By HERMAN B. DUTCH LEONARD                                                                                                                            
                                                                                                                                                      
WHEN Severe Acute Respiratory Syndrome (SARS) first appeared, it                                                                                      
had all the hallmarks of a true crisis: urgency, potential to                                                                                         
create widespread and substantial (and perhaps even                                                                                                   
catastrophic) damage, and significant novelty. The novelty is                                                                                         
that there were no obvious similar experiences that could                                                                                             
provide reliable guidance about how best to respond.                                                                                                  
                                                                                                                                                      
Situations of high urgency that are not novel – a modest                                                                                              
earthquake, for example, in an area long known to be susceptible                                                                                      
to such events – should not create a crisis; public officials                                                                                         
and the larger public should be prepared with plans, trained and                                                                                      
practised response teams that are adequately resourced, and a                                                                                         
command and communications structure that should permit                                                                                               
effective response to the situation. Thus, a reasonably                                                                                               
predictable situation should produce only a routine emergency –                                                                                       
not a crisis.                                                                                                                                         
                                                                                                                                                      
By this definition, the outbreak of SARS last winter and spring                                                                                       
was clearly a true crisis. The crucial question for today is how                                                                                      
should we be organising and preparing public and private                                                                                              
organisations and the public at large for a possible                                                                                                  
reappearance of SARS.                                                                                                                                 
                                                                                                                                                      
                                                                                                                                                      
Leonard: Preparing for the unexpected.  A central responsibility                                                                                      
facing public officials and relevant private organisations now                                                                                        
is to ensure that if SARS does reappear (in some reasonably                                                                                           
predictable form), it does not again become a crisis.                                                                                                 
                                                                                                                                                      
There are several forms in which SARS could reappear that are                                                                                         
reasonably predictable based on its behaviour over the last                                                                                           
eight months. We can distinguish four different possibilities,                                                                                        
each of which calls for different elements of an overall prudent                                                                                      
response:                                                                                                                                             
                                                                                                                                                      
CASE 1: SARS could simply disappear. This is, obviously, a                                                                                            
widely shared hope – but hope is an emotion, not a policy. We                                                                                         
can hope that this scenario has high probability, and we can                                                                                          
hope that it comes true, but it is not safe to rest policy on                                                                                         
this assumption by itself.                                                                                                                            
                                                                                                                                                      
Response: If our hopes are realised, we will not have to deal                                                                                         
with a recurrence of SARS. We should remain ready, with a                                                                                             
well-developed reporting and response system, in case it does                                                                                         
recur – but if it does not, we will not need to expend resources                                                                                      
beyond those necessary to support reporting, reasonable                                                                                               
planning, and appropriate readiness for action.                                                                                                       
                                                                                                                                                      
CASE 2: SARS could disappear for an indefinite period and then                                                                                        
reappear episodically in a form similar to its recent                                                                                                 
appearance.                                                                                                                                           
                                                                                                                                                      
Response: If we find ourselves in Case 2, with episodic                                                                                               
recurrences of SARS outbreaks, we will find the prudent                                                                                               
investments in reporting, planning, and readiness made in                                                                                             
response to the possibility of Case 1 both wise and useful.                                                                                           
                                                                                                                                                      
In addition, Case 2 will require the expenditure of operational                                                                                       
funds to provide an appropriate response in the case of each                                                                                          
outbreak.                                                                                                                                             
                                                                                                                                                      
Thus, the possibility of Case 2 calls for the same reporting,                                                                                         
planning, and readiness funds as Case 1, and also for                                                                                                 
maintaining availability of resources to pay for an operational                                                                                       
response where it is needed.                                                                                                                          
                                                                                                                                                      
Prudence would also suggest investments in medical research on                                                                                        
SARS.                                                                                                                                                 
                                                                                                                                                      
CASE 3: SARS could emerge this fall in essentially the same form                                                                                      
as it took last year, and thereafter exhibit a reasonably                                                                                             
consistent annual cycle.                                                                                                                              
                                                                                                                                                      
Response: Like Case 2, Case 3 calls for investments in                                                                                                
reporting, planning, and readiness and for available operational                                                                                      
funding – but now all of these resources would have to be                                                                                             
arranged on an expected annual basis.                                                                                                                 
                                                                                                                                                      
