LU PING/CHINA DAILY

After the height of the COVID-19 pandemic passed more than a year ago, China took steady and solid steps to improve its public health system in preparation for future outbreaks and to safeguard the health of its people.

The legal framework regarding the response to public health emergencies has been reinforced, while lessons learned during the three-year battle against COVID-19 have been used to draw up new guidelines.

Over the past year, upgraded disease control measures, including regular pathogen surveillance and quickly increased capacity to handle an acute health event, have also been introduced. These measures have tackled sporadic outbreaks of COVID-19, cases of monkeypox that spread to more than 20 provinces, and a number of respiratory pathogens that caused an increase in hospital admissions this winter.

The mission of "building a powerful public health system" was proposed by the central leadership in June 2020, several months after the pandemic emerged. Efforts to achieve this goal have been accelerated in the past year and will continue in the years ahead.

Late last month, the State Council's General Office released a guideline aimed at promoting high-quality development of China's disease control system. Enhancing the role of science and technology in combating viruses, and nurturing more public health professionals, were among the key tasks.

Wang Hesheng, director of the National Disease Control and Prevention Administration, said during a recent news conference, "The new document puts forward a blueprint and vision for China's disease control sector and will play an essential role in establishing a powerful public health system and contribute to the grand goal of building a healthy China for all."

Restrictions eased

On Jan 8 last year, China downgraded its management of COVID-19 from the top-tier category A to category B, meaning that infected patients would no longer be quarantined or their close contacts traced. Inbound passengers would not face mandatory isolation.

In early May, the World Health Organization ended the designation of COVID-19 as a global health emergency, as the number of cases was falling and life in much of the world had returned to normal.

However, the relief brought by the eased restrictions was also intertwined with increased alertness and an urgent need to reflect on the pandemic.

WHO director-general Tedros Adhanom Ghebreyesus said: "COVID-19 has left — and continues to leave — deep scars on our world. Those scars must serve as a permanent reminder of the potential for new viruses to emerge, with devastating consequences.

"We owe it to those we have lost… to learn those lessons and to transform that suffering into meaningful and lasting change."

Liang Wannian, head of an expert panel on epidemic control at the National Health Commission, said the WHO's decision does not mean that the virus can be left to run rampant.

Continuous monitoring of variants, expanding vaccination among vulnerable groups, and improvements to the public health system and grassroots medical facilities remain essential ways to cope with the disease, he said.

While China swiftly noted the significance of committing to a stronger public health system during the pandemic, a series of concrete steps were taken in the legal field, along with institutional reforms.

In May 2021, the National Disease Control and Prevention Administration, a new central-level body, was inaugurated.

Shen Hongbing, deputy director of the new administration and director of the Chinese Center for Disease Control and Prevention, said during an event in April that the year 2023 would be an important one for disease control system reforms that would spread from central to regional level.

"Provincial-level disease control administrations should also be set up in reference to the central model. At municipal and county level, disease control bureaus should be established within the local health commissions, and local disease control centers should be set up," he said.

By the end of June, nearly all provincial-level regions in China had announced the establishment of their own disease-control facilities.

For example, the disease control administration in Yunnan Province was unveiled in late May. Local authorities said the new institute would strengthen leadership and coordination across different tiers of disease control bodies throughout the province. They also noted that the administration would improve communication with many ports in Yunnan, which shares long borders with Myanmar, Laos and Vietnam.

The legal foundation for disease control work has also been strengthened in the past year.

In late October, a draft revision of the Infectious Disease Prevention and Control Law was submitted to the nation's top legislature for review. The focus was on improving China's epidemic surveillance and early warning and reporting system, including prohibiting interventions and providing incentives for early reporting.

Li Wei, a senior legislator, said the draft added an entire section on monitoring and early precautions against contagious diseases, and also clarified legal responsibilities.

"Effective approaches and experiences such as scientific-based disease control and a whole-of-society approach toward coping with the epidemic have also been incorporated into the law, which is of great significance toward building a sound legal system on public health," he said.

Last month, Chinese lawmakers reviewed draft revisions to the Frontier Health and Quarantine Law aimed at bolstering emergency response measures against major outbreaks at ports across the country.

Shen, head of the China CDC, said, "The legal landscape surrounding disease control work in China, with the law on infectious disease and control, the law on vaccine management, as well as the regulation on emergency response to acute public health events that are in the pipeline, has become more sophisticated in recent years."

