Dr Donald Li, Dr Wong, Dr John Chung and all colleagues,

I wish to thank you for giving me this opportunity to speak on the subject of communicable disease control for which our family physicians have, for a long time, been our closest partners.

In the post-SARS period Hong Kong has, as a whole, won praise after praise for how we have fought and won the battle. The recent SARS outbreak put the disease control mechanism of Hong Kong through a stringent test. With the benefit of hindsight, we know that, although we may be worthy of this praise in some areas, there were areas in which we could have done better. More importantly, we are firmly of the belief and have the conviction that we will be able to perform a lot better the next time we are confronted with SARS or another deadly pathogen.

The Chief Executive first announced in May 2003 the Government's decision to study the establishment of a CDC-like organisation in Hong Kong to fight and prevent communicable diseases.

The SARS Expert Committee, appointed by the Chief Executive, released its report in October, recommending the establishment of a new organisation which should not only have professional knowledge and expertise in combating communicable diseases, but also the administrative skills and statutory power to co-ordinate various Government departments and the community when dealing with health threats and emergency. The Expert Committee recommended this new organisation to be named "Centre for Health Protection" instead of CDC.

Health protection in this context means measures that public health authorities and others take to protect the population from communicable diseases and public health hazards.

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* This paper was presented at the HKCFP Annual General Meeting on 12 December 2003.

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Communicable disease control in Hong Kong

Communicable disease control is currently one of the key functions of the Department of Health. The duties are discharged through various services and units, including the Disease Prevention and Control Division, the Regional Offices, the Pathology Service, the Tuberculosis and Chest Service, the Social Hygiene Service and the AIDS Programme.

There are in fact several functional components in the control of communicable diseases, and surveillance is one of them. Surveillance is the continuing scrutiny of all aspects and occurrences of diseases that are pertinent to effective control. We have a framework for the surveillance of communicable diseases in Hong Kong. In practical terms, this includes: a statutory notification system for 28 communicable diseases; special reports of field investigation and individual reports; mortality and morbidity reports and statistics; laboratory surveillance, which is becoming increasingly sophisticated; sentinel surveillance for non-notifiable diseases that are of public health importance; and behavioural surveillance, etc.

The other components of communicable disease control are:- outbreak control mechanism; enforcement of public health legislation, and this includes isolation of patients, premises and various quarantine and border control measures; immunisation programmes for children and the elderly; curative services for conditions like tuberculosis; public education and risk communication; and finally, coordination and collaboration with related local and international parties. The existing disease control mechanism has risen up to many challenges in the past until the SARS epidemic revealed some gaps and areas where we need to improve on. These include insufficient co-ordination among hospitals, universities, Government departments and other sectors involved in the control of diseases; inconspicuous interface with the community; insufficient provision for applied research inadequate preparedness and contingency planning and lack of a strategic risk communication arrangement.

On the other hand, let us not forget our strengths in the health care system, some of which reside in the Hospital Authority, some in the Department of Health, and others in the private sector. These include an experienced team of field staff including doctors and public health nurses dedicated to communicable disease prevention and control; integration of communicable disease control activities with treatment services for instance, for TB, HIV and STD; high quality medical care; a clear legal mandate for disease control; and international recognition in the fields of virology, influenza and AIDS.

We believe that the duty to protect members of the community from the threat of communicable diseases rests with the Government. We are also of the view that the Centre for Health Protection (CHP) should be built upon existing strength and should serve to bridge the existing gaps among the stakeholders. The Department of Health is preparing for major internal re-organisation to make way for the establishment of the CHP within the Department.

An Advisory Committee has been set up in the Health, Welfare and Food Bureau chaired by its Secretary with representatives from the medical profession, academia and other government departments, to advise on the way forward. A Planning Office for the CHP has been set up within the Department of Health to prepare for the setting up of the CHP. It is hoped that with the efforts put in by all parties concerned, the CHP will be established by 2004.

The Centre for Health Protection

The Vision of CHP is to become a centre of excellence in disease control and prevention, and the Mission of CHP is to achieve effective prevention and control of diseases in Hong Kong in collaboration with major local and international stakeholders.

In order to prevent and control diseases effectively and efficiently, the CHP will be charged with authority, responsibility and accountability to take overall charge in the prevention and control of communicable diseases. Upon its establishment, the CHP will take on the role as the Government's adviser on communicable diseases. It will be vested with the appropriate statutory powers to carry out its key functions. The authority will be sought through amendment of the existing ordinance.

However, the SARS experience showed us that concerted and often multidisciplinary efforts are required for effective disease control. Hence, it is anticipated the CHP will tap the resources and particularly expertise from its partners which will include local academics, neighbouring health authorities, national as well as international health authorities.

Initial thoughts suggested that the CHP should begin with the setting up of six functional branches, each of which will be headed by specialist relevant to that particular function. They would in turn report to the Head of CHP. The branches are Surveillance and Epidemiology Branch, Emergency Response and Information Branch, Programme Management and Professional Development Branch, Infection Control Branch, Public Health Laboratory Services, and Public health Services.

What difference will the Centre for Health Protection make?

One of the major responsibilities of CHP, and the expectation of the community, is to improve communicable disease outbreak management. The most important factors in effective outbreak control include sensitive and comprehensive surveillance and rapid response to outbreaks. Undoubtedly, CHP will set targets in this regard. The CHP will also establish evidence and develop future strategies on the effective control of communicable diseases. CHP will strengthen our emergency preparedness, which will comprise strengthened epidemiological capacity, an early detection and reporting system, contingency planning, clear command and control structure, integrated response, surge capacity and effective communication.

The CHP will interact actively with the academia. Exchange programmes, joint training and collaborative research with local and overseas universities will be developed. It will also focus on areas which were not very central to the Department in the past. For example, the CHP will develop research agenda and support applied research on the prevention and control of communicable diseases.

The CHP will need excellent staff to carry out health protection duties. We are now in the processing of recruiting overseas experts in epidemiology and virology as a short term measure to improve our professional capacity. However, I am sure all of you would agree that we should be investing our resources in the building up the expertise of local health care professionals as a medium and long term objective.

CHP will work with its partners. It will collaborate with health professionals, such as private practitioners, our community, national and international authorities, to minimise the negative impacts of communicable diseases.

In the CHP, there will be a new initiative called Health Protection Programmes. These programmes will be disease and hazard specific and are intended to manage diseases and health hazards in their entirety. The programmes will adopt a multidisciplinary approach, which will be supported by functional branches and professionals from HA, academia, and various Government departments. Ultimately, strategies will be set up for systematic prevention of disease occurrence, and intervention.

I would like to take this opportunity to express my deep respect for the health care workers of Hong Kong, for their selfless dedication, professionalism and contribution in the SARS epidemic. I sincerely hope that the medical profession, the academia and the community would work together towards putting in place a system with the capacity to meet new challenges posed by new and emerging infectious diseases in the future.

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