RURAL POOR IN CHINA

Poor people living in rural areas depend on agriculture to make a living and feed their families.
Most of the crops are raised for food. Meager surpluses or rice or potatoes or animals are sold
for money. The head of the household and other family members often have no other job. Up
until a few years ago It was not uncommon for a family to earn less than six dollars a month and
be required to pay taxes of $10 a month.
Many people live in huts with a thatch or tin roof held on with rocks. They subsist off daily
rations of flour and sugar, supplemented with tomatoes and yoghurt. They cook their meals over
wood dung fires and gather their water down stream from village privies. Wood is in short
supply. The wells from which water is fetched are often dry. Sugar, cigarettes and liquors have
traditionally been regarded as the luxuries of village life. Cigarettes are a often luxury they can't
afford.
Health care and education for the poor is generally of poor quality. According to World Bank
economists, the mortality rate in the Chinese countryside is "as bad as you'll find in the
developing world," and four out of five peasants can't afford to see a doctor. More than 180
million rural Chinese are illiterate. A Communist party cadre in Hubei wrote: "I often meet old
people, grabbing my hands, saying they are wishing for an early death and young people
running up to him recounting the tragedy of not being able to afford elementary school."
In remote Duyun prefecture of Guizhou province half of the 3.8 million people live below the
poverty line of $1 a week. Many of these people are worse of than they were during the Mao
era, when at least they were guaranteed grain rations and given subsidized medical care and
free schooling. Tania Branigan wrote in The Guardian, “To understand just how poor rural
Guizhou is, you can look at the statistics. Or you can look at the children in Qixin village. Zhao
Ai is nine, but is so short he appears three years younger. He eats nothing between leaving
home at 6.30am---for a two-hour trek down the mountain to Ruiyuan primary school---and
returning at 5pm. [Source: Tania Branigan, The Guardian, October 2, 2011]
In 2010, Shanghai took the top spot in the Organisation for Economic Co-operation and
Development (OECD)'s international rankings for reading, maths and science in state schools.
Meanwhile, at Zhao's primary, the big educational challenge is "no food", says headteacher Xu
Zuhua. Malnutrition stunts her pupils' growth and hampers their concentration. "Even though we
are developing, it feels like urban areas are running while we are strolling," says Zhou Liude,
who oversees Ruiyuan and nearby schools.
The government has sought to invest in rural areas, and the benefits of growth are spreading. In
the towns around Qixin you see stores with gleaming yellow motorbikes and adverts for 3G and
coffee. But these remain unimaginable luxuries for families like Zhao's, who survive on basic
farming and wages sent home by relatives working in cities. Their poverty is disguised by
development: the further away from the road people live, the poorer they are---and the worse
their children's grades---says Ruiyuan's headteacher.

Daily Life of Rural Poor in China

In the poorest areas, people have no running water or electricity. They use digging sticks to
plow their fields and irrigate they land with water carried in buckets fastened to either end of
yoke-like shoulder poles and have to walk more than 20 miles on dirt paths to reach the nearest
dirt road. Their dream is replacing their rickety stone and log shacks for small brick homes.
Many poor peasants in China subsist off bread and shrimp paste or boiled turnips and eat meat
only once a month, and that often is dog or cat. Children go barefoot and use discarded
syringes for water guns. Many people are so poor that they decorate their houses with empty
Coca-Cola cans, have never heard of electricity, let alone have it, and sell the blood of their
children to buy fertilizer.
Some people have nothing. The New York Times did an interview with a peasant in a poor
village north of the Yellow River in Shandong province. The peasant was asked how often he
had meat or eggs? "Never," she said. Is her 14-year-old daughter in school? "No." Does her 8-
year-old some have any toys "None."
Despite being for poor, rural families until recently were required to turn over about half their
harvest to the government as tax, leaving just enough grain to feed their families and enough to
barter for shrimp paste to flavor their food.
Some rural poor earn money by doing things like laboring on highway crews or carrying bricks in
a brick klin. For many the easiest way to make money is selling blood for around $12. But
because people have contacted AIDS, hepatitis and other disease from tainted blood, selling
blood is no longer widely practiced, denying the rural poor of a way to make money.

Rural Problems in China

Excessive taxation, local corruption and declining services are problems faced by many people
in the countryside. In their book Will the Boat Sink the Water: The Life of China's Peasants
Chen Guidi and Wu Chuntao describe a village chief who murdered a man who tried to audit
villages books; a township leader that forced peasants to grow mulberry trees so he could get
rich from selling the seeds; and a Communist Party boss who called in armed troops to put
down a tax revolt.
Many villagers have hacking coughs and respiratory ailments as result of being exposed to
indoor cooking fires. They avoid going to the doctor because they can't afford the $5 visits.
Some receive very little government support. One woman who lived in a mud hut in Ningxia
province and tried to raise seven children with her husband on an income of $120 a year told
Newsweek, "We get no government services, no medical care. If I want birth control I have
leave here and buy it myself."
Riots by angry farmers have occurred in many different places. The government now fears that
a major revolt is more likely to come from the countryside than in the cities. See Taxes, Local
Government, Government; See Land Seizures, Agriculture, Economics

