Build a Strong Public Health System

Build a Strong Public Health System*

June 2, 2020

Since the 18th CPC National Congress in 2012, the Central Committee has made clear the Party’s working guidelines for public health in the new era, and reaffirmed its responsibility to provide safe, effective, convenient and affordable public health services and basic medical care. We contained and responded effectively to the outbreaks of such epidemics as the H1N1 flu in 2009, H7N9 bird flu in 2013, and Ebola hemorrhagic fever in 2014. The incidence of major epidemics has fallen remarkably in China.

At the Fourth Plenary Session of the 19th CPC Central Committee in 2019, the Party proposed to strengthen the institutional guarantee for improving public health. It was decided that one of the important goals and tasks for modernizing China’s governance system and capacity would be to strengthen the system of public health services, and address major emerging infectious diseases (EIDs) in a timely and meticulous manner. Special emphasis was laid on preventing and controlling serious epidemic diseases and steadily developing the system of public health services. In the course of achieving the Two Centenary Goals, public health has always been and will continue to be one of the foundations of all undertakings. It is inextricably linked with our country’s overall development strategy and plays a strong supporting role.

The fight against Covid-19 has proved that China’s public health service system, medical care system, medical security system, and medicine supply system, and the system of prevention and control and emergency response to major epidemics are effective on the whole, but there are weak links. Some of these problems can be attributed to shortcomings in our systems and mechanisms, some to poor policy enforcement, and some to the limits of our development to date. Only by building a strong public health system, improving the early warning and response mechanisms, reinforcing our capacity for prevention, control, and treatment, and creating a tight-knit network of forceful protective measures, can we guarantee the people’s health. Based on your views and proposals, I would like to elaborate on the following points:

First, we should reform the disease prevention and control (DPC) system. Prevention is the most efficient and economical strategy for health. The DPC system is an important guarantee, protecting and safeguarding public health, and maintaining social and economic stability. In the fight against Covid-19, our public health system has played a significant role, but has exposed some deficiencies, such as insufficient capacity, inflexible mechanisms, inadequate impetus, and disconnects between prevention and treatment measures. These are long-standing problems, and it is time to resolve them once and for all. Efforts should be directed towards more precise and effective prevention, with further reform to coordinate systems and mechanisms, define functions and boundaries, and improve professional competence.

We should put in place a reliable funding mechanism for public health, and improve DPC facilities and public health service programs. 

We must optimize the functional structure of DPC institutions. We need to establish a DPC system that is mainly composed of DPC centers at the national, provincial, city and county levels and specialized DPC institutions, that relies on the support of medical institutions with primary medical and health institutions serving as the first DPC line, that is characterized by civil-military integration in medicine and health services, and that gives equal weight to prevention and treatment. We need to set up mechanisms with clearly defined responsibilities for each level of management from top to the bottom and with effective coordination among them.

We should improve the capacity building of national DPC institutions, update their technology, expertise and talent reserve, and strengthen their leading role in protecting public health. We need to improve coordination between DPC institutions and urban and rural communities, and strengthen the role of town and township health centers and community health service centers in epidemic prevention, so as to consolidate the foundations for joint prevention and control at the grassroots.

We should initiate a mechanism for increasing collaboration between hospitals and disease control agencies, in which personnel, information, and resources are shared, and oversight and regulation operate as mutual restraints.

We should cultivate high-caliber DPC professionals, develop mechanisms for their training and management that are adaptive to the modern DPC system, and introduce measures to ensure grassroots DPC institutions are always well-staffed.

We should develop a number of first-class public health academies, and focus on the training of professionals specialized in pathogen identification, epidemic trend analysis, research on the patterns of epidemic transmission, field epidemiology, and laboratory testing.

Second, we should strengthen the capacity for monitoring, early warning, and emergency response. After the SARS epidemic in 2003, China established mandated online reporting of cases of infectious diseases, and has seen a notable improvement in the facilities and equipment of DPC institutions.

We should strengthen monitoring and early warning as the top priority for improving the public health system, as detection holds the key to the policy of early detection, reporting, quarantine and treatment.

We need to put in place a better monitoring system for epidemic outbreaks and public health emergencies, as well as for diseases with unknown causes and abnormal health incidents, and improve the sensitivity and accuracy of assessment and monitoring. We should build smart early warning mechanisms through multi-point triggers, improve the multi-channel monitoring and early warning mechanism, and increase the capacity for real-time comprehensive analysis and assessment.

The network of laboratory testing for epidemic diseases must be improved. Public health institutions and medical institutions must coordinate their efforts in epidemic monitoring to ensure early detection, early reporting, and early treatment at grassroots institutions.

