From SARS to bird flu: lessons learnt for China
[BEIJING] "Fight bird flu with the spirit of fighting against SARS,'' reads the slogan that hangs in a poultry farm in eastern China's Anhui Province, where a new outbreak of avian influenza – or 'bird flu' – was reported early in July.
Both Chinese health authorities and scientists say that much has been learnt from last year's outbreak of severe acute respiratory syndrome (SARS), and is now being put into practice as the country tackles a new disease crisis.
"As a result of the SARS crisis, the [Chinese] government now understands the importance of ensuring a flow of accurate information, as well as the urgency of technical cooperation, and how to effectively coordinate different departments dealing with a crisis," says Xue Lan, dean of the School of Public Policy and Management at Tsinghua University in Beijing.
"All of these measures played an important role in dealing with this year's bird flu, as well as the re-appearance of SARS.''
In the first three months of the year, bird flu spread through 16 of China's 32 provinces. During that time, the Ministry of Agriculture and the Ministry of Health provided a daily information service, and held regular news conferences to keep the public informed of the situation. In addition, experts from World Health Organization (WHO) were invited to China, and consulted at an early stage of the disease outbreak.
This represented a sharp contrast to the situation a year ago, when the public was kept in the dark until SARS had claimed hundreds of lives, and the international community only learned about what was going on through information smuggled out of the country by a retired military doctor, Jiang Yanyong.
Before abating in July 2003, SARS had killed 774 people worldwide, and infected a further 8,000. According to the Asian Development Bank, the epidemic cost China almost US$18 billion in direct medical costs, a fall in consumer sales, and losses in the tourism industry.
On the positive side, however, the fight against SARS provided significant experience in the rapid isolation and quarantining of epidemic sources, whether humans or animals, says Xin Chao'an, a professor of animal epidemiology at the Southern China University of Agriculture in Guangzhou.
This experience has proved invaluable for those engaged in efforts to control bird flu and other nationwide epidemics, says Xin, who was a member of an expert group set up by the Ministry of Agriculture to guide its efforts to contain the spread of bird flu early this year.
Other benefits from the SARS experience, he adds, include improved measures for protecting medical workers, and safer laboratory techniques for handling viral samples.
Medical workers have also improved their ability to handle outbreaks of infectious disease. "After SARS, we have been better trained to detect diseases, to report information accurately, and to protect ourselves,'' says Zhang Shuguang, a rural epidemic prevention worker in Yanqing County outside Beijing.
Although bird flu has not appeared in the area, there have been a number of reports of suspected cases. Each time such a report was received, Zhang and his colleagues ensured that the poultry farm in question was appropriately quarantined.
One particularly effective measure adopted by local governments during the bird flu outbreak seems to have been the decision to provide rapid compensation to farmers whose chickens have been killed as a precautionary measure.
In Yanqing County, for example, farmers were paid 10 yuan (US$1.2) – nearly market price – for each bird killed. Such a move, which had previously been relatively rare, helped persuade the farmers to cooperate with local government officials in applying quarantine measures and agreeing to health inspections.
The compensation was made possible by the government decision to increase substantially its spending on disease control. In 2003, the Chinese government spent 134.6 billion yuan (US$1.64 billion) in the fight against SARS. In March this year, China's finance minister, Xiang Huaicheng, promised to increase federal spending on disease control and health education by 10 billion yuan (US$1.2 billion) in 2004.
Another factor that has actively encouraged government officials to fight aggressively against the spread of bird flu, says Xue, has been the punishments handed out to those who performed poorly during last year's SARS outbreak.
Almost 4,000 Chinese civil servants and officials suffered in this way, including the former mayor of Beijing and a former minister of health. Both resigned in April 2003. Indeed after a relatively small outbreak of SARS this year, which claimed one death and infected nine, five senior scientists of the Chinese Centre for Disease Control and Prevention lost their jobs.
Even with the lessons of SARS, however, some experts say that China still has a long way to go before its ability to control animal and human epidemics reaches an acceptable level.
Liu Huidong, for example, a professor with Anhui Agricultural University, says that despite the apparent success on containing bird flu, the public veterinary system in China remains weak, and still lacks the capacity to respond rapidly and effectively to a serious animal epidemic.
He points out that only one out of 86 students who graduated in veterinary studies from his university this year chose to work for a government veterinary body, because of the poor salaries on offer and the heavy workload.
Zhang Linqi, an associate professor of epidemic control with the Rockefeller University in New York, and a researcher with the Chinese Academy of Medical Science, points out that it requires a significant effort to train grassroots medical workers, to increase their ability to detect new diseases, and to improve their equipment, their salaries and their living standards.
Thus even though Chinese leaders have promised to keep the public better informed in situations such as the bird flu outbreak, there is still a long way to do before they can be confident of handling major disease outbreaks successfully in the future.