Money Problems for Rural People in China

Rural people enjoyed benefits in the early stage of the Deng reforms when peasant were
released from the communes but suffered in the 1990s and 2000s as the emphasis of the
economic reforms switched to the cities

The annual income of people living in Shanghai is around 18,000 yuan while those living in
agricultural areas around the city is 7,000 yuan. Six percent of elderly people in rural areas
receive a pension compared to 60 percent in the big cities. Teachers and health workers in rural
areas go unpaid for months and are forced to seek bribes to survive.
The incomes of farmers rose dramatically during the early years of the Deng reforms, but
recently their incomes have leveled off or dropped. In many cases the poverty situation is
getting worse for villagers and the income gap between them and urban people is widening.
Ability to make money often depends on access to non farm jobs.
While incomes have stagnated costs for basic things like health care and education have risen
out of reach. The cost of treating the most basic health problem is often more than people earn
in a year.The annual cost of $250 to send a child to high school is either beyond a family's
reach or enough to drive them deep into debt. Unlike urban Chinese, peasants are not entitled
to government benefits such as health care and unemployment payments. What is more the
cost of food, fertilizer and seeds has risen so that farmers are earning even less than they did.
In some places earning are declining by around 5 percent a year.

Rural Wealth Gap near ‘Danger’ Level

China's countryside is facing a widening wealth gap as hundreds of millions of residents
abandon farming for better paid work in cities, a report said, warning rural inequality was
approaching “danger” levels. AFP reported: The Centre for Chinese Rural Studies said
inequality in rural areas was growing given the difference in incomes between those who farmed
and those who flocked to cities as migrant workers. “The difference in rural residents’ income is
getting bigger and pressure on living expenses is increasing," the centre said in a statement
reported in state media today. [Source: AFP, August 22, 2012 ==]
“China's growing wealth gap is a major concern for authorities keen to avoid public discontent
that could lead to social unrest in the rapidly developing country of 1.3 billion people. The
centre, which has links to the state, estimated the Gini coefficient, a measure of inequality, was
0.3949 for rural residents last year, nearing what it called the “danger” level of 0.40, the
statement said. The commonly used Gini coefficient measure varies between 0 – reflecting
complete equality – and 1, which indicates complete inequality. China has not released a Gini
coefficient for the country as a whole for more than a decade, amid worries over the widening
income gap. An official said in January that data on high income groups was incomplete to
explain why the government had again failed to issue the statistic for 2011. ==
“Rural residents who work as migrant labourers in cities earn twice as much as those who farm
for a living, the official Xinhua news agency quoted the centre as saying, but gave no figures.
Although most migrant workers live in cities for most of the year, they are officially registered as
rural residents. As a result, incomes as a whole for rural households were rising sharply, with
average cash income jumping more than 14 percent to around 38,894 yuan (US$6,174) last
year, the Xinhua report said. Deng Dacai, deputy head of the centre, said the Gini coefficient for
all of China was likely “well above” 0.40, Xinhua reported. The government-backed Chinese
Academy of Social Sciences estimated China's Gini coefficient at nearly 0.47 in 2005. ==
A survey released in July 2013 by Peking University survey found showed a vast difference
between earners in top-tier coastal cities and those in interior provinces. Edward Wong wrote in
the New York Times:“Average annual income for a family in 2012 was 13,000 renminbi, or
about $2,100. When broken down by geography, the survey results showed that the average
amount in Shanghai was just over 29,000 renminbi, or $4,700, while the average in Gansu
Province, in northwest China, was just 11,400 renminbi, or just under $2,000. Average family
income in urban areas was about 16,500 renminbi, or $2,600, while it was 10,000 renminbi, or
$1,600, in rural areas." [Source: New York Times, July 19, 2013]
A study by the Chinese Academy of Social Sciences found that the urban-rural wealth divide
had grown 26 percent between 1997 and 2012 and 68 percent between 1985 and 2012. In
2011, year, rural dwellers had an average annual disposable income of around $1,030 ,
according to China's National Bureau of Statistics, compared to $3,242 for their urban
counterparts.
"Hu Jintao did not do much [to stop the] gap increasing," Mark Wang, a University of Melbourne
scholar and expert in rural China, told The Telegraph. "The gap is still huge and people feel
angry. It's very dangerous for China. People expect [incoming president] Xi Jinping to fix the
problem." [Source:Tom Phillips, The Telegraph, November 12, 2012 ><]
Tom Phillips wrote in The Telegraph, “The wealth gap is immediately clear in Guizhou province,
where politicians pushing the relocation scheme say some 11.5 million people live below the
poverty line, with around two million in "chronic poverty". Outside the airport in its capital,
Guiyang, a white-gloved chauffeur ushers a woman and her shopping bags into a black Rolls-
Royce. ><

