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Chua Jui Meng, the most irresponsible Health Minister in Malaysian history, had manipulated statistics to deliberately mislead Parliament and Malaysians about the worst dengue epidemic in nation's history instead of spearheading a nation-wide alert and awareness campaign which could have saved at least 80 lives who perished during the epidemic

Speech
- in a briefing to MPs in Parliament House on how Health Minister, Datuk Chua Jui Meng had mishandled the worst dengue epidemic in the nation's history in Parliament House
by Lim Kit Siang

(Kuala Lumpur,  Wednesday): I thank the DAP MP for Batu Gajah, Fong Po Kuan on behalf of DAP MPs for inviting me to Parliament to give a briefing on how the Health Minister, Datuk Chua Jui Meng had mishandled the worst dengue epidemic in the nation's history and all MPs who have come to share our deep concerns of this continuing disaster and tragedy which is so unnecessary and avoidable if Malaysia has not only "First World Infrastructure" but also "First World Mentality".

We read in today's press the Health Minister's announcement of the establishment of the operations room by the Health Ministry to monitor the "atypical pneumonia" illness, also known as severe acute respiratory syndrome (SARS), which has been reported in several Asian nations.

Chua said the operations room, under the ministry's Disease Control Department, is open from 7.30am to 6.00pm daily and could be contacted at 03-2694 6394.

"All measures taken by the ministry would be pro-active," he said. He said the operations room would monitor the disease's situation in the country and provide Malaysians with information on it.

I commend Chua for such swift pro-active response to the SARS crisis, which only highlights the Health Ministry's grave negligence in failing to set up a similar operations room to monitor the nation's worst dengue epidemic, although it had killed at least 100 people last year and is still raging unchecked, and I will not be surprised if it had claimed the lives of at least 20 people this year alone!

Is Chua's prompt response to set up an operations room for SARS because there is so far no reported cases of atypical pneumonia in the country, although there are 170 reported cases of SARS worldwide, but once there are reported cases and God forbid, fatalities, the Health Ministry would immediately close down the SARS operations room and retreat behind the Official Secrets Act by imposing one of Chua's famous "gag orders", refusing to provide Malaysians with timely, accurate and full information as is the tragic case with with the raging dengue epidemic?

The worst dengue epidemic in the nation's history had been raging in the country for about a year, claiming over a hundred lives, but last Tuesday was the first time the Health Minister had addressed this issue in Parliament. How irresponsible can a Health Minister be?

Chua's 11-page parliamentary reply on the dengue epidemic, answering nine parliamentary questions in one-go which was a most irresponsible manoeuvre to evade detailed questioning and scrutiny by MPs, was an indictment and proof that he is the most irresponsible Health Minister in the history of Malaysia - who could trifle with the lives of Malaysians by trying to manipulate facts and figures to downplay the gravity of the worst dengue epidemic in the nation's history and which is still causing unnecessary and avoidable deaths.

In his answer, Chua revealed for the first time that there had been 11 dengue deaths this year till February 22, which I believe err seriously on the low side - but the country had become so numbed and insensitised by a prolonged campaign of disinformation by the Health Ministry that such a shocking revelation was virtually ignored by the mainstream media like the New Straits Times and Utusan Malaysia, disregarding the killer dengue epidemic which had been officially certified to have claimed 11 lives this year till February 22 and yet could blazon screaming headlines about the SARS when there is not a single reported case let alone death in the country! Chua said in his parliamentary answer:

"Pada tahun 1998 boleh dikatakan seluruh dunia mencatatkan peningkatan kes termasuk juga egara kita yang meningkat sebanyak 73.1%. Di Malaysia, sejak tahun 1997 sehingga 2002 purata kes dengi (demam denggi dan deman denggi berdarah) setahun adalah 8,364 kes dan kematian sebanyak 54 kes. Jumlah kes tertinggi dilaporkan dalam tahun 1998 (13,742 kes). Dalam tempoh masa yang sama beberapa negeri telah melaporkan purata yang tinggi. Negeri-negeri tersebut ialah Selangor (1,661 kes), Wilayah Persekutuah (1,326), Johor (1,268 kes) dan Perak (926 kes). Lain-lain negeri melaporkan purata kes kurang dari 700 setahun.

