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profiles by mike field

Jean-Marc Olivé discusses SARS with Philippines President Gloria Macapagal Arroyo.

JEAN-MARC OLIVÉ
When SARS arrived in the Philippines, Jean-Marc Olivé was one of the first to know. As representative for the World Health Organization (WHO) there, Olivé, MD, MPH ’80, learned that a native Filipino was the business partner of one of the first people to die from a strange new illness recently identified in Hanoi, Vietnam. This was before the term SARS—severe acute respiratory syndrome—had been coined, before the WHO began an unprecedented worldwide alert to contain the disease. The Filipino had developed diarrhea and other signs of illness soon after his partner’s death. He was sick, he was scared, and one more thing—he was coming home.

“We were quite lucky,” says Olivé of what happened next. “We were able to track the man down and convince him to go to a hospital, where we had him isolated.” As it turns out, the man soon recovered. But Olivé thinks the false alarm was a big help. “We right away began developing strategies and procedures, so we were a bit primed when the first case actually arrived.

“We had two and a half very ‘hot’ months—it was very tense,” he says. “The health infrastructure in the Philippines is weak, and it was thought if SARS got here it would be a huge problem.”

The WHO was particularly worried about the Philippines because of its unique economy. Nearly 10 percent of Filipinos live and work abroad. Early in the outbreak, Filipino nurses died in Hong Kong and Singapore. At that time, there were at least 10 flights a day from Hong Kong to the Philippines. WHO authorities worried that all the Filipino overseas workers returning to the country could be prime vectors for the disease.

“By this time SARS was all over Singapore and Hong Kong, but the Philippines had yet to report its first case,” Olivé remembers. “People were thinking we were withholding information. Officials in Geneva [WHO headquarters] had difficulties understanding that no case of SARS had yet been identified.”

Overall, the Filipino response was impressive—and effective. “We only had 12 cases and two deaths, and all of the transmission occurred within the hospital, with no risk of infection in the community,” says Olivé. Even so, he had heated discussions with WHO in Geneva about the type of transmission occurring. “All of it occurred in the hospital, but the Philippines was put on the list of ‘B’ countries—meaning there was ‘community transmission.’ As soon as the country was listed, it was a disaster,” he says. “Many countries issued travel bans to the Philippines, and many Filipino overseas workers could not get back to their workplace.”

Eventually, the country was removed from the list and certified safe. Olivé credits two factors for the success of their efforts: political commitment at the highest level, and the tremendous work of local epidemiologists in tracking and isolating all contacts of the index cases, thus preventing transmission to the community.