Help for Rural Poor in China

In recent years the government has promised to more to help to rural people. Government
assistance for the poor includes rural anti-poverty projects, new drinking water systems and
incentives for investments in poor provinces. Nobel-Prize winner Muhammad Yunis was invited
to China for a trial of his “micro credit” system. See Farmers.
In an attempt to reduce the number of people migrating from the countryside to the cities,
governments have put more funds into rural development for things like village schools, clinics,
and sewers. In some places craft and weaving schools have been set up for young men and
women to give them a basic education and teach them skills they can use in their villages. Even
so, there are so many village and rural communities out there that these programs affect a
relatively small number of people.
Perhaps the biggest help to villagers is the $45 billion sent back to relatives from migrant
workers who left the villages. Without this money many villages would die.

See Taxes, Government; Improvements for Farmers, Agriculture, Economics; Electricity,

Energy, Public Services

The Chinese economist Hu Angang has called for large amounts of money to be spent in the
countryside in what some Western analysts call "a Chinese New Deal." In regard to talk about
investments in the poorer provinces, local people often say, "the thunder is huge, but the
raindrops are tiny."
Undermining the ability of rural poor to help themselves are government policies that require
them to grow grain when they could make more money growing fruits and vegetables and
policies that restrict the migration to the cities. Some of programs end up cheating villagers.
Some farmers surrendered their land for reforestation programs that promised $65 a year for
the rest of their life but ended up receiving nothing,"

Hu Jintao Government and Help for Rural Poor

In a New Year speech in 2007, Hu said he was committed to spreading the wealth in China so
the have-nots could get their share. In his speech a before the 17th Congress in October 2007
Hu said, “There are still a considerable number of impoverished and low-income people in both
urban and rural areas and it has become difficult to accommodate the interests of all sides."
Over a two year period starting in 2003 the Chinese government paved more rural roads than it
did in the previous half century.
By 2007 there was a shift in focus on policy with the government saying that it was just as
responsible for improving the quality of life as it was for delivering economic growth. The shift is
at least partly a reaction to increasing discontent over income disparities, land seizures and
other problems.
In a speech in March 2006, Chinese Prime Minister Wen Jiabao promised massive social
spending in the poor countryside. Wen said “building a new socialist countryside” is a major
historic task and said the government would spend $5.2 billion on rural schools, hospitals, crop
subsidies and other programs, raising spending in these areas by 15 percent.
China spent $70 billion on rural development in 2008, a quarter more than in 2007, on roads,
health care, education, agricultural subsidies and things like patching up crumbling dams.
Beijing hopes the measures will do something to shrink the gap between the rich coastal cities
and the rural interior and reduce the number of migrant workers to the cities by giving them
more opportunities at home.
In a major speech marking the opening of National People's Congress in March 2010, Chinese
Premier Wen Jiabao promised to expand old-age pension coverage and other social benefits for
rural residents.

Chinese Village Drained by Migrant Labor

Describing a village in Shandong Province, a 12-hour bus ride from Beijing, Megan Stack and
Barbara Demick wrote in the Los Angeles Times, “Nobody remembers just how Liloucun village
came to be. There is a vague story, something about how a group of Li men moved here 300
years ago in search of wider tracts of fertile land for farming. The name translates as "Li house
village," and the men who live here today all bear the surname Li. The exact relations are lost to
time, but the villagers assume their blood is shared, and intermarriage is forbidden. Men remain
in the village, choosing wives from elsewhere, and the village daughters marry out. [Source:
Megan K. Stack and Barbara Demick, Los Angeles Times, February 20, 2011]
“Today, Liloucun is home to 160 people, three computers and a single car...There are two main
roads; at their intersection are two general stores, a fertilizer shop and a small restaurant. There
is no running water, and the town got electricity only a decade back. Most of the money comes
from migrant workers. About 40 percent of the villagers leave home to join China's urban
workforce." [Ibid]
“The migrants' salaries have bought bricks and lumber to replace the grass and mud once used
to build homes. People proudly show off their televisions, washing machines and refrigerators;
everybody knows who has what, and how much it cost. The price is paid in absence. Most of
the year, these hamlets are ghostly, drained of the young and fit." [Ibid]
For two week Chinese New Year holiday “the village looks like its old self. Couples get married,
taking advantage of the luck of a new year and the presence of migrating relatives. Roving
holiday markets spill from one village to the next, peddling live fish, dried lotus, pigs' heads,
hand-pounded sesame oil, mountains of fireworks." [Ibid]