We should improve contingency plans for public health emergency response, and organize response teams at various levels and in various categories, with plans and staff covering outbreak assessment, epidemiological investigation, medical treatment, laboratory testing, community guidance, and deployment of supplies.

Grassroots medical staff should receive response training and drilling to expand their knowledge and raise their skill level in providing early treatment. Education on public health emergency response should be provided to increase the public’s awareness and their capacity for disease prevention and self and mutual medical aid.

Party committees and governments at all levels should establish working mechanisms for regular analysis and planning on the prevention and control of major epidemics. They should improve coordination among different levels for concerted, interdepartmental, and cross-region anti-epidemic measures that are applicable for both normal circumstances and emergencies, and they should see to it that instructions are given clearly and executed systematically, smoothly and effectively.

Third, we should improve the system for medical treatment during major epidemics. Treatment of Covid-19 patients is a challenging test for our nation’s medical services, developed over the past 40 years since the launch of reform and opening up. It also tests the results of building key medical specialties that have developed over the past 20 years, and the reform of the medicine and healthcare system that has unfolded over the past 10 years.

China has put the people first in its Covid-19 response, because we know nothing is more precious than people’s lives. We have mobilized medical resources across the country on a scale never seen before. Not a single infected person is left unattended; not a single confirmed patient is left untreated. From newborns to centenarians, all have been treated to the best of our ability. There is not a single case of lack of treatment due to affordability.

Almost all the 42,000 medical workers of the 346 medical teams from across the country who rushed to Hubei Province for emergency relief work were from public hospitals. Experience has proved that a treatment system that is dominated by the government, that serves the public interest, and that is underpinned by public hospitals provides an important guarantee for effective response to major epidemics. Therefore, public hospitals must develop stronger capacity for the treatment of infectious diseases, and general hospitals must enact higher standards for prevention and control facilities, so that we have a greater reserve for emergency medical treatment. With these measures in place, we will raise China’s system and capacity for fighting major epidemics to a higher level.

Medical resources should be rationally distributed. We should coordinate emergency response efforts by medical institutions in terms of mobilization, regional cooperation, and personnel deployment, to shore up weak points and be prepared for both normal circumstances and emergencies.

We need to put in place a sound, graded, multilevel, and referral-based treatment network for infectious diseases and other serious epidemic threats. We should improve the three-tiered urban-rural medical service network with the focus on urban communities and rural villages, border and port cities, county-level hospitals, and traditional Chinese medicine (TCM) hospitals.

We will further develop national and regional medical centers to provide more effective treatment of serious epidemic diseases. We must redouble our effort to develop disciplines related to the treatment of diseases during major epidemics, particularly intensive care medicine, respiratory medicine, anesthesiology, and other urgently-needed disciplines. We must enact policies and measures to recruit more high-caliber medical workers to the profession of epidemic prevention and control.

Fourth, we should further implement public health campaigns. The campaigns, which began in the 1950s with an emphasis on sanitation and personal hygiene, represent a successful case of our Party’s application of the mass line to boosting public health. We must summarize our successful experience in Covid-19 prevention and control, and integrate new concepts with new approaches to drive this campaign. The focus of our work should shift from public sanitation governance to comprehensive public health management, targeting widespread and long-lasting issues concerning public health.

We must comprehensively improve the living environment, public health infrastructure, and urban and rural environmental sanitation, and honor model cities and towns in public health.

We should encourage positive, healthy and green lifestyles, popularize health knowledge, and promote healthy dietary trends. Good habits in daily life, such as wearing masks when going out, sorting garbage, maintaining social distancing, using individual serving dishes and serving chopsticks, and making clinical appointments online, should be promoted.

We should include public health in all government policies, apply the philosophy of full life-cycle health management to the whole process and every link of urban planning, construction, and management, and move faster to build a public health system adapted to rapid urbanization and high population density.

Party committees and governments at all levels must put the public health campaign high on their agenda, ensure its implementation through rational organizational structure, appropriate adjustment in functions and responsibilities, adequate staffing, and proper funding, and explore more effective ways of public mobilization.

Fifth, we should exploit the strengths of TCM in the prevention and control of major epidemics. The clinical approach to combining Chinese and Western medicine and therapies has been a success as well as a point to be noted in the fight against Covid-19. This manifests the inheritance and innovative development of the best of our TCM heritage. Over five millennia, the Chinese nation has pulled through numerous health crises thanks to TCM; in the fight against disease, many TCM classics have been written and handed down, including Treatise on Febrile and Miscellaneous Diseases, Treatise on Differentiation and Treatment of Epidemic Febrile Diseases, and Treatise on Epidemic Febrile Diseases. The Three TCM Drugs and Three Herbal Formulas selected for the clinical treatment of Covid-19 in China derived exactly from TCM classics.

