Since the Hong Kong health system is often an important gatekeeper with regard to pandemics, I was interested to find out how the government structures preparedness efforts for both unintentional and intentional biological incidents.
Before the coronavirus pandemic, I spoke to a senior officer who is working for the Government of the Hong Kong Special Administrative Region (HKSAR). We discussed the Hong Kong Government’s approach to bioterror and public health preparedness.
Due to the sensitive and often classified nature of my research topic, it sometimes happens that experts who are working for government entities ask to remain anonymous. This happened in Hong Kong and I am therefore unable to share details of my interviewee’s work experience and educational background1.
Before my conversation with the public health expert, I had also approached the Centre for Health Protection at the Department of Health in Hong Kong by email to ask for information. An officer at the Emergency Response and Information Branch kindly replied to my request and provided me with links to various websites outlining the details how Hong Kong protects against a possible terrorist threat2, HKSAR Government’s preparedness and response plans for communicable diseases3, an overview of the roles and functions and major area of works of the Centre for Health Protection (CHP)4, and an overview of the health care system in Hong Kong5.
I found Hong Kong’s emergency plans to be detailed, transparent, and clear. Hong Kong is making an effort to reduce complexity with a “three tier” response system6. Citizens have access to easy-to-understand information and practical instructions to an extent I have not seen in other countries, including the US.
Q: Please could you tell me a little about how Hong Kong has organized itself to deal with biological terror threats? Is there a single national organization that is responsible? Or would several different entities be involved?
A: These kinds of preparations are led by the Security Bureau of the Government of the Hong Kong Special Administrative Region. On the Security Bureau’s website6, you will find detailed information on emergency response management. It’s very transparent.
The Security Bureau will verify a potential threat, and then alert police and medical departments. Different departments have different roles to play. Police do one part, health and other bureaus deal with other aspects. Evacuation and international coordination efforts are handled by the Security Bureau, which reports to the Chief Executive. From there, they will report to Beijing.
Q: How would the response differ in Hong Kong in the case of a bioterror incident as compared to a pandemic?
A: Pandemics are handled solely by the food and health bureau. It is the Security Bureau that would be involved in bioterror incidents. H1H1 is an example of the former. The health center would liaise with different health departments overseas. It provides the resources and manpower to educate people how to avoid contamination. All that would be coordinated by the government. When there is a ban on travel from Hong Kong, the Security Bureau would get involved and issue a quarantine order.
Q: How would Hong Kong work with mainland China in the case of a bioterror incident? Who would make the decisions?
A: One country and two systems exist here, with Hong Kong having its own policies. But in a bioterrorist incident, the Security Bureau would initially handle the situation.
Q: What do you think are the pros and cons of the current public health system in Hong Kong? How does it compare to the systems in other countries?
A: Hong Kong has a very efficient and mature system in tackling pandemics. We have a lot of expertise and good relations with other countries and are generally well prepared.
Q: At what point would Hong Kong ask for help from abroad if there were a biothreat incident?
A: The initial responsibility lies with the local health authority. They alert other health authorities. Hong Kong is quick to report pandemics and it is crucial that this is done as early as possible. You may remember that during the avian flu pandemic, we quarantined foreigners in hotels for one week. If a large bioterror incident happens, we would send representatives to the WHO and ask for international collaboration and help, also from the CDC.
Q: What would you say are the advantages and disadvantages of the current international system?
A: The advantages are that most countries have similar goals, aspirations and policies or strategies to prepare for and combat pandemics and biothreats. The role of the WHO is to write policies that aim for a maximum of coordination.
In terms of disadvantages, not all countries can follow the rules and regulations laid out by the WHO, partly due to a lack of money. We will have to strike the right balance between the standard and reality.
Q: Do you have any suggestions for how to achieve a more coordinated approach?
A: Different countries have their own agendas when there are pandemics. There is always the fear of negative financial impact when certain areas are labeled as dangerous. One suggestion might be to have a more customized approach in each market.
Q: In the case of a biological attack, what do you think would be more effective, a centralized health system (like South Korea) or a decentralized one (like in the USA)?
A: A centralized system may be better to control a bioterrorism incident. The freedoms of a decentralized system might make it hard to centralize later.
Q: Are there any hot topics in this area that you think might be worth looking at?
A: Yes, contingency planning for pandemics. Hong Kong is not a high-risk area in this case. Exercises done here are good for bioterror preparedness. For pandemics, Hong Kong has a lot of experience with emergency responses. Rehearsals for pandemics, public health services, investigations, etc. are well structured.
Q: Thank you so much for taking the time to speak with me today!
A: Anytime, Mia!
1 Personal interview with a public health specialist who works for The Government of the Hong Kong Special Administrative Region, which took place in Hong Kong, S.A.R., on July 9, 2018