I for a  map of total SARS cases and deaths.) WHO’s Response to SARS Was Extensive, but Was Delayed by an Initial Lack of Cooperation from China and Challenged by Limited Resources

WHO’s actions to respond to the SARS outbreak were extensive, but its  response was delayed by an initial lack of cooperation from officials in  China and challenged by limited resources. There  were two primary aspects to WHO’s activities during the SARS outbreak:  One was the direct deployment of public health specialists from around the  world to affected Asian governments to provide technical assistance; the  other was the formation of three virtual networks of laboratory specialists,  clinicians, and epidemiologists who pooled their knowledge, expertise, and  resources to collect and develop the information WHO needed to issue its  guidance and communications about SARS. WPRO also facilitated the deployment of an additional 80  public health specialists to SARS-affected areas. U.S. Government Had Key Role in Response to SARS, but Efforts Revealed Problems in Ability to Respond to Emerging Infectious Diseases

CDC, as part of HHS, and State played major roles in responding to the  SARS outbreak, but their actions revealed limits in their ability to address  emerging infectious diseases. CDC worked with WHO and Asian  governments to identify and respond to the disease and helped limit its  spread into the United States. However,  State encountered multiple difficulties in helping to arrange medical  evacuations for U.S. citizens infected with SARS overseas. After Initial Struggle, Asian Governments Brought SARS Outbreak under Control

The Asian governments we studied initially struggled to respond to SARS  but ultimately brought the outbreak under control. Improved screening, rapid isolation of suspected cases,  enhanced hospital infection control, and quarantine of close contacts  ultimately helped end the outbreak. In the aftermath of SARS, efforts are  under way to improve public health capacity in Asia to better deal with  SARS and other infectious disease outbreaks. An Initial Lack of Effective Leadership and Coordination in SARS- Affected Areas in Asia Hindered Response

As acknowledged by government officials, a lack of effective leadership  and coordination within the governments of China, Hong Kong, and Taiwan  early in the outbreak hindered attempts to organize an effective response  to SARS. Dampened consumer confidence from SARS also had negative impacts on  retail sales and foreign trade and investment, according to anecdotal  evidence. Member states will have to resolve at least five important  issues, regarding (1) scope of coverage, (2) WHO’s authority to conduct  investigations in countries absent their consent, (3) the public health  capacity of developing country members, (4) an enforcement mechanism  to resolve compliance issues, and (5) how to ensure public health security  without unnecessary interference with travel and trade. It also revealed limitations in the International Health  Regulations. To assess the role of the U.S. government in responding to SARS in Asia  and limiting its spread into the United States, we analyzed program  documents and interviewed officials from the Departments of Health and  Human Services, State, Defense, and Homeland Security, and the U.S.  Centers for Disease Control and Prevention (CDC). Finally, to examine the status of efforts to update the International Health  Regulations, we reviewed the current International Health Regulations, a  draft of WHO’s proposed revision of the regulations, the initial U.S.  government response to the proposed revisions, and the WHO constitution. WHO  activates its global influenza laboratory network and calls for heightened global surveillance.
Why GAO Did This Study

Severe acute respiratory syndrome (SARS) emerged in southern China in November 2002 and spread rapidly along international air routes in early 2003. Asian countries had the most cases (7,782) and deaths (729). SARS challenged Asian health care systems, disrupted Asian economies, and tested the effectiveness of the International Health Regulations. GAO was asked to examine the roles of the World Health Organization (WHO), the U.S. government, and Asian governments (China, Hong Kong, and Taiwan) in responding to SARS; the estimated economic impact of SARS in Asia; and efforts to update the International Health Regulations.

What GAO Found

WHO implemented extensive actions to respond to SARS, but its response was delayed by an initial lack of cooperation from officials in China and challenged by limited resources for infectious disease control. WHO activated its global infectious disease network and deployed public health specialists to affected areas in Asia to provide technical assistance. WHO also established international teams to identify the cause of SARS and provide guidance for managing the outbreak. WHO's ability to respond to SARS in Asia was limited by its authority under the current International Health Regulations and dependent on cooperation from affected areas. U.S. government agencies played key roles in responding to SARS in Asia and controlling its spread into the United States, but these efforts revealed limitations. The Centers for Disease Control and Prevention supplied public health experts to WHO for deployment to Asia and gave direct assistance to Taiwan. It also tried to contact passengers from flights and ships on which a traveler was diagnosed with SARS after arriving in the United States. However, these efforts were hampered by airline concerns and procedural issues. The State Department helped facilitate the U.S. government's response to SARS but encountered multiple difficulties when it tried to arrange medical evacuations for U.S. citizens infected with SARS overseas. Although the Asian governments we studied initially struggled to recognize the SARS emergency and organize an appropriate response, they ultimately established control. As the governments have acknowledged, their initial response to SARS was hindered by poor communication, ineffective leadership, inadequate disease surveillance systems, and insufficient public health capacity. Improved screening, rapid isolation of suspected cases, enhanced hospital infection control, and quarantine of close contacts ultimately helped end the outbreak. The SARS crisis temporarily dampened consumer confidence in Asia, costing Asian economies $11 billion to $18 billion and resulting in estimated losses of 0.5 percent to 2 percent of total output, according to official and academic estimates. SARS had significant, but temporary, negative impacts on a variety of economic activities, especially travel and tourism. The SARS outbreak added impetus to the revision of the International Health Regulations. WHO and its member states are considering expanding the scope of required disease reporting to include all public health emergencies of international concern and devising a system for better cooperation with WHO and other countries. Some questions are not yet resolved, including WHO's authority to conduct investigations in countries absent their consent, the enforcement mechanism to resolve compliance issues, and how to ensure public health security without unduly interfering with travel and trade.