What are the lessons to be learned from the SARS crisis? How do we keep the lines of communication for disease reporting open and accessible to all officials and keep the public in the know?

These were the issues that top Chinese disease control and prevention officials grappled with at a symposium held in Beijing on Wednesday.

At the initial stages of the SARS (severe acute respiratory syndrome) outbreak in early 2003, the public grapevine was buzzing about the spread of the disease although officials remained close-mouthed, resulting in the quick spread of the epidemic.

Since then, the central government has spent more than 120 million yuan (US$14 million) strengthening the national network for reporting infectious diseases and public health issues.

Before the establishment of the network in January 2004, it took at least 24 days for local hospitals to report a potentially infectious disease to the Chinese Center for Disease Control and Prevention (CDC).

Now, any suspicious case can be reported to the CDC within one day, according to Vice Minister of Health Wang Longde. The health authority can now monitor the situation daily and quickly inform the public of any outbreaks, Wang said.

At the end of 2004, the network covered 14,000 agencies above county level, 18,000 township hospitals; 3,000 disease control centers and 3,000 health authorities at various levels.

Despite the impressive numbers, more than 57 percent of the country's township hospitals are still not plugged into the network and the system is nowhere near functioning at an optimal level, said Rao Keqin, director of the Ministry of Health's Information Center.

Reporting, monitoring and treatment in rural areas and small urban centers are much slower than in big cities.

For instance, experts believe that about 70 percent of HIV/AIDS cases and the majority of tuberculosis patients are in the rural and remote areas of China, but nearly 90 percent of the country's estimated 840,000 HIV carriers and most TB patients have not been diagnosed because of poor surveillance.

Another problem is the shortage of qualified people who can collect and report data, especially in the less developed western and central regions.

For example, the Ministry of Health plans to buy 16,000 computers for hospitals in remote and poverty-stricken areas; but local health workers are not well versed in the use of the technology, said Rao.

(China Daily April 21, 2005)