"Pada tahun 2002 kejadian kes denggi telah meningkat di seluruh Malaysia sejak pertengahan tahun. Jumlah kes demam denggi dan demam denggi berdarah yang sah serologi yang dilaporkan pada tahun 2002 ialah sebanyak 11,394 kes dengan 57 kematian. Negeri-negeri yang sama mengalami jumlah kes yang tinggi. Pada tahun 2002, kadar kematian yang disebabkan oleh demam denggi berdarah di Malaysia ialah 10.0% iaitu 57 kematian daripada 568 kes demam denggi berdarah. Peratus ini menunjukkan kadar kematian disebabkan demam denggi berdarah di Malaysia adalah lebih rendah jika dibandingkan dengan negara lain. Kejadian demam denggi berdarah di negara ini adalah hanya 0.1% daripada jumlah kes demam denggi berdarah yang dianggarkan berlaku di dunia ini."

The Star the next day also reported what Chua told reporters at the Parliament lobby after question time. When asked that about "the DAP's statistics" that there were 32,289 cases of dengue fever with 57 deaths until Dec 28 last year, Chua said he did not know where DAP had obtained the statistics but it could be the number of suspected cases instead of confirmed ones.

"The number of suspected cases will definitely be higher than confirmed cases," he said.

I confess that I was stumped by Chua's statement, implying that I had been rather irresponsible, anti-social, and indulging in the despicable conduct of rumour-mongering to create panic in talking about "suspected cases" instead of relying on "confirmed cases" of dengue.

My sense of unease that I had done something wrong and been guilty of being anti-social was not relieved when in response to my rebuttal that the Selangor Mentri Besar, Datuk Seri Dr. Mohamad Khir Toyo had in his email to me dated February 24 as good as confirmed the figure of 32,289 dengue cases till Dec. 28 last year when he confirmed that there were 9,385 cases in Selangor state for the period, Selangor State exco member for health, Datuk Tang See Hang said Khir Toyo was referring to "reported cases" and not "confirmed cases"!

Was I responsible for irresponsible rumour-mongering in referring to 32,289 dengue cases till Dec. 28 last year, and was Chua being responsible in blithely claiming that there were really only 11,394 "confirmed" cases and dismissing the 32,289 "reported cases" ?

This question nagged and mortified me, as I had no intention of being irresponsible, anti-social or to rumour-monger and create baseless public panic.

It vexed me for in its literature on dengue in Malaysia, the World Health Organisation (WHO) used the figure of 27,379 reported dengue cases for 1998, the worst recorded year for dengue until last year, and not the 13,742 confirmed cases used by Chua in Parliament on last Tuesday. In fact, Chua himself used the "reported dengue cases" for 1998 in a speech in April 1999 talking about the 20-fold increase in dengue cases from 1986 to 1998, when "there were only 1,408 cases with eight deaths in 1986 but 12 years down the line, the number had spiraled to 27,373 cases with 58 deaths". Was Chua being irresponsible, anti-social and even guilty of rumour-mongering when he referred to "reported cases" instead of "confirmed cases" for dengue?

I have received an education in the past few days to understand the difference and the importance of the distinction between "reported" and "confirmed" cases when referring to dengue in particular in the current dengue epidemic raging in the country.

I feel a great sense of outrage from what I have learnt at the utterly irresponsible attempt by Chua to try to pull the wool over the people's eyes in a matter affecting the life and death of Malaysians, as well as the colossal failure of the Health Ministry to educate and alert the people about the killer dengue disease - although the Health Ministry has indirectly admitted that we are facing not an epidemic but a pandemic! It has also given incontrovertible proof that we have in Chua Jui Meng the most irresponsible Health Minister in the history of Malaysia.

Without going into all the technical and scientific details of laboratory diagnosis of dengue infection, let me draw the following conclusion from my recent education on "reported cases" and "confirmed cases" of dengue.

Firstly, it is the height of irresponsibility of the Health Minister to dismiss "reported cases" of dengue as if they are baseless suspicion no different from rumour-mongering with no scientific basis whatsoever. Is Chua seriously suggesting that apart from the "confirmed cases" of dengue, the "reported cases" could he dismissed as nothing more than Old Wives' Tales?

