Conference sponsored by:

Center for Biosecurity of UPMC

Deutsche Bank

The Contingency Planning Exchange

The Economic Impact of SARS in Toronto
Gene Matthews, J.D., Director, Institute of Public Health Law

Speaker biography  |  Slide thumbnails  |  Slide show  |  Video

Let me talk just for a few minutes about how this public health law issue applies to where you are and where you're going. There is a renaissance taking place now in the field of public health law, and and it appears to be [happening] just in time.

The reason behind this [is that] public health law was a very quiet subspecialty in the law for the last 50 years of the 20th Century. And beginning in the 1990s, we became aware, because of the bioterrorist and an emerging infection threat, of the need to start a public health law initiative. That was moved forward rather dramatically by the anthrax attacks following September 11, 2001, and then the international components got in gear after the SARS epidemic of 2003.

Just as an example of the renaissance, there are all sorts of practitioner-related courses out there that are particularly directed toward, [for instance], forensic epidemiology, a new course for law enforcement, public health emergency law for emergency management, public health law 101 for practitioners. Courses are being developed for the judiciary, who would have quite a role in a quarantine situation. So there's a lot going on.

I think it's important to think about that and clearly. Peter will talk more about the communication aspects of it. But I use the Guns of August analogy of Barbara Tuchman, Guns of August and March of Folly, where she talks about how great tragedies occur when technology leaps ahead of strategy and doctrine. And we are at one of those moments--just like in August of 1914, except it is our communications technology, our transportation technology that has simply leapt ahead, certainly in my world of public health strategy and doctrine. And we need to really adapt to that.

The two thought leaders that I look to on this are David Fidler, who is a law professor at Indiana University and his book, SARS, Governance and Globalization of Disease. And Thomas Friedman, whose most recent book, The World is Flat, I think, is compelling reading for anybody in this room.

Fidler talks about how, after SARS, because of the communications technology, the Central Beijing government could not control the flow of information that came out through cell phones and web chat rooms and all of that. And there were two important vertical governance entities that reacted. One was the WHO -- Gro Brundtland and David Heyman stepped up. The other one was CNN, the Cable News Network, the 30-minute news cycle. We're going to talk about it.

And so we're getting into an area of vertical governance as opposed to horizontal government, which has been in place internationally since the Treaty of Westphalia in the 1600s. Friedman talks about, in The World is Flat, how we're all so interconnected and clearly, in a pandemic flu situation that lays directly on us.

This is the saddest slide in my accounts, as far as I'm concerned, because I've been using this slide for two years now. Why should I care? In an outbreak situation, the private sector cannot afford for the government to fail. Think of New Orleans. Governments are facing multilevel budget deficits at the federal, state, and local levels. So, as Winston Churchill or David Fedson would say, would conclude, we're going to need all the help from the private sector leadership and experience that we can to get through these situations.

It's important for the business community, I think, to reflect on the rediscovery of public health. Forty years ago, your professional parents and grandparents came to the conclusion that they were in the business of healthcare provision as well, to employees. A whole set of cottage industries developed, many of which many of you are institutionalized in this room, of providing, having to deal with the healthcare needs of employees.

So, now you are facing the fact that you are also in the business of public health. Your supply chains are impacted by international public health events, the interruptions of global markets, and employee travel that we've already talked about, and the new business opportunities and risks. The risks are clear. The opportunities -- look at Wal-Mart and Home Depot over the last two weeks -- in the corporate benefit that they incurred by being independent, being resilient, and being prepared.

So it is a very interesting time. But you are clearly in the business of public health.

Because of time limits, I'm not going to go deeply into this "I" chart, but any lawyer can fly over this at 40,000 feet and immediately extract the legal and policy issues embedded in an economic recovery from a public health event like avian flu.

You've got to deal with sick leave policies, wage replacements, grace periods for people paying bills -- again, we're applying this right now in New Orleans -- viability of insurance coverage, temporary support of populations, liability protection, both individuals and entities. If you want my hospital to be on the list of collaborating institutions in an emergency, what is my liability exposure in volunteering to do that? The laws have got to address this. Compensation for personal injury and for the property that's taken or redirected in these emergencies, the recovery strategies at the national, international, and community levels, and how we're going to rebuild New Orleans or Houston. Regulatory waivers are a hot issue right now, leading into the environmental issues of remediation and cleanup, exposure assessments, monitoring, healthcare tracking. All of that sort of stuff is critically important.