Village Family Fractured Absent Migrant Father

Li Guangqiang works on the construction of the new Microsoft site in Beijing. His children in his
home village in Shandong Province have grown up without him. Megan Stack and Barbara
Demick wrote in the Los Angeles Times, “He seems uneasy around them, scoffs that their
mother gave them names that are embarrassingly rural. His son, Shengshun, has been acting
out. He skips school, runs off with his friends. To the fury of his teacher, who threatened to ban
him from school, he dyed his hair bright red. His grades are terrible; in a few years, he'll
probably follow his father's example and migrate to a big city. [Source: Megan K. Stack and
Barbara Demick, Los Angeles Times, February 20, 2011]
“Now he trails after his father, hurls himself at the older man, who brushes the boy away. He
manages to lure his father into a wrestling match, but it doesn't last long. As for 15-year-old
Yingying, she is tall and dreamy. She earns better grades than her brother, and helps her
mother in the kitchen. She pines for adventure, of becoming a factory girl someplace bustling
and distant." "I always think outside is better than my village," she says. [Ibid]
‘sun Fengzhi is mincing goat fat for the stew, banging it over and over with a shining cleaver.
She married Li more than 13 years ago, when she was 26. She has hardly seen him since. It's
cold in the kitchen; her breath hangs in front of her mouth, and the fat is freezing. Her thick,
strong fingers ache from the work. With her husband out of earshot in the yard, Sun describes a
melancholy family life." "He went away and I had to take care of everything," she says quietly. "It
was really difficult for me. I had to take care of the kids myself. I used to hold them so long my
arms were in pain. I had to be their father and their mother." [Ibid]
‘since coming home, her husband has shared his son's bed, not his wife's. He has spent a lot of
time visiting his friends, driving around in his cousin's van. He wears his nice city clothes, and
although his family speaks to him in local dialect, he stubbornly replies in the Mandarin of
Beijing...While Sun is telling her storey one of the neighbor women slips out to warn Li: Your
wife is criticizing you to outsiders!...Li bursts into the room. "Stop complaining so much!" he yells
at his wife, who cringes and shrinks from him. Their son joins in, echoing his father's orders:
“Stop complaining!” Sun drops her reddened eyes and turns her attention to the goat stew."
[Ibid]
“On the wardrobe, in pride of place, hangs a picture of Sun and three other women. They stand
in factory smocks, smiling shyly at the camera. She looks younger and prettier, but the photo is
only 2 years old. That year, Sun tried her hand as a migrant worker. She left her children with
her parents and found a job at a DVD component factory in Qingdao. Those days were happy.
But her son grew unruly; nobody could control him. After six months, Sun returned to the village.
[Ibid]
Li is sullen. His efforts to portray a family life unscathed by his gaping absence have fallen
apart. "I guess you can tell, since my wife just says whatever comes into her head, that we don't
have a very good relationship," he says grimly. Still they try to put on a happy face. A few days
later, the whole family travels two miles down the road to visit Sun's village. "I don't go to her
village very often," Li says. "It's something I have to do." [Ibid]

Children in Chinese Villages Emptied by Migrant Labor

Migration rates exploded over the last two decades as residents left their fading villages in
droves to seek jobs in the cities. The left-behind children are the fallout of a rapid dissolution of
traditional Chinese values in the rush for economic opportunity and growth, and a vivid reminder
of how routine migration has become in the country's lifestyle.
Describing a remote village in Anhui Province,Megan Stack and Barbara Demick wrote in the
Los Angeles Times, “This is a village of empty rooms, children left behind and frail grandparents
who struggle to hold it all together. Most of the able-bodied adults have left the hamlet of rutted,
muddy roads and drought-withered fields of corn. House after house, the same family tale is
repeated: The parents have migrated to the big cities for work; their young children stay with
grandparents, great-grandparents or any other relatives who can shelter and feed them. At the
age of 10 or so, when the youngsters are considered old enough, many move into packed
boardinghouses attached to their public schools. [Source: Megan K. Stack, Los Angeles Times,
September 30, 2010]
“A generation of left-behind children is growing up in China. Researchers estimate that at least
58 million---nearly a quarter of the nation's children and almost a third of its rural children---are
growing up without one or both of their parents, who have migrated in search of work. More than
half of those were left by both parents. The youngsters face psychological and emotional
challenges; many struggle to keep up with their lessons and end up abandoning school in their
teens to join their parents on the road, researchers say." [Ibid]
"Their education is always lagging behind," Nie Mao, author of "Hurt Village," a book on the fate
of the separated children, told the Los Angeles Times. "Their safety is always compromised
because they are far from their parents. Their future is not clear. "This is a social problem in
China and, as a society, we have to find a solution," Nie said. Bringing their children along
means paying city school costs, sheltering them despite their own dubious living arrangements,
and keeping them supervised during long work shifts. Chinese children are entitled to nine years
of free public education but must pay steep fines to enroll in schools outside the town or village
where their residence is registered."
"People choose to be separate from their children because they don't have any other choice,"
Shi Zhengxin, secretary general of the China Social Assistance Foundation, told the Los
Angeles Times . Despite the hardships, Shi urges parents to try to keep their children with them.
Most of them will eventually end up migrating anyway, he says, so they might as well get used
to urban life. "If they get left behind, they grow up into the second generation of migrant
workers," he said. "They'll still have to come to the city to work, and it will take them much
longer to adjust and learn how to live here." [Ibid]
“There is general unease, among government officials and the intelligentsia, about the plight of
the left-behind children and the fraying of the Chinese family, which traditionally prized
togethernesss and intensive parenting," Stack and Demick wrote . “The government has
created migrant schools, and this year launched a program that gave children the chance to
travel to the city to spend summer holidays with their parents. But the migrant schools are
notoriously inferior to the mainstream public schools, and so far just one trainload of children
has gone to Beijing for a reunion with their parents. [Ibid]