It is shocking that the professionals in the Health Ministry could allow the Health Minister to indulge in such unprofessional, unscientific and irresponsible behaviour, when they know fully well the implications, especially as WHO literature on dengue rely more on "reported cases" than "confirmed cases" of dengue.

This is because the "reported cases" of dengue are not the suspicions of any Tom, Dick and Harry, but the reports to the authorities by doctors and other health practitioners of suspected dengue cases as required by law on notifiable diseases - about patients who had undergone the Hess test with confirmed small bleeding spots, blood tests with low platelet count, hospitalization from high fever and haemorrhag and even cases of fatalities.

There are medical practitioners who hold that easily 80 to 90 per cent of the "reported cases" of dengue are actual dengue cases. "Reported cases" means clinically diagnosed as dengue by doctors, while "confirmed cases" mean cases which have been "laboratory-confirmed" - and in the case of dengue, it is the clinical diagnosis which is more important in life-and-death terms.

Although a high percentage of the clinically-diagnosed dengue cases, including dengue deaths, cannot be lab-confirmed because of technical and practical constraints, the number of "reported cases" are a more accurate measure of the gravity of the dengue epidemic.

There are two basic methods for establishing a laboratory diagnosis of dengue infection - detection of the virus (e.g. culture) or detection of the anti-dengue antibodies (serology).

Detection of dengue virus by culture is the definitive diagnostic test, but practical considerations in particular its cost limit its use. Can Chua state what percentage of the confirmed cases of dengue are the result of virology tests?

The serology tests also have practical limitations, whether IgM or IgG tests for primary dengue infection (first infection) or secondary infection (second infection).

The bottom line about the dengue epidemic however is that reported dengue cases should be an even greater cause of concern than confirmed cases, in view of the limitations of laboratory facilities in the country, and this is why Chua was acting most irresponsibility in failing to address the question of reported dengue cases last year, for which he should be severely censured by Parliament.

Chua dishonesty and manipulation with facts and figures to mislead Parliament and the country can also be illustrated by the following instances:

  1. His denial that WHO had issued a global dengue alert in July last year warning governments to take effective counter measures against a dengue epidemic and even pandemic worse than 1998. I had given three Internet reports on such a warning, and Chua should explain how he could have missed the WHO global dengue alert, resulting in his failure to take any follow-up pro-active measure as was successfully done in Singapore, which brought the dengue epidemic under control in November last year.

  2. Chua's press secretary, Woon Yong Teal, in a letter to Malaysiakini (17th March 2003) recapitulated the Health Minister's parliamentary reply, described the 1998 year as a "dengue pandemic". Why is Chua continuing to insist that dengue was "endemic" and not even an "epidemic" last year, although there should now be no dispute that the number of reported dengue cases last year exceeded that of 1998?

  3. In his letter, Woon inadvertently revealed that there had been 82 dengue deaths in 1998, confirming widespread suspicions that the Health Ministry had been manipulating dengue statistics even in the past few years. WHO literature on dengue In Malaysia in 1998 had always referred to 58 deaths. Even the Health Ministry's website on "Health Indicators" gave 58 dengue deaths in Malaysia for 1998. For five long years, the nation and the world, especially WHO, had been misled into believing that there were only 58 dengue deaths in 1998 when there were actually 82. How could anyone have belief and trust in facts and figures furnished by the Health Ministry henceforth?

  4. Chua Jui Meng said that there were 11 deaths this year till Feb. 22. Why didn't he give the most update figures till the first week of March? Is this because there had been more dengue deaths since then, including two in Perak after Feb. 22, one on Feb. 27 and another one on March 1?

  5. Chua is very proud that the DHF case-fatality rate for last year was 10%, totally forgetting that under the Seventh Malaysia Plan, the target for case-fatality rate for DHF alone is not more than 1% - which is now exceeded by over 1,000 per cent with a DHF fatality rate of 10%.

Parliament must not allow Chua to get away with such irresponsible Ministerial performance and in particular his manipulation of statistics to deliberately mislead MPs and Malaysians about the worst dengue epidemic in the nation's history when he should be spearheading a nation-wide alert and awareness campaign which could have saved at least 80 lives who perished during the epidemic.

(19/3/2003)

* Lim Kit Siang, DAP National Chairman