And then, on the international level, the revisions of the international health regulations, which are currently underway. I might drop a footnote that the ABA and the Public Health Law Association will sponsor, I believe on November 17th, a teleconference on what you in business need to know about WHO's new international health regulations, and I can get you more information on that if you're interested. So, things are moving along quite smartly.

Well, a tale of two cities I'd like to talk about. How am I on time? Are you tracking me? Okay. Oh, no, it's okay. We're going to make it, don't worry.

I have a presentation, which I've been using, some of you may have heard, regarding what we learned at Toronto in the Sloan workshop that we did. But I think we're sort of left this morning with why did Toronto go the direction of Toronto and why did New Orleans go the direction of New Orleans, on the scale of divisiveness and panic versus social cohesion?

Let me say a moment about Toronto, because I found it fascinating. I was watching this and interacting with this in my old job as Chief Council at CDC. Toronto quarantined 30,000 people, voluntary quarantine. Now, if you ask Barbara Yaffe what does she mean by a voluntary quarantine, she said, "It's a voluntary quarantine so long as you voluntarily went along with it."

Okay, intriguing, but it's important that only 27 people in Toronto actually needed to be served with a formal quarantine order and [there was] only one appeal, which was withdrawn after he was told what his exposure event was. So on the scale of divisiveness and panic versus cohesion, Toronto coalesced. They experienced a temporary shift of cohesion.

From [the perspective of] a lawyer, that's very relevant, because how many law enforcement people are you going to have out there enforcing your quarantine? You've got to have voluntary cooperation for this thing to work.The compliance with the directives was substantial. It's an example of how a culture temporarily changes in one of these emergency situations.

From a business point of view the story is that on the day that the large medical conventions -- American Psychiatric Association canceled its conference for Toronto, and it was in April, they said, We ain't coming in June in 2003 -- the center of leadership shifted. SARS was no longer a health problem for government leaders to solve. It was an economic problem for business leaders to solve. They got it, and they went about it.

They created a roadmap of recovery while the epidemic was raging of beginning to think, now, once the all-clear sounded, we're going to need a grassroots engagement to get people in Toronto feeling good about themselves again. Phase two, we're going to have to have a rally and a festival and a big bang event.

They got Mick [Jagger] and Keith [Richards and] the Rolling Stones to come, okay, and planned events around that and then gradually shifted on over into the traditional marketplace outreach.

The importance is they came together, and they started thinking while the epidemic was going on: What are we going to do on the first green day that occurs after the all-clear is sounded? And they put together marketing tools and branding elements and so forth.

I'll give you one example . . . Peter Wilson's fascinating story from Air Canada. All of them had put together a logo, "Canada Loves Toronto," you know, the heart, the maple leaf, the Toronto Needle, good stuff. They thought this out and focus-grouped it upstream. But it's real interesting. This is from Air Canada's website at the time, and the point of this slide is they had the usual promotions -- flight deals, hotels, car rentals, entertainment discounts, go dollar night at the Blue Jays game, etc. But over here, there are two important things: Bus deals and rail deals. This is Air Canada. Who is the mortal enemy of the airline industry? Steel wheels and rubber tires, okay? But during the emergency, the VIA Rail person said to Peter Wilson, "Are you saying to me you're going to let me put a passenger train discount hot link on your Air Canada website?" And he said, "Yes."

Okay? The world changed up on him. It's an important idea to stay in touch with. So the lessons from Toronto are understandable and transferable.The biggest lesson is that the balance of governance is significantly, if only temporarily, altered during an emergency, and business and public health need to be building bridges with each other.

In light of time, I'm not going to go into further details. But if you'd like the report there's a 12-page report that we did for Sloan, which you can pull off the CDC Foundation website at www.cdcfoundation.org. Okay, we're there. So take a look at it if you're interested.

So let's talk for a minute, then, going back to why did Toronto go its direction and New Orleans go its direction, why the city's different. Remember Maslow's Pyramid and the hierarchy of needs beginning with physiological needs -- food, water, shelter, safety needs. And then it moves on up -- belonging, esteem, understanding, aesthetics, self-actualization, and then I transcend into the universe.

Well, there's something to focus on regarding the bottom of the pyramid. When we move away from having shelter and safety and food and water, we behave differently, and that was identified in New Orleans, and it didn't occur the same way in Toronto. I leave the question at the bottom for Peter. How does communication fit in?