CASE 4: SARS could reappear in some completely unpredicted and                                                                                        
unpredictable form.                                                                                                                                   
                                                                                                                                                      
Response: If we find ourselves in Case 4, the reappearance of                                                                                         
SARS would again present significant novelty, and we would have                                                                                       
to face it, as before, with ingenuity and improvisation.                                                                                              
                                                                                                                                                      
There is no good way to prepare for the additional features that                                                                                      
this kind of event presents – except to maintain                                                                                                      
high-performance public organisations and infrastructure and to                                                                                       
practise improvisational responses.                                                                                                                   
                                                                                                                                                      
Given the uncertainty about which of these four cases will                                                                                            
occur, reasonable prudence would call for building an effective                                                                                       
and comprehensive reporting system so that the authorities are                                                                                        
able to recognise the reappearance as quickly as possible.                                                                                            
                                                                                                                                                      
Which cases should we be preparing for?                                                                                                               
                                                                                                                                                      
Case 1 is, of course, our fondest hope – but it is only that.                                                                                         
Thus, we have at least to prepare for Case 2 (episodic                                                                                                
recurrence). We would have to consider ourselves lucky if SARS                                                                                        
does not reappear at least episodically, so we clearly need to                                                                                        
be prepared if it does.                                                                                                                               
                                                                                                                                                      
Do we need to prepare for Case 3 (an annual recurrence)? Since                                                                                        
we are prepared for an episodic recurrence, then we should be                                                                                         
ready for the first annual recurrence; if SARS does appear next                                                                                       
fall and disappears again in the spring, then we will have a                                                                                          
reasonable presumption that it has an annual cycle, and we can                                                                                        
prepare accordingly.                                                                                                                                  
                                                                                                                                                      
But what about Case 4? We always need to be prepared for the                                                                                          
appearance of unexpected, potentially deadly diseases.                                                                                                
                                                                                                                                                      
How do we do this? Much of the first line of response will be                                                                                         
provided by the public sector – and therefore we need to                                                                                              
maintain strong public sector administrative, planning, and                                                                                           
response capacities, together with robust systems for being able                                                                                      
to raise resources when necessary.                                                                                                                    
                                                                                                                                                      
In summary, given the range of possibilities we face regarding                                                                                        
future SARS outbreaks, prudence would counsel:                                                                                                        
                                                                                                                                                      
(1) Development of a comprehensive reporting mechanism to                                                                                             
provide early detection and early notification to public health                                                                                       
and other relevant officials should there be a renewed outbreak;                                                                                      
                                                                                                                                                      
(2) Reasonable efforts at planning and maintaining readiness to                                                                                       
deal with the possibility of a renewed outbreak;                                                                                                      
                                                                                                                                                      
(3) Identification of operational resources that would be                                                                                             
required in the event of an outbreak;                                                                                                                 
                                                                                                                                                      
(4) Development and maintenance of a general public capacity to                                                                                       
respond to novel dangers – for example, by improving                                                                                                  
coordination among different government agencies, practising the                                                                                      
ability of different response organisations to work together and                                                                                      
to improvise in unusual circumstances; and                                                                                                            
                                                                                                                                                      
(5) Aggressive efforts to inform the public about (a) the                                                                                             
possibility of future SARS outbreaks, and (b) what may be                                                                                             
required from the public and from individual members of the                                                                                           
public in the event of future outbreaks.                                                                                                              
                                                                                                                                                      
The overwhelming implication of our existing knowledge of SARS                                                                                        
is that if it recurs and we are not ready, we have failed in the                                                                                      
most elementary of public duties – the duty to anticipate and                                                                                         
prepare for likely hazards to public health.                                                                                                          
                                                                                                                                                      
Such a failure will turn what should be a routine challenge into                                                                                      
a true crisis. This would then be a crisis of our own making.                                                                                         
                                                                                                                                                      
Herman B Dutch Leonard is a Professor of Public Management,                                                                                           
John F Kennedy School of Government Harvard University and                                                                                            
Visiting Professor at Harvard Business School University.  He                                                                                         
will address a full-day seminar on ‘Leadership in Crisis                                                                                              
Situations’ in Kuala Lumpur on Sept 25 2003. Please call MIM at                                                                                       
tel. 03-2164 5255, see www.mim.edu or e-mail                                                                                                          
enquiries@mim.edu for further details.