot more than 6 deaths in 1997. Similarly, SARS was highly infectious with a fatality rate of 17.1%. (SARS Expert Committee Summary Report) and could caused long-term sequelae to SARS victims even after rehabilitation.

    Rosanne

    References:

    Sandra Maclean, “Microbes, Mad Cows and Militaries: Exploring the Links Between Health and Security” Security Dialogue 39(5): 475-494, October 2008

    SARS Expert Committee’s Summary Report, http://www.sars-expertcom.gov.hk/english/reports/summary/files/e_sumrpt_sect2.pdf

    WHO website, http://www.who.int/csr/disease/avian_influenza/country/cases_table_2009_03_10/en/index.html

  3. pinkychu Says:

    Thank you for your comment Maggie!

    Securitizing the threat of Avian Influenza is a must! After the implementation of the current policies on bird flu, poultry import from Mainland has become highly regulated and is under more intensive investigation. The government’s effort on trying to prevent H5N1 invasion to Hong Kong through chicken/poultry import is obvious.

    But you have pointed out a loophole in the policies. Recent events such as chicken carcass with H5N1 was found floating in the sea off Ping Chau, probably, from Mainland. We agree that these cases are bringing serious threat of avian flu to Hong Kong people, and they are potential time bomb of the disease outburst.

    Yet, there is little the government alone can do in avoiding these from happening, it seems to be out of the control of the government. Rather than working on our own, we believe that cooperation and coordination among different places on securitization would be more effective. A cooperation agreement on Response Mechanism for public health emergencies was already signed by China, Macau and Hong Kong in 2005 to prepare for prevention and control of bird flu and other infectious diseases. This is aimed to exchange first hand information among the three places, so that earlier detection and immediate response can be made. Although the effectiveness of this mechanism is uncertain as no large-scale outbreak of avian influenza was found, it reflects governments’ determination in fighting against the disease.

    – Pinky and Katrina

    IS Department, HKSAR (2008). HK, Mainland and Macau test emergency response to avian flu. Retrieved from http://www.info.gov.hk/gia/general/200812/16/P200812160179.htm on 11 March 2009.

    South China Morning Post (2009). H5N1 carcass found. Retrieved from http://www.scmp.com/portal/site/SCMP/menuitem.2c913216495213d5df646910cba0a0a0/?vgnextoid=1b43eb01d4cdf110VgnVCM100000360a0a0aRCRD&vgnextfmt=teaser&s=news on 11 March 2009.

  4. lkmkatrina Says:

    Rosanne,

    Thanks for your comment.

    We agree that securitization of avian flu has to be done by the government, but we would like to highlight the conflict of interests is making the securitization difficult to be effective. The government faces dilemma in securitizing the public health and balancing the interest of poultry traders. Resource constraint is one of the problems in dealing negotiations with poultry traders as only 75% of them were willing to participate in the license buyout scheme, meaning that much more money is needed to make everyone happy. In addition, legislators representing particular constituencies, like the catering sector and agriculture and fisheries sector, have also made the process of securitizing bird flu a long one. It takes a long time to agree with the centralized slaughter house proposal, for example.

    As for the potential misallocation of resources, cancer is only one of the examples in the list of health issues. We understand that cancer, compared to avian flu, may seem more “in control”. The seemingly less urgency is the reason why we think that it may be neglected by both the public and the government. Securitization of avian flu is definitely needed, but what we are suggesting is other health issues should not be taken less, problem (i.e. consequences of other diseases being ignored) may eventually occurs if resources are misallocated.

    – Katrina and Pinky

  5. Becky Says:

    Thanks for your post. It is quite interesting and make me to associate bird flu with the outbreak of SARS in 2003. In my opinion, in fact, sadly to say…the Hong Kong government is always working hard on “misallocating resources”, in ALL ASPECTS I can think of. But I have a little question on your comparison of lung cancer and bird flu as their patterns are very different. Bird flu is an epidemic which can potentially outbreak in large scale (even global scale with massive deaths) but lung cancer is not infective and will not exceed our control. The great concern of bird flu by the government is she learned lessons from the SARS in 2003. With the origin in mainland China, this epidemic further spread and transmitted to different places around the world through travelling (for further figure can refer to Summary of probable SARS cases: http://www.who.int/csr/sars/country/table2004_04_21/en/index.html). In the outbreak of SARS, the financial situation of HK was deadly bad and negatively affected many sectors like tourism and retailing as people were not willing to go out and tourists avoided to come. Which the no. of aircraft landing HK then suffered from a great drop (ref:Civil Aviation Department: http://www.cad.gov.hk/english/p-through.htm). As Hong Kong relies heavily in tertiary industry, the outbreak of diseases and epidemic would be a fatal hit to the economy and tumble inconceivable subsequences. So the reason why the government so concern about avian influenza is imaginable.

    However, the actions of government are abstruse like the mass killing of live chicken and to request shops to sell out all chicken before they closed. In fact, the virus of bird flu can be all killed if we cook chicken thoroughly. Also a better personal hygiene is a good way to avoid infection. I think the main point is not the problem whether the resources is misallocate by the government or not, it whether the government doing right and suitable things to that epidemic or not. Money on public health should be a great amount but there is still no lesson for the government to learn “how to spend those money smartly”.

  6. Tong Yui Wa Andy Says:

    Thank you very much for sharing your ideas with us. You have raised interest points on of which is the consequence of the securitization policy. I highly agree with the point which is “misallocation of health resources”. I have even regarded misallocating resources as normal in Hong Kong. The government prefer to killing all the chickens when one chicken has been found to have H5N1 rather than implementing policies on checking the qualities of imported chickens at the borders. Hong Kong government’s action is more reactive than proactive. It has really made me confused.