Grandparents Raising Children in Chinese Village Drained by Migrant Labor

“At 77, Cai Zhongying is the matriarch of a nearly empty homestead," Megan Stack and Barbara
Demick wrote in the Los Angeles Times. “From a mud road where scraggy dogs roam, the
cluster of family homes looks almost splendid: a string of buildings adorned with turquoise trim
and statues of birds perched on curled rooftops, still being built piece by piece with wages from
Cai's faraway children. Inside, the rooms are mostly bare. Her children and the grandchildren
who left have spent much of their money, scraped together during shifts in far-flung urban
factories, to build the rooms. The cash to furnish them will have to come later. They come home
once a year, if they can earn the fare and get the time off." [Source: Megan K. Stack, Los
Angeles Times, September 30, 2010]
“For years, people here tried to stay ahead of hunger as subsistence farmers. There is a coal
mine nearby, but only a few villagers have been lucky enough to land jobs there. For the rest,
there's the road. Villagers go south and east, to the massive coastal cities of skyscrapers and
suburban factories, or to bigger coal mines in more prosperous towns. To Shanghai, Pinghu or
Xuzhou."
“It's the job of Cai, along with her 78-year-old husband, to keep an eye on the houses and raise
the younger children until they are old enough to work. The couple had six children, with hopes
of being cared for in their old age. Instead they are locked into perpetual parenthood, raising
waves of grandchildren and great-grandchildren. These days, they are tending to two
youngsters, ages 4 and 6, plus fields of vegetables and a pomegranate orchard in the
mountains." [Ibid]
"My husband just cries sometimes because the little boy is always clinging to his neck and
climbing all over him," Cai told the Los Angeles Times. "And my husband is exhausted." Still, it
is an improvement from recent years, when the couple had as many as six small children under
their roof. Back then, they struggled to find enough food for everyone. Bitter arguments would
erupt at mealtimes. "The whole scene was a mess," Cai said. "Some of them really needed to
be taken away to be with their parents. Thinking about it now, I want to cry." [Ibid]
As noon rolled around, Cai's husband, Li Jiachen, arranged their 6-year-old great-
granddaughter on the rear rack of his bicycle and pedaled her home from school for a lunch
break. Li's is a farmer's face, weathered with deep ruts; his pants were smeared with mud. He
sat, lighted a cigarette and began to cry as he described the choices his family has faced.
"When I was raising my grandchildren, I could only provide them with food, nothing more," he
said sorrowfully. "And then when they were 15, they all left to go work." At other moments, Li
and Cai are more sanguine. The children have never known their parents well enough to miss
them, they say, shrugging. And anyway, there is nothing unusual in their circumstances. Most of
their neighbors are also grandparents raising the younger generation. [Ibid]
“The family has faced worse," Stack and Demick wrote. “Years past, when the harvest was
particularly thin, Cai was reduced to begging in order to feed her children. That seems like a
long time ago now. And like the other villagers, the family regards the en masse exit from the
village as a double-edged sword. For all the emotional turmoil of shattered families, there is a
new gleam of prosperity on the landscape.The dirt roads are littered with construction materials:
Bricks, roofing tile and cement. Old-style houses, built from rocks bound together with a paste
made from ashes, are regarded as evidence that the household's migrants haven't done their
part. [Ibid]
Inside their home, Cai's great-granddaughter hides from visitors in the double bed she shares
with her great-grandparents. There is another bed nearby, the mattress still sheathed in plastic
from the factory. On the label, a Western-looking woman reclines dreamily under a nonsensical
English slogan: "Salubrious endless imagination you life." Nobody sleeps there."It's my son's,"
explains Li. Then the family turns to examine in silence the newly bought bed. [Ibid]