We should strengthen research and clinical trials, summarize TCM theory in epidemic prevention and control and the best clinical practices, and carry out intensive R&D for breakthroughs. We should explain the therapeutic effect of TCM, by adopting modern assessment tools and drawing on ancient experience at the same time.

We should delve deeper into and analyze TCM classics, create a number of TCM research platforms, and reform the mechanisms for TCM review and approval, to encourage the R&D of new medicines and boost the TCM industry.

We should improve the TCM service system and raise the capacity of TCM hospitals in emergency response and treatment. Training of TCM professionals should be strengthened in order to build a highly capable TCM team for epidemic prevention and control at the national level.

We must probe into the institutional problems in the administration of TCM, strengthen the leadership over and management of its development, and promote complementary and coordinated development between TCM and Western medicine.

Sixth, we should improve laws and regulations on public health. Since its victory over SARS in 2003, China has revised the Law on the Prevention and Treatment of Infectious Diseases, and enacted the Emergency Response Law and the Regulations on Response to Public Health Emergencies along with contingency plans. These laws and regulations constitute the legal basis for responding to epidemics but some of their stipulations are incoherent or inconsistent with each other.

We need to further amend the Law on the Prevention and Treatment of Infectious Diseases and promulgate a law on the response to public health emergencies to meet new demands, and strengthen law enforcement mechanisms for epidemic prevention and control, with clearly defined powers and responsibilities and standardized procedures for effective enforcement. All of these will help improve legislation on the measures against emerging epidemic diseases, and define the functions and responsibilities of central and local authorities, of the government and its functional departments, and of administrative organs and professional institutions.

We need to raise public awareness of laws and regulations on public health security and on epidemic prevention and control, so that all members of society act in accordance with the law in this regard.

Seventh, we should leverage the essential role of science and technology in the prevention and control of epidemics. I have always emphasized that science and technology are effective weapons for fighting epidemics. Humanity’s victories over major disasters and pandemics could not have been possible without scientific progress and technological innovation.

In the early stage of the Covid-19 epidemic, China’s research institutions acted together in etiological investigation and pathogen identification. It took us only eight days to identify the pathogen of this “viral pneumonia of unknown cause” as a novel coronavirus. It took us only 16 days to optimize the nucleic acid test kits, enabling the screening of suspected cases on a large scale. We acted promptly in selecting a number of effective medicines and therapeutic regimens. We expedited the development of vaccines through multiple approaches and made them available for clinical trial. All these efforts have laid solid ground for China’s fight against Covid-19.

Major scientific and technological achievements in life security and biosafety are treasures of the country and must be kept in our own hands.

We must increase science and technology input in public health endeavors: improving the systems for epidemic prevention and control and for key public health R&D that are applicable for both normal circumstances and emergencies; intensifying efforts to make breakthroughs in core technologies; increasing funding for the prevention and control of epidemics; addressing defects in such areas as life sciences, biotechnology, medicine and health care, and medical equipment at a faster pace.

Currently, we must leverage our institutional advantage of being able to pool nationwide resources and strive to become the first developer of Covid-19 vaccines, so as to keep ourselves well-positioned strategically.

Moreover, we need to extend institutional reform for the development of science and technology talent, and improve the mechanisms for discovering, training and motivating leading scientists with strategic vision and innovative technology talent, so that more outstanding professionals will engage in scientific research and have the opportunity to demonstrate their outstanding capabilities.

Eighth, we should strengthen international exchanges and cooperation on public health. Since the Covid-19 epidemic broke out, China, which is committed to building a global community of shared future, has been actively fulfilling its international obligations through close cooperation with the WHO and other countries. China has shared its successful experience with the rest of the world concerning case reporting, virus identification, and control measures. China has, to the best of its ability, offered material and technological assistance to more than 100 countries and international organizations, honoring its responsibilities as a major country.

In responding to Covid-19, we must have plans in place for worst-case scenarios. We must maintain our strategic resolve, stay firmly on track, meet challenges head-on, adopt effective approaches, and unite all the forces at our disposal.

At the 73rd World Health Assembly in 2020, I explained, in my video speech, China’s vision and proposals on fighting Covid-19, and announced five policy measures, which were widely welcomed by the international community. The final agreements reached at the Assembly conform to China’s position as well as the shared aspirations of most countries.

Covid-19 is still raging around the world. China will continue to perform its international obligations, play its role as the world’s biggest supplier of protective materials, participate in the formulation of relevant international guides, norms, and standards, and share its solutions and experience. In doing so, China will exert a greater impact on and have a greater say in the global health governance system as we work with other countries to build a global community of health for all.

* Part of the speech at a meeting with experts and scholars.

(Not to be republished for any commercial or other purposes.)