SARS and the Communication Challenges of Global Public Health

The spread of the Zika virus has brought global attention to the issue of epidemics – and the international public health and communications challenges that go with them.

Huiling Ding, director of NC State’s graduate-level Technical Communication program, is an expert on these challenges. Her book, Rhetoric of a Global Epidemic: Transcultural Communication about SARS, won the CCCC’s Best Book Award in Technical or Scientific Communication for 2016 for its analysis of how government organizations and media respond to and report on emerging global epidemics.

We wanted to talk with her about the SARS epidemic and the communication challenges associated with addressing contagious disease on the world stage.

The Abstract: When did you first become aware of SARS? Do you remember your first impressions when it first started making the news in 2003?

Huiling Ding: I learned of SARS in early April 2003 when alternative ethnic Chinese media started to report about the mysterious pneumonia in Guangzhou. As I grew up in China, I heard from fellow kids about rumors of No. 1, No.2, or No. 3 epidemic that wiped out entire villages in remote areas, which I now believe may have been cholera, smallpox or plague. So when I heard about the contagious pneumonia, I immediately thought about these highly contagious epidemics that took place in the past and called my parents and asked them to buy masks for self-protection. Another thought at that time was, “Too bad we cannot go home this summer.” Indeed, many Chinese students studying abroad cancelled their plans to return home to visit their families in 2003.

TA: You’re a health communication researcher, but there are hundreds of issues that you could be working on. When did you decide to focus on how governments and news media were communicating about SARS? Was there a particular moment or event that made you want to dig into the subject?

Ding: I was studying communication about SARS in real time, since I started to collect data in early April 2003. One of my original plans was to compare the ideological and political values reflected in scientific and popular reports about the same epidemic, which was done in many epidemic studies I had read. It did not work because of the relatively few scientific studies published about SARS at the early stage of my study. Fortunately, I had been doing quite a few projects using textual and rhetorical analysis, and learned to adopt an open-minded approach and follow my own data instead of using pre-existing hypotheses to direct the study. That was what led me to focus on governmental, media and grassroots discourses on SARS. One thing that always fascinated me was the early underreporting of SARS from the Chinese Ministry of Health, the firing of the Minister of Health and Beijing’s mayor, and the subsequent overreporting of SARS in mainstream media. One of the news outlets I followed closely at the early stage of my study was People’s Daily, which remained silent about the outbreak before April 20 before devoting most of its space to SARS-related reports afterward. This sharp contrast really became the revealing moment that led me to focus on official and media responses to SARS.

TA: Your book evaluates cultural differences in how governments and media communicated about SARS in China and the U.S. as well as how the World Health Organization handled it. That’s an incredibly broad scope for study. Where did you start, and how did you organize your work so that you could address these issues systematically?

Ding: When I started my dissertation, I saw it as a work on intercultural communication because there was no way to talk about an emerging global epidemic in a nationalistic or geographically contained manner. I wasn’t sure how to cope with the international dimension back then, so I started small, by focusing on the coverage from People’s Daily, which turned out to be not so productive. It did point me to repeated references to WHO’s visits in various parts of China, which led me to examine WHO travel advisories. I quickly realized that Chinese national media remained silent about WHO’s travel advisories targeting particular parts of China, yet offered prominent coverage of WHO’s compliments about China’s anti-SARS efforts. This finding clearly pointed me to the political negotiations between WHO and China and the diplomatic approaches both players took to work with each other without direct confrontation.

I wanted to include media and grassroots responses from the U.S. because it provided interesting comparative insight about the vastly different ways emerging epidemics get interpreted and constructed by both the epicenters and those countries fortunate enough to be relatively unaffected by such epidemics. Analysis of such narratives often reveals the historical, political, economic and cultural forces that work to shape the interpretive frameworks adopted by different storytellers, which in turn contributes to our intercultural understanding about global epidemics and the different stories told about them.

Is there a way to systematically address issues related to intercultural health communication about epidemics? I really doubt it. Our studies are always limited by time and resources and thus limited in scope. For my book, I worked on a chapter by chapter basis, since the finished ones often informed the following chapters. It is like putting a puzzle together without any hint of what it looks like. You have access to unlimited pieces, but with limited time, each one of us may build something different. As long as the puzzle you build is complete in itself, it is OK. If time allows, you can continue to expand your puzzle about one room into a much larger one that is about a castle, and that’s what I am doing with my second book, which examines SARS quarantine policies and practices used in the four epicenters: China, Hong Kong, Singapore and Canada.