Village Culture Disappearing in China

Ian Johnson wrote in the New York Times, “Across China, cultural traditions like the Lei family's
music are under threat. Rapid urbanization means village life, the bedrock of Chinese culture, is
rapidly disappearing, and with it, traditions and history. “Chinese culture has traditionally been
rural-based," says Feng Jicai, a well-known author and scholar. “Once the villages are gone, the
culture is gone." That is happening at a stunning rate. In 2000, China had 3.7 million villages,
according to research by Tianjin University. By 2010, that figure had dropped to 2.6 million, a
loss of about 300 villages a day. [Source: Ian Johnson, New York Times, February 1, 2014 ++]
“For decades, leaving the land was voluntary, as people moved to the cities for jobs. In the past
few years, the shift has accelerated as governments have pushed urbanization, often leaving
villagers with no choice but to move. China's top leadership has equated urbanization with
modernization and economic growth. Local governments are also promoting it, seeing the sale
of rural land rights as a way to compensate for a weak tax base. Evicting residents and selling
long-term leases to developers has become a favored method for local governments to balance
budgets and local officials to line their pockets. Numerous local officials are under investigation
for corruption linked to rural land sales. Destroying villages and their culture also reveals deeper
biases. A common insult in China is to call someone a farmer, a word equated with
backwardness and ignorance, while the most valued cultural traditions are elite practices like
landscape painting, calligraphy and court music. ++
But in recent years, Chinese scholars have begun to recognize the countryside's vast cultural
heritage. A mammoth government project has cataloged roughly 9,700 examples nationwide of
“intangible cultural heritage," fragile traditions like songs, dances, rituals, martial arts, cuisines
and theater. About 80 percent of them are rural. In the past few years, for example, Mr. Feng
has documented the destruction of 36 villages in Nanxian, a county on Tianjin's outskirts, home
to a famous center of woodblock printing. “You don't know if it will survive or not because when
they're in their new homes they're scattered," he said. “The knowledge isn't concentrated
anymore and isn't transmitted to a new generation." ++

Chinese Village Musicians Lose Their Village

Ian Johnson wrote in the New York Times, “Once or twice a week, a dozen amateur musicians
meet under a highway overpass on the outskirts of Beijing, carting with them drums, cymbals
and the collective memory of their destroyed village. They set up quickly, then play music that is
almost never heard anymore, not even here, where the steady drone of cars muffles the lyrics of
love and betrayal, heroic deeds and kingdoms lost. The musicians used to live in Lei Family
Bridge, a village of about 300 households near the overpass. In 2009, the village was torn down
to build a golf course and residents were scattered among several housing projects, some a
dozen miles away. Now, the musicians meet once a week under the bridge. But the distances
mean the number of participants is dwindling. Young people, especially, do not have the time. “I
want to keep this going," said Lei Peng, 27, who inherited leadership of the group from his
grandfather. “When we play our music, I think of my grandfather. When we play, he
lives."[Source: Ian Johnson, New York Times, February 1, 2014 ++]
“Mr. Lei said that keeping their village life intact would have helped most. “It was really
comfortable in the old village," he said back in his new home, a small two-bedroom apartment
high up in an apartment block a half-hour drive away. “We had a thousand square meters and
rented out rooms to migrants from other provinces. Lots of buses stopped nearby, and we could
get into the city easily." ++
“Like all rural residents, the Leis and their neighbors never owned their land; all land in China
belongs to the state. So when the plans were announced to build the golf course, they had little
choice but to move. “No one protested," he said. “We knew we didn't have a choice. You have
to just go with the flow." Everyone got free apartments and $50,000 to $100,000 in
compensation. Strangely, however, the golf course has never been built, and the village still lies
in ruins. No one here can figure out if this is because the development was illegal, or perhaps
part of a corrupt land deal that is under investigation. Such information is not public, so villagers
can only speculate. Mostly, they try to forget. “I try not to think about these things too much," Mr.
Lei said. “Instead, I try to focus on the music and keeping it alive." ++

Disintegration of Chinese Village Life

Joe Zhang wrote in New York Times, “The peaceful and idyllic village I grew up in, like many of
China's rural towns, has been brought to ruins by the breakdown of traditional social norms that
followed decades of failed policies and neglect by the state...China's traditional social fabric has
become shredded — and the disintegration is most obvious in the countryside, where families
are falling apart, crime is soaring and the environment is killing people. Many villagers who were
happy to have the state retreat from their private lives in recent decades are now crying for
government intervention. Something has to be done to rebuild China's languishing village life.
<>[Source: Joe Zhang, New York Times, November 28, 2014 <>]
“The state of my family's home village of Jingmen, Hubei Province, is common across China. Its
roads are no longer usable as they have not been maintained for over a decade. The
community buildings have been torn down; the last time I was there I only saw dust and broken
tiles all around. Rural families are suffering. The suicide rate in the countryside is three times as
high as in the cities, according to reports from 2011. My uncle, who had been living in a
makeshift shack after his grown children kicked him out of their house, hanged himself four
years ago, never having recovered from the death of his wife two years earlier. <>
It is common for both parents to leave their small children at home in the village while they go to
work in factories elsewhere. Some 60 million children suffer this fate; most are left in the care of
their grandparents, but more than 3 percent — millions of children — are left to live on their
own. Children who stay behind often have to cope with loneliness (not many have siblings) and
helplessness. Some reports say that sexual abuse of left-behind children is on the rise. In many
cases, men go to jobs in the cities while their wives stay behind with the children in the village.
They get to see each other only a few days a year. Distance, emotional stress and financial
frustration tear families apart. According to the journal Learning Weekly, China's rural divorce
rate surged fourfold between 1979 and 2009. Lianhe Zaobao, a Singapore-based newspaper,
and numerous government publications have reported that many parts of rural China have
become anarchic, with rising crime rates and election fraud. <>
“Beijing's effort to decentralize the country's governance over the past few decades has played
a major role in this social decay. The elections of village heads are often rigged and corruption
is rampant. The retreat of the state has left a dangerous power vacuum, and many villagers
have been left to fend for themselves. There is a lot of talk of mafia-like groups wielding power
behind the scenes. <>