Reporting systems

The pandemic prompted disease control authorities and experts to decide on the key capabilities needed to tackle such an outbreak or other acute health emergency.

Building a regular surveillance and early warning system for pathogens, as well as implementing triaged treatment systems during outbreaks have been emphasized repeatedly, and the results of immediate efforts have already been used to cope with threats of infection.

Wang, head of the national disease control administration, said China has built the world's largest online reporting systems for contagious diseases, reducing the time it takes to report a new outbreak from five days to four hours.

A nationwide network of facilities capable of testing for contagious diseases and pathogens has also been established. Within 72 hours, more than 300 types of pathogens can be rapidly identified, and all provincial-level CDC centers and 90 percent of such centers at the municipal level can perform nucleic acid tests and isolate viruses, he added.

Zhang Guoxin, an official at the administration, said 84,000 medical institutions nationwide have been linked to the direct reporting system.

"We are carrying out regular surveillance of key infectious diseases such as plague, polio, malaria and influenza. For COVID-19 and other acute respiratory illnesses, we have established a 10-pronged surveillance system that integrates monitoring of hospital visits, variants and urban wastewater," he said.

Work on a pilot surveillance program dedicated to acute respiratory illnesses is also in progress, he added.

In June, the number of monkeypox cases in China began to rise due to stealth transmission of the viral disease among high-risk groups, and a rising number of imported cases.

Shi Guoqing, a researcher at the China CDC's emergency center, said that to enable swift detection of new cases, the nation has established a multichannel monitoring and early warning system for monkeypox, and carried out tests among inbound passengers suspected of contracting the virus.

"HIV clinics at hospitals and dermatology and sexually transmitted disease departments are also required to inquire about the epidemiological history of visitors with monkeypox-like symptoms," he said. "We have also strengthened education among key groups — men who have sex with men — and asked them to seek treatment promptly upon exhibiting suspicious symptoms."

Meanwhile, the number of medical facilities considered essential in tackling epidemics has increased.

Zhuang Ning, an official at the National Health Commission's Department of Healthcare Reform, said 98 percent of grassroots medical institutions and hospitals have set up their own fever clinics, while more intensive care unit beds and equipment have been provided at major hospitals.

Since October, China has witnessed a surge in patients at major hospitals, driven by the circulation of various pathogens, including COVID-19, mycoplasma pneumoniae, and influenza.

Mi Feng, spokesman for the commission, said lower-level hospitals, traditional Chinese medicine and primary health institutions have been mobilized to relieve pressure on large hospitals during the peak of respiratory illnesses.

"Fever clinics and fever rooms at grassroots level have handled 44 percent of visits at all fever departments across the nation, effectively meeting patients' demands," he said during a news conference last month.

"Given the complicated situation this winter, with multiple pathogens circulating simultaneously, we have attached greater significance to coordinating resources across different regions and hospitals, and added treatment areas and personnel to improve services."

Gao Xiang, president of the ECO-City Hospital of Tianjin Fifth Central Hospital, said that during the peak in patient visits, the hospital coordinated resources between emergency care, fever and respiratory clinics and used real-time data monitoring to allocate patients and maintain services in an orderly manner.

Zhuang, the health official, said the commission is also drafting diagnosis and treatment plans for contagious diseases such as plague, cholera and anthrax in an attempt to enhance the knowledge and skills of medical workers and promote standardized treatment of infectious disease patients nationwide.

New requirements

The guideline released last month has resulted in new requirements for disease control development in China, including enhancing the scientific prowess of relevant institutions and cultivating high-quality public health professionals.

It states that central- and provincial-level CDC centers should also develop functions as preventive medicine academies.

Zhang, the administration official, said: "Reflecting on the domestic battle against COVID-19, science and technological research have played a significant role in isolating and decoding the genome sequences of the virus, developing vaccines, testing kits and therapeutics. Big data and artificial intelligence tools have also been widely used in epidemiological investigations."

The new requirements are expected to concentrate resources and personnel to resolve problems in disease control and ease channels for converting research results into real-world applications, he said.

Wang, the administration head, said a task force dedicated to cultivating talent was recently set up within the administration, to improve the quality of public health colleges and introduce programs to support the nurturing of high-level talent.

The guideline also states that when assessing the performance of public health workers, less attention should be paid to the number of papers they have published, and more emphasis attached to the outcomes of their disease control work.