I believe that as we have evolved in this electronic era of the 21st Century, when we're cut off from communication that's almost like being cut off from food and water and safety. We are different in that regard, when our cell phones don't work and we can't go on the web, and our access to communications is cut away. We can't see what's going by on the crawl on CNN. We are different because of this, I am convinced.

Okay, just quick comparisons of Toronto and New Orleans that immediately come to mind. The New Orleans communication system was knocked down. Not only did it impact the mid-level managers not being able to communicate, but I think it impacted the population--not being able to know what was going on increased the panic and divisiveness. The experience of shortages of food, water, shelter, transportation, etc., was clearly different in New Orleans.

Toronto, don't forget, had not only a public health system, they had a unified healthcare system. So when we try to do something like this in this country, with our privatized multi-point healthcare system, it could be different. Both countries had serious problems with leadership linkages, when the communication went down between city, provincial, state, and national. Those are comparative.

The hurricane displaced all of New Orleans but the persons who didn't have resources were the ones that couldn't evacuate. In Toronto, SARS initially impacted a higher socioeconomic layer -- international travelers and healthcare workers -- maybe the communication was changed because of that. I'm not sure. But comparable in both is that the business communities reacted quickly.

You have the parable of Air Canada. You know the lesson of Wal-Mart and Home Depot. In normal days, government, individuals, and business like to keep their distance from each other. When SARS comes to town, you find them pull in on your Ven diagram so that individuals listen to their government about quarantine. Employees are connected to their businesses about what's going on, where is everybody, should I come in to work today, and businesses take over a quasi-governmental role in plotting out the recovery.

The PowerPoints, by the way, will be made available through your conference support people, so this is all public domain, and you don't need to scribble furiously.

Well, if you step back on it, on a normal day, whether we are businesses, whether we're people, whether we're government, we're sort of spread out. When the emergency occurs, there's a collapsing down. People draw closer together. Now, after New Orleans, I might add a third point out there. If it gets so bad, we may explode. We go far away again. It becomes anarchy and chaos. So it's an interesting situation.

The cycle of change in one of these situations is very important to you, okay. Normally we're on a green zone day. You know, we're just watching TV and whatever is happening. The emergency occurs, your culture temporarily changes. You've got to go do it. Get it done, okay. Then, when it's over, you have this immediate aftermath of changing your laws and policy.

Okay, you can pass the Homeland Security Bill and airline recovery, okay. All these things occur. The president stands in Jackson Square and announces a major recovery after the hurricane. Then the blame game cranks up, okay, who is going to pay for all this? Toronto went through this in great, exquisite detail, excruciating detail.

But who paid? And then, we're an ADD culture, you know, selective amnesia sets in, and we go back to the green zone again. You got to remember, when you're planning your business strategy, where are you on that cycle? You can't do legislative change if this is a green day. Nobody cares, okay, and if you are in the red zone up here, if you are Wal-Mart and you're sending your trucks with ice and water into New Orleans and somebody at FEMA is setting down here saying, well, you can't go in unless you've got a tracking number, a FEMA tracking number, you can't go into the city, somebody's not playing on the wrong face of the script here.

So, it is important, the flat world message to all this is coming out of Thomas Friedman. He talks about wholesale reform and retail reform. It's in the interest of governments to provide the best legal and institutional framework with which to innovate, start companies, and become attractive partners for global collaboration.

The final message for you, out of this, is what can business and legal communities do?

One, we've touched on this earlier, verify that your governments are ready and prepared. Are your legal and institutional frameworks there? If you have a footprint in China, you need to be testing.

Do they really have epidemiology, laboratory, intervention, communications, command and control, okay? That's part of your due diligence to find out. Wherever you are, are they really ready?

Second, you need to build your own external preparedness networks, geographically, wherever you are, be it Chicago or Guangdong, and industry-wide, within your own supply chain structures. And then finally, prepare for the moments of change. Your leadership arrangements are going to shift. The laws and policies are going to change. You've got to prepare for that upstream and as Bob Shapiro pointed out . . .

If I were saying what we need to do, the great challenge here is to build some new bridges. I really want to thank the sponsors of this, for Roseann and Deutsche Bank, for Paul H. Sloan and for Tara at UPMC.

The law can assist in building some of these new bridges, but I'm very gratified to be here and see that you're well on your way. Thank you very much.

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