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From SARS to 2019-Coronavirus (Ncov): U.S.-China Collaborations on Pandemic Response

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From SARS to 2019-Coronavirus (Ncov): U.S.-China Collaborations on Pandemic Response Testimony From SARS to 2019-Coronavirus (nCoV): U.S.-China Collaborations on Pandemic Response Jennifer Bouey CT-523 Testimony presented before the House Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation on February 5, 2020. For more information on this publication, visit www.rand.org/pubs/testimonies/CT523.html Testimonies RAND testimonies record testimony presented or submitted by RAND associates to federal, state, or local legislative committees; government-appointed commissions and panels; and private review and oversight bodies. Published by the RAND Corporation, Santa Monica, Calif. © Copyright 2020 RAND Corporation is a registered trademark. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html. www.rand.org From SARS to 2019-Coronavirus (nCoV): U.S.-China Collaborations on Pandemic Response Testimony of Jennifer Bouey1 The RAND Corporation2 Before the Committee on Foreign Affairs Subcommittee on Asia, the Pacific, and Nonproliferation United States House of Representatives February 5, 2020 hairman Bera, Ranking Member Yoho, and members of the subcommittee, thank you for inviting me to testify about U.S.-China collaboration on pandemic response, especially Cin light of the recent novel coronavirus outbreak. First, I will describe the 2002–2003 outbreak of severe acute respiratory syndrome (SARS) and the global response. Next, I will discuss U.S.-China collaboration from 2003–2012, followed by developments in the years prior to the current coronavirus outbreak. Lastly, I will analyze the characteristics of 2019-nCoV and China’s early responses, and offer policy recommendations. 2002–2003: SARS Almost 17 years ago, a novel coronavirus was silently causing deadly pneumonia outbreaks—which later became known as SARS—in China. The index case of the SARS outbreak occurred in the city of Foshan in Guangdong Province, China, on November 16, 2002. Neither this case nor a few other cases in December attracted any notice from the public. A public health expert team from the province, which included a few representatives from the national Ministry of Health, went to one of the cities in Guangdong province in January 2003 to investigate. The team concluded that the atypical pneumonia diagnoses were probably caused by a virus. The team then suggested in a “top-secret” report that the provincial health bureau should establish a case-reporting system. This reasonable—although rather feeble—suggestion was expressed in a news bulletin for local health care professionals but fell on deaf ears during the Chinese New Year. The world did not find out for another two months that this was severe acute 1 The opinions and conclusions expressed in this testimony are the author’s alone and should not be interpreted as representing those of the RAND Corporation or any of the sponsors of its research. 2 The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. 1 respiratory syndrome (SARS), a viral pneumonia that would infect more than 8,000 people globally and lead to 774 deaths. At that time, China lacked a national center for disease control, which would have been responsible for maintaining a robust surveillance system for detecting emerging diseases. It also lacked a national case-reporting system. In addition, according to the Implementing Regulations of the Law of the People’s Republic of China on Guarding State Secrets regarding the handling of public health-related information, any occurrence of infectious disease should be classified as a state secret before it is “announced by the Ministry of Health.”3 No physician or journalist can alert the public without breaking the law. With no information from government or media, the Chinese public was unaware of the outbreak until cell phone messages about a “deadly flu” started to circulate in early February 2003 in Guangzhou. A widespread panic caused residents to clear out antibiotics and flu medicines in pharmacies. Prompted by the public panic, the Guangdong health officials finally held a press conference on February 11 to announce the 305 atypical pneumonia cases in the province. China submitted the case report to the World Health Organization (WHO) as atypical pneumonia, probably caused by chlamydia or a virus around the same time. Afterward, information about the disease was reported on the news media, but the flow of information stopped on February 23. The news blackout from February 23 continued during the run-up to the National People’s Congress in March, and the government shared little with the public until early April.4 Meanwhile, a “super-spreading” chain of transmission emerged at the end of the January and lasted until March, causing international attention on the outbreak: A patient with pneumonia in Guangdong was transferred between three different hospitals, ultimately infecting 200 people, including a doctor from Zhongshan Hospital. The doctor traveled to Hong Kong and infected 12 people in a hotel, and these 12 people then carried the virus to Singapore, Vietnam, Canada, Ireland, and the United States.5 By mid-March 2003, SARS clusters started to appear in Vietnam, Hong Kong, Singapore, and Canada. The WHO subsequently picked up the alerts from the Global Outbreak Alert and Response Network (GOARN) and issued a global alert about a new infectious disease of unknown origin. Between March 16 and March 21, the WHO started to suspect that the more than 300 cases from February—which China had labeled “atypical pneumonia” in its report— were actually SARS cases. At China’s request, the WHO sent a team to China on March 23. On March 27, the WHO team concluded that the “atypical pneumonia” cases were same as SARS, and China announced 792 cases and 31 deaths.6 Under intense international pressure to mobilize against the pandemic threat, the Chinese government publicly acknowledged the SARS outbreak 3 Yanzhong Huang, “The SARS Epidemic and Its Aftermath in China: A Political Perspective,” in Stacey Knobler, Adel Mahmoud, Stanley Lemon, Alison Mack, Laura Sivitz, and Katherine Oberholtzer, eds., Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary, Washington, D.C.: The National Academies Press, 2004 4 Huang, 2004 ibid 5 Institute of Medicine, “Summary and Assessment,” in Stacey Knobler, Adel Mahmoud, Stanley Lemon, Alison Mack, Laura Sivitz, and Katherine Oberholtzer, eds., Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary, Washington, D.C.: The National Academies Press, 2004. 6 World Health Organization, “Severe Acute Respiratory Syndrome (SARS) Multi-Country Outbreak – Update 10: Disease Outbreak Reported,” news alert, March 26, 2003. As of February 3, 2020: https://www.who.int/csr/don/2003_03_26/en/ 2 at the end of March and undertook a series of responsive actions in the following weeks, including establishment of new rules requiring all local health officials to report the number of cases daily, with severe penalties for noncompliance streamlining of interdepartmental communication and cooperation on the crisis creation of national and provincial interdepartmental SARS task forces dedication of over $1 billion to treating the patients and controlling the epidemic.7 In late April 2003, China’s health minister and Beijing’s mayor were fired one day after the Chinese Premier announced severe consequences for local officials who failed to report SARS cases in a timely and accurate manner. (That same day, the number of cases in Beijing jumped from 37 to 407.) By the end of May, more than 1,000 officials were fired or penalized for their “slack” responses to SARS.8 The remaining officials, driven by political zeal, began to seal off villages, apartment complexes, and university campuses; quarantined tens of thousands of people; and set up checkpoints to take temperatures. A new hospital was built within 20 days in Beijing to accommodate and quarantine SARS patients. The epidemic started to subside in late May. By June 27, the WHO announced that China was “SARS-free.” On August 16, the last two SARS patients were discharged from a Beijing hospital. SARS revealed the state of China’s unprepared public health system. It led the country to significantly rethink its approach to both domestic and global health. The government soon invested 6.8 billion renminbi (RMB) (850 million U.S. dollars [USD]) for the construction of a three-tiered network of disease control and prevention. The outbreak also spurred China to strengthen its relationships with the United States and the wider international community around issues of public health concerns. The change in China was welcomed and enthusiastically supported by governments and scientists around the world. 2003–2013: U.S.-China Collaborations and China’s Public Health Restructuring and Capacity-Building Increased
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