    Regarding to flu virus as a “nationalized” issue through “securitize” it, I am worried that it may not be the best way out. It does effectively help to prevent major spread of the avian flu virus which has helped to assure that Hong Kong’s economic which highly relies on tourism, logistic industries will not be negatively affected because of flu virus like SARS. However, as what has been mentioned by Junio Valerio Palomba (2008) in the article “What are the risks of securitizing infectious disease pandemics such as HIV-AIDS and SARS?”, one of the major consequences of securitization process of infectious disease is that the humanitarian and global aspect of the illness may be undermined. Will Hong Kong do nothing when the mainland or other palces are suffering from flu virus ? Flu virus as well as other infectious disease should be regarded as humanitarian threat towards human security. It is not the case that you are affected, so you take actions but whoever are affected, you also take actions. As a result, I think that the current health securitization policies in Hong Kong may be feasible one but not an ideal one. Indeed there are many prevention measures to prevent the spread of fle virus like educating the public by the government/schools/NGOs; correcting our behaviours like washig hands, cooking food fully; better urban planning to improve the ventilation of buildings and many other measures. However, everything is just to late. I have not watched any advertisements which teach us the wash hands nor any notices in public spaces (schools, shopping plazas etc) before SARS. It is really confusing.

    Thank you again for sharing your ideas with us. It has made me rethink that the previous invastion SARS can indeed have been prevented.

    Cheers,
    Andy

    Reference:
    Junio Valerio Palomba. (2008). “What are the risks of securitizing infectious disease pandemics such as HIV-AIDS and SARS?” Retrieved on 12th March, 2009 at http://www.e-ir.info/?p=523

  7. Pinky Chu Lai Man Says:

    Thank you for your post, Becky!

    We agree with you that the government’s reaction to bird flu may be greatly affected by the SARS in 2003. The government is working seriously on this issue to fight against the disease and avoid the similar chaos as 2003 from happening again.

    We understand that the nature of cancer and that of avian flu are different, and of course the method of responding would also be different. Our intention in pointing out this disease is to raise the attention on potential consequence of resource misallocation, it is possible that the fear for chaos (mentioned above) may affect rational decision of the government.

    Some of the government policies for avian flu may not be perfect. Just like the example that you have raised. It is true that experts have suggested H5N1 virus of the chicken can be destroyed if they are well-cooked. However, as the government of Hong Kong, it is her duty to take the initiative in minimizing the risk as possible. By just asking citizens to be more careful when cooking is too much a risk for the government.

    But as a whole, we all believe securitizing the threat of avian flu and balancing the spending of difference health issues are both important!

    -Pinky and Katrina

  8. lkmkatrina Says:

    Andy,

    Thanks for your comment!

    We agree with you that the government’s response is reactive rather than proactive. This is a weakness of our government, often being blamed for her hindsight on all kinds of issues, including health, economic and social aspects. However, we think that the government does not prefer the culling of all chickens over import quality controls in the borders because both measures are adopted by the government and it is understandable that preventive measure (i.e. killing all chickens) has to be adopted even if only one chicken is found infected as no one can say for sure that others are not infected.

    You have also raised some good points about drawbacks of securitizing a health issue and a major consequence is that the humanitarian and global aspect of the illness may be undermined. The process of securitization risks distorting prioritizing logic that policies are aimed at controlling the disease rather than fighting it because the virus is perceived as threatening the security of the state in the sense of traditional security instead of people becoming ill. Nonetheless, we should not forget that the process of securitization does benefit developing nations in overcoming scarce resources in developing bird flu vaccines by raising the awareness of the potential bird flu pandemic throughout the world. For example, vaccines tackling avian flu have continuously been developed with multiple efforts from the international community, like the joint efforts between Hong Kong and the U.S. recently. Other countries like Japan, China, and the Netherlands have also contributed to the development of bird flu vaccines.

    With the pros and cons of securitizing health issues in mind, we believe that securitizing bird flu is necessary but we should also take care of the possible drawbacks of it. In addition to securitizing the issue in a local level, securitization should be extended across the region as well to maximize the effectiveness of the policy.

    References:
    Junio Valerio Palomba. (2008). “What are the risks of securitizing infectious disease pandemics such as HIV-AIDS and SARS?” Retrieved on 13th March, 2009. http://www.e-ir.info/?p=523

    China Daily (HK edition). “H5N1 vaccine offers many advantages”. 10 Mar 2009. Retrieved on 13 Mar 2009. http://www.chinadaily.com.cn/hkedition/2009-03/10/content_7557512.htm

    – Katrina and Pinky

  9. benitozenil Says:

    Thanks for the info Pinky and Katrina.

    I like the blog, was very informative. I had a flashback to 2003 when there was a concern in North America than SARS disease could be spread and create huge problems. I remember that because just three months before I went to Canada, in Toronto they found few cases of people coming from China and were infected with SARS. Also remember some actions Canada’s government applied such as cancel temporary flies coming from Asia and the people that were on the first plane were in quarantine. Few friends and myself didn’t know what would happen by the time we arrived to Canada west coast (6 hours of difference in airplane and more than 3000 kms from Toronto).
    My point over here is that just few passengers were in quarantine in Toronto and some flies were cancel so SARS can be stopped. However in China they took several actions. Now, we are talking about the most populate nation in the world. If avian flu could evolve to an infectious disease that can be spread through human2human contact there is going to be lots of consequences.

    Hong Kong is one of the most important ports of China. To promote international commerce has few regulations to import and exports products. If avian flu or any other disease happen right now, the economic, social and health impacts could be enormous affecting not only Hong Kong are but, to all parties involve in international trade. So, what’s more important, prevent this disease to improve health and regulations or to promote trade by regulating trade threats? Could you imagine Hong Kong in quarantine? Or China?


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