As the epicenter of severe acute respiratory syndrome (SARS), China’s ability to combat the crisis is bound to have global implications. The good news is that the daily number of reported new probable cases of SARS in China has declined considerably in recent weeks. During the first week of May, the daily average cases were 166. Over the past 6 days, the daily number of reported new cases has dropped to an average of 2.5. In my testimony, I like to brief the Commission on some major public health responses to the SARS crisis in China, and share with you my assessment of the likely impact on health system and overall economic situations that SARS may have in the longer run.

The development of SARS epidemic and public health reactions in China can be divided into three phases: 1. Local crisis, 2. National crisis, 3. National emergency responses. From late 2002 and early April 2003, SARS was perceived by many (or made to believe) to be a local problem, mainly concentrated in the southern city of Guangzhou.

By mid-April, with rapid increasing number of new cases in the capital city of Beijing, it became apparent to the top leadership in China that some dramatic measures have to be taken to contain the epidemic before it is too late. Sacking the Beijing mayor and Health Minister further fueled the public perception that there had been an earlier cover-up by the government officials. Rumors about the seriousness of the disease and distrust in the government created widespread panic. While people in big cities were asked to stay put to reduce the risk of further infection in other provinces and vast rural areas, thousands and thousands of panicked residents, especially the migrant workers, disregarded that advise and jammed the railway stations to flee town.

In late April 2003, a national command center was established, thus began the phase of national emergency responses. Madame Wu Yi, deputy Premier, has been acting as the chief commander and Health Minister. Billions of dollars have been allocated to control the crisis. Combating SARS has become the number one priority for the Party and the government. The whole country has been mobilized, including the military medical corps, to participate in the campaign.

China has adopted three major strategies in combating SARS, which have proven to be effective. First, concentrating SARS patients in a few designated hospitals. Hospitals are at the center of the SARS epidemic, both in their role as provider of health services and in terms of the high toll SARS has taken on doctors and nurses (more than 50% of the cases are estimated to be infected within the hospitals). Most of China’s hospitals do not have adequately equipped isolation rooms with negative pressure etc. Stringent infection-control measures are also lacking. Therefore, consolidating SARS patients in the newly built up hospitals or hospitals with much improved facilities can help reduce intra-hospital infection as well as improve quality of care.

The second strategy is to mobilize a mass campaign to identify the people at risk, who were either exposed to SARS patients or experienced SARS-like symptoms, for in-house or institutionalized quarantine. The third strategy is to activate a SARS emergency reporting and communication system, where any cover-up and belated reporting is being severely punished by "law", which was recently passed by the State Council.

There are reasons to think that China can succeed in controlling the epidemic. Unlike many other transitional countries, China still has a formidable capacity to mobilize its population and its government infrastructure to carry out politically mandated campaigns and programs. One of the strategies used to move the local bureaucracies is to make success in dealing with SARS a criterion for local officials’ career survival. Moreover, ever since the fiscal system decentralization reforms in the 1980s, local governments have been responsible for generating revenues for local spending. In their competition for business and investment, especially foreign investments, local governments have strong incentive to do everything their can to prevent and control the SARS epidemic, so that they can demonstrate to the world that their city or county is a SARS-free place.

China’s national emergency responses to SARS crisis have been massive and begun to show some success, as indicated by the significant decline of number of reported new cases in recent days. This progress demonstrates the critical importance of high-level political commitment and enforcement of control measures that have proven their effectiveness. But the challenge ahead should not be under-estimated. SARS is already having a major economic, social, and psychological impact on the populations. Some of the impacts are already visible, including the worst hit service industries (e.g. tourism, business travel, and retail sales) and closure of hospitals and schools. Other impacts such as possible stoppage of basic public services, crisis of confidence, and human resource implications (e.g. how many people will leave the health care profession) are likely to be felt over time, depending on the duration of the epidemic.

Experiences elsewhere indicate the need for maintaining a vigilant and cautious approach to SARS, particularly in a country as large and diverse as China. The resurgence of cases in Toronto serves as a vivid reminder of how difficult it can be to maintain control over a new disease with it’s epidemiological and clinical features still remaining unknown. Nobody can be sure whether recent decline of the number of reported new cases masks some SARS cases that went undetected in China’s vast rural areas, where the infrastructure for diagnosis, disease surveillance, and infection-control is lacking.

However, several positive outcomes are likely to emerge out of the current crisis:

First, a much more strengthened public health emergency detection and response system will be developed. Never before has public health received such high profile in the country. Current and continued effort by the government to combat SARS will help correct the trend of under investment in public health infrastructure. Already, more than a billion dollars have been allocated to build up China’s national and regional Centers for Disease Prevention and Control. China will be better prepared the next time a new highly infectious disease surfaces — or SARS resurfaces.

Second, SARS crisis also revealed broader structural deficiencies with China’s health system. A much decentralized and fragmented health system has proven to be ill suited for a rapid and coordinated response to public health emergencies. Commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of under-provision of public goods such as health surveillance and preventive care. For the past 25 years, the Chinese government has kept economic development at the top of the policy agenda, at the expense of relative neglect of public health, especially access to health care for the 700 million rural populations. The current crisis helps heighten a sense of urgency to carry out health system reforms.

Third, SARS crisis also helped arouse the health-consciousness among the public. Demand for preventive medicine and personal hygiene seemed to have increased remarkably. It is also reported that demand for health insurance increased significantly since the inception of SARS epidemic. Therefore, consumption in certain areas may go down, while health-related consumption may go up, which may be good news for the economy. Furthermore, enhanced personal investment in health, combined with improved access to health care as a result of expected health system reforms, would help produce a healthier contingent of work force, which in turn would help generate higher productivity.

Last, but not the least, China will become a more responsible member of the global community. Infectious diseases do not respect national boarders, as the SARS epidemic has painfully shown. China’s new leaders have learned the hard way that hiding of information (even temporarily) that the public had a right to know had dire consequences both in terms of missed opportunities to more effectively control spread of the deadly diseases and in terms of suffered confidence and trust in the government. The Chinese leadership clearly recognizes that accountability to its own citizens and citizens of the world about epidemic outbreaks is a necessity in a globalized world.