TA: At what point did you realize that this was going to be a book, instead of a journal article (or series of journal articles)?

Ding: Pretty early in the process. As a doctoral student, I was always interested in doing original research, be it empirical work requiring recruiting research participants and working with them to gather data or textual analysis of news reports, scientific publications, grant proposals or personal statements. I also read many books on epidemics and health communication, including Paula Treichler’s How to Have Theory in an Epidemic: Cultural Chronicles of AIDS and Scott Blake’s Risky Rhetoric: AIDS and the Cultural Practices of HIV Testing. These two authors’ work were very inspiring to me and I wanted to follow their example and develop a solid study of the way institutions, media and affected communities made sense of SARS. Therefore, my goal was to write my dissertation as a publishable book during my four years at Purdue.

TA: What were some of the key themes you uncovered in terms of cultural differences in how governments and reporters communicated about SARS?

Ding: Globally speaking, the official and media communication about emerging epidemics is first and foremost shaped by our relationship with the epidemics: Is it a local one? An invading one? An imported one? Or one that’s too distant to be concerned about? It is also shaped by the relationship and negotiations between the epicenters and us. For instance, while the U.S. media covered the SARS epidemic as an invading epidemic that would be imported by foreign students and travelers from epicenters, such stances can be negotiated and changed as reflected in the aggressive intervention from Hong Kong in negotiating with University of California Berkeley and the active political campaign Canada launched in its protests against WHO’s inclusion of Toronto in its April 23 travel advisory. In addition, the political and economic interest and infrastructural conditions of the epicenters also exert great impacts on the way we communicate about such epidemics.

One such example is the impact censorship and political will had on the way SARS was covered in Beijing. It was not until the new leadership of Hu Jingtao took over from Jiang Zemin and appointed their own personnel as the Minister of Health and Beijing mayor did changes take place to ensure more transparent risk communication and stronger accountability mechanisms.  Last, but not the least, individuals and communities affected by SARS also strove to have a say, often by circumventing the power apparatuses, in the deliberation of risk policies about SARS. Therefore, to ensure full cooperation from the public, it is key to create an open communication environment to allow participation from communities in making decisions that would eventually affect their wellbeing.

TA: Were there any surprises? I mean, were there instances when the ideas you had going into the work turned out to be very different from what you anticipated?

Ding: Yes, good research should often bring new and surprising insights. Indeed, my book turned out to be nothing close to what I had planned at the beginning of the project. I was originally hoping to compare scientific and popular reports and see how these two types of outlets differed in their interpretation of SARS, as many of the books on epidemics had done. This plan was quickly proven infeasible because of the small number of scientific publications on the topic back in 2003 and 2004 and the relative lack of ideological twists in these articles. The news reports from People’s Daily were informative yet formulaic, focusing on the success stories and heroic devotion from medical care workers, and thus less interesting to write about.

I tried to explore other publications on SARS in China and came across many news reports about the so-called atypical pneumonia from the Guangdong province. So I did extensive research on Guangdong media, managed to find a couple of central databases for the mainstream and regional newspapers, and collected many news reports retrospectively from these media. As Guangdong media were less controlled and more commercialized, their reports contained more controversies, inside stories and often contradictory claims about local outbreaks, which provided a fertile ground to analyze the different ways local and national media constructed the same outbreak and to compare the different claims made about the same incidents from different media at different stages of the epidemic.

TA: Has the book led to any discussions with other researchers, or public health officials, about how this work could inform future public health communications efforts?

Ding: Yes, my work on extra-institutional risk communication has been picked up by other researchers in professional and technical communication, and we had a panel devoted to grassroots risk communication in our annual conference on technical communication this year, as well as a special issue on tactical technical communication from a leading journal in the field. The rise of social media after 2003 provides multiple open platforms for unofficial risk communication, which also poses challenges for concerned citizens to distinguish between rumors and leaked information from concerned professionals. In addition, I was invited to serve on the pandemic preparation committee back at Clemson University, where committee members talked extensively about possible ways to make quarantine, living and community support arrangements for international students when they could not return to their home countries in the hypothetical scenario of a quickly spreading global epidemic. At the international level, I met with my informant from China’s Ministry of Health to share my findings with him/her and have been invited to review grant proposals on health communication projects for the Hong Kong Research Grant Council in the past few years.