Rising Crime and School Drop Out Rates in Chinese Villages

Joe Zhang wrote in New York Times, “Crime, rare in the Communist era, is increasing. Statistics
are hard to come by — even the police do not publish them. In the countryside, only the most
extreme crimes get reported, but even some horrific cases are ignored. Several years ago, my
cousin was almost beaten to death by a fellow villager and his relatives in a conflict over an
extramarital affair. My sister reported the brutality to the police but they never followed up.
[Source: Joe Zhang, New York Times, November 28, 2014 <>]
“In the old days, officials at the village and townships had the mandate and resources to
mediate disputes, including domestic violence. The police would patrol even the most remote
villages. Today the police seem to stay in cities, and village heads don't have the resources to
intervene in social issues. The abolition of an “agriculture tax” about a decade ago has added to
the budget constraints of local governments. <>
“Meanwhile, increasing numbers of rural children are dropping out of school. One study
suggests there are at least 20 million school dropouts in rural areas, or 1 in 10 young villagers.
The primary school that I attended in the 1970s was dismembered a decade ago, due to
dwindling numbers of students. As a result, young kids in the village have to travel along more
than five miles of mud roads each day to go to school. <>

Reasons for the Disintegration of Chinese Village Life

Joe Zhang wrote in New York Times, “The period of renaissance in the countryside ended in the
mid-to-late 1990s. Reckless growth of bank credit powered by the central bank's printing press
caused years of double'digit inflation that quickly eroded the incomes in the countryside and
helped widen gaps between rural villages and the cities. Average monthly wages in the cities
surged from a few hundred yuan two decades ago to about 4,000 yuan ($650) today, while
incomes in the countryside lagged far behind. [Source: Joe Zhang, New York Times, November
28, 2014 <>]
“More important, following the government's privatization of state housing, urban housing prices
grew exponentially, five-to-six-fold in many cases, while the value of rural homes rose little by
comparison. Too many rural residents have missed out on China's property boom, contributing
to the wealth gap between the cities and the countryside. <>
“Local governments have done little to help. As more and more farmers flocked to factories in
coastal cities, layers of local government were neglected and decayed. Factories eventually
emerged in towns near rural villages, sucking the lakes dry and poisoning the rivers and the air.
Experts estimate China has more than 450 cancer villages, towns where cancer cases cluster at
much higher than average rates. Villagers have paid a steep price. Some residents of my village
have died of unknown ills in their 40s and 50s. <>

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London,
National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides,
Compton's Encyclopedia and various books and other publications.

Abstract

More than two billion people in low- and middle-income countries (LMIC) lack adequate access
to essential medicines. In this paper, we make strong public health, human rights and economic
arguments for improving access to medicines in LMIC and discuss the different roles and
responsibilities of key stakeholders, including national governments, the international
community, and non-governmental organizations (NGOs). We then establish a framework of
pharmaceutical firms’ corporate responsibilities - the “must,” the “ought to,” and the “can”
dimensions - and make recommendations for actionable business strategies for improving
access to medicines. We discuss controversial topics, such as pharmaceutical profits and
patents, with the goal of building consensus around facts and working towards a solution. We
conclude that partnerships and collaboration among multiple stakeholders are urgently needed
to improve equitable access to medicines in LMIC.

Keywords: Pharmaceutical Products, Health Policy, Health Financing, Health Systems

Introduction

More than two billion people in low- and middle-income countries (LMIC) lack adequate access
to essential medicines [1]. The problem is complex and views of stakeholder responsibilities to
solve it differ.

Increasingly, demands are being placed on the pharmaceutical industry to contribute to

improving access to medicines for poor patients in developing countries [2,3]. A consensus on
what constitutes an appropriate portfolio of corporate responsibilities for access to medicines –
under conditions of failing states and market failure – is in the interest of the world’s poor and of
corporations that want to be part of the solution for one of the most pressing social issues of our
time.

In this paper, we provide public health, human rights and economic arguments for improving
access to medicines and discuss the different roles and responsibilities of key stakeholders. We
then establish a framework of pharmaceutical firms’ corporate responsibilities and make
recommendations for actionable business strategies for improving access to medicines. We aim
to contribute to constructive dialogue on the responsibilities of the pharmaceutical industry and
its activities of good corporate practice. We conclude that partnerships and collaboration among
multiple stakeholders are urgently needed to improve equitable access to medicines in LMICs.

