(Source: China Daily)
Editor's Note: During this year's two sessions－the annual meetings of the National People's Congress and the National Committee of the Chinese People's Political Consultative Conference－China Daily will publish a series of stories focusing on the achievements the country made in various fields during the 13th Five-Year Plan (2016-20). They show how the country met its development goals in different fields in the face of numerous challenges.
Experts say COVID-19 experience could provide impetus to further improve disease control measures
With bustling restaurants, packed cinemas and campuses gearing up for a new semester this month, hopes for a return to normal life are running higher than ever in China.
Over winter and early spring, the country stamped out a slew of domestic outbreaks of COVID-19. More than 2,000 infections were registered, however, a major resurgence of the novel coronavirus was prevented, a testament to the effectiveness of the country's disease control strategies.
As summer approaches, four domestically developed vaccines have been approved for use and are being gradually rolled out nationwide. More vaccine candidates are in the pipeline to bolster mass inoculation.
No new local cases have been reported since Feb 15, official data shows. "Now we have entered the last stage of the suppression (of local outbreaks)," Gao Fu, director-general of the Chinese Center for Disease Control and Prevention, said in a recent article.
However, both short-term and long-term challenges in fighting the disease still abound. "Looking into the future, there will still be many uncertainties this year," Gao said, pointing to risks such as reinfection, the long-term health impacts on recovered patients and new variants of the virus. In the long-run, major improvements in the country's public health system are expected. Ma Xiaowei, minister of the National Health Commission, said, "The history of humankind is shaped by fights against infectious diseases ...the sudden COVID-19 outbreak has sounded the alarm again."
Zhang Wenhong, leader of the Shanghai team of medical experts treating COVID-19 cases, said:"Mass immunization will take time. Though China is now capable of reining in the virus, we have sacrificed many aspects of our normal lives. This Spring Festival, about 100 million stayed put instead of returning to their hometowns.
"China must strengthen its public health system to achieve a true return to normalcy," he said.
In a nod to the urgency and significance of this undertaking, the Communist Party of China Central Committee has listed "strengthening capabilities in coping with public health emergencies" as a key task in the draft of a landmark document setting the tone for the country's development.
Proposals for the 14th Five-Year Plan (2021-25) for National Economic and Social Development and the Long-Range Objectives Through the Year 2035, released in early November, will be reviewed during this year's two sessions－the country's largest annual political event. To achieve the goal, experts said concerted efforts should be made to empower disease control authorities, intensify surveillance of infectious diseases and train more public health professionals.
Focal point
Wu Xifeng, dean of the School of Public Health at Zhejiang University, said major points of contention in controlling the outbreak are the rights and responsibilities of disease control and prevention centers.
"A widespread point of view is that in the face of the epidemic, disease control centers merely followed orders issued by higher authorities and were immersed in churning out work in laboratories," she said.
However, Wu said that the China CDC had independently contributed a great deal to early knowledge about the virus. "The China CDC swiftly decoded and released the genome sequencing data, which enabled global scientists to create testing kits and begin developing treatment and vaccines," she said.
The pandemic has underscored the significance of improving communication and coordination between CDC agencies and other government departments, she said.
Shu Yuelong, dean of Sun Yat-sen University's School of Public Health in Shenzhen, Guangdong province, said at the heart of empowering China CDC is granting it the right to obtain, analyze, supervise and, in some cases, publish a wide array of information vital to coping with a viral outbreak.
That includes information from government departments－including health, customs, agriculture, forestry, education and transportation－as well as test results from thirdparty agencies and findings from research laboratories.
"Only through thorough information sharing can we quickly come up with a science-based and rational evaluation of an emerging health crisis and then unite all forces to stamp it out during the golden window of opportunity," he said.
Gao, head of the China CDC, said the key to reform is to maintain the technical prowess and authority of the center's officials and experts rather than give the agency administrative powers.
China's four-tier disease control network took shape around 2000 to mainly focus on technical work. For years, agencies at the provincial, city and county levels have been under the direct supervision of regional health authorities and receive guidance from the CDC.
Gao said during an interview with China Youth Daily that disease control experts are entitled to put forward suggestions, but are unable to be deeply involved in making final decisions. "Suggested steps include allowing disease control institutions to have the final say in their area of expertise, exerting more control over lower-level divisions and reducing health authorities' micromanagement and direct oversight over the disease control network," he said.
Efficiency is key
The COVID-19 pandemic has also directed attention to the country's surveillance and reporting system for infectious diseases.
Following the severe acute respiratory syndrome outbreak in 2003, China CDC set up the world's largest online direct reporting system for contagious illnesses, shortening the length of time between detecting a new case at the grassroots level to notifying the center from five days to four hours.
Liang Wannian, former director of the National Health Commission's institutional reform department, said the country's response to 40 reportable infectious diseases cataloged under the system has been satisfactory.
However, there is still room to improve the system's efficiency in monitoring and sending alerts on new and mysterious diseases.
Wu, from Zhejiang University, said to efficiently mobilize resources to tackle and emerging threat, novel disease in the system can not be overlooked.
In 2003, the first case of H7N9 influenza, which was a new disease not included in the online system, was logged on March 25. Alert to the abnormal situation, the China CDC in early April added two separate categories for H7N9 cases in the system to facilitate case reporting and data collection.
While hailing the CDC's swift calibration of the system at that time, Wu suggested the method needs more improvement to be more sustainable.
"Simply expanding the classification of contagious diseases is not going to stop us from being caught off guard when the next major outbreak hits," she said.
Instead, new technologies such as big data and blockchain should be deployed to explore convenient and comprehensive methods of gathering and processing data on infectious diseases, such as integrating the massive amount of information stored by medical institutions, Wu added.
Health authorities have already taken action to sharpen the China CDC's ability to send early alerts. Health Minister Ma Xiaowei said at a conference that more routes for obtaining information will be set up, including from public opinion, reports from medical workers and research findings. "A smart multi-point trigger system for early warnings will be built," he added.
Talent cultivation
At the same time, Ma pointed to the issue of the brain drain in the public health sector in China, calling for improvements in talent cultivation, as well as the working conditions, salaries and welfare of public health workers.
According to an article published in the Chinese Journal of Preventive Medicine, the number of employees in the disease control network peaked in 2004 at 210,000 and has been declining since. In 2018, the number dropped to about 188,000. The article was co-written by four experts from Peking University's School of Public Health.
Liang, the former health official, said it is essential to intensify "core competitive" training for public health workers.
"Their core skills consist of disease monitoring, analysis of data, formulation of public health measures and evaluation of implementation results," he said. "Improving these skills will be conducive in raising their salaries, brightening their career prospects and helping them win more social recognition."
The COVID-19 pandemic could provide the impetus to draw more well-trained young people into the field. Gao Xuehuan, who graduated from Fudan University's School of Public Health last year, told Xinhua News Agency that working for a CDC agency used to be at the bottom of his job list.
But the outbreak had tugged at his heartstrings. Last March, before he obtained his master's degree, he accepted an offer at a CDC unit in his hometown in Anhui province and has been busy since then.
He Na, dean of the school, said about 24 percent of its students ended up in CDC agencies after graduation, but there is a high chance of them quitting three to five years later."Merely expanding enrollment of public health majors while neglecting their career development will not stop CDC professionals from changing careers," he said. "The key is to increase the attraction and the sense of achievement of the position."