Go to:

Improving Access to Medicines – Health, Human Rights and Economic Rationales

WHO’s Director General, Dr. Margaret Chan, asserts that, “much of the ill health, disease,
premature death and suffering we see on such a large scale is needless, as effective and
affordable interventions are available for prevention and treatment [4].” Essential medicines are
such interventions. Used properly, essential medicines and vaccines could save up to 10.5
million lives each year and reduce unnecessary suffering [5].

However, a third of the world’s population (up to 50 percent in parts of Asia and Africa) lack
access to essential medicines [6].Average availability of generic medicines is only 38 percent in
the public sector in LMIC [7]. Although private sector availability is higher – on average 64
percent – medicines in private pharmacies are often not affordable [7]. Consuming 25-65
percent of total public and private spending on health and 60-90 percent of household
expenditure on health in developing countries, [8] medicines pose an enormous economic
burden on health systems and households. Unfortunately, spending on medicines is often not
cost-effective: almost half of all medicines are inappropriately prescribed, dispensed, or sold
and patients do not adhere to about 50 percent of the medicines they receive [5,9].

There is a strong human rights argument for improving access to medicines [10]. Given that
morbidity and mortality can be reduced by ‘good governance’ and spending resources
according to actual needs, [11] and that medicines are vital for good health, there is a moral
imperative for evidence-based policies and fair distribution of resources to improve access to
medicines for the poor and vulnerable.

Similarly, there is a strong economic argument for improving access to medicines in LMICs.
Today, about 2.5 billion people struggle to meet their basic needs [12]. In a vicious circle of
poverty and illness, poverty is a both cause and an effect of poor health [13] and lack of access
to medicines. Since health of their bodies and minds is often the only asset of poor people,
access to medicines becomes particularly crucial for them.

Experts concur on the dismal state of access to medicines in LMICs. There is less agreement
on sources of the problem, and while there are strong public health, human rights and economic
arguments for improving access to medicines in LMIC, there is little consensus on who is
responsible for action.

Go to:

Improving Access to Medicines – Responsibilities of Stakeholders

Primary Duty Bearer

The Nation State, supported by the international community, bears the primary responsibility for
ensuring that the right to health is respected, protected, and fulfilled [10].

WHO holds the “failure of health systems” [4] responsible for the “unacceptably low” health
outcomes across much of the developing world. If low-income countries devoted 15 percent of
their national budgets to health and added appropriate development assistance, they could
finance adequate primary health care for the poor [14]. However, governments of many
developing countries continue to spend most resources on sectors other than health and
education [15,16] and scarce resources on health are wasted or misallocated, [17] often as a
result of politics or corruption. Nevertheless, governments can facilitate significant progress
toward improving access to medicines, even under budget constraints. For example,
governments can abolish import tariffs, duties, and sales taxes on medicines, which contribute
little to government budgets, unfairly tax the poor, and increase end-user prices of medicines in
the public sector, sometimes by more than 80 percent [7,18].

Where capacity and efficacy in the public sector are still low, adopting strategies that place a
greater workload on public institutions may prove detrimental [19]. Other actors must therefore
assist to facilitate improvements. The international community, nongovernmental organizations
(NGOs) and the pharmaceutical industry share responsibilities for improving access to
medicines. However, their contributions will only be as effective as national political and social
constraints will allow [4].

Other Duty Bearers

International Community

International recommendations [11] and binding treaties [20] outline the roles of the international
community in development assistance. In the Millennium Declaration, 147 heads of state and
governments “recognize that, in addition to our separate responsibilities to our individual
societies, we have a collective responsibility to uphold the principles of human dignity, equality
and equity at the global level [21].”

Despite global commitment and unprecedented amounts of donor support, international efforts
to improve medicines access leave much room for improvement. Programs that rely on donor
funding are at risk when donor countries – themselves under financial pressure - fail to honor
their commitments [22]. For decades, the international community has neglected programs for
treatment of non-communicable diseases [23].International development assistance, which is
often targeted at specific diseases rather than general health sector support [24], may actually
hinder progress towards broader public health goals [25].

With respect to medicines access, international community efforts might benefit from
coordination, a focus on strengthening health systems across vertical programs, and evaluation
of the desired and undesired impacts of interventions [25].

Non-Governmental Organizations
Many NGOs play a vital role in development and in almost all aspects of health-related work for
the poor. In contrast to governments (and pharmaceutical companies), NGOs tend to score
highly among poor people on responsiveness and trust [26]. NGOs raise public awareness for
health care issues affecting the poor, support policies that directly benefit the poor, supply
medicines, and deliver care. NGOs have also been integral to promoting a rights-based
approach to pharmaceutical policy [10] and pressing for more comprehensive corporate
awareness of, and responsibility for, access to medicines [2].

However, like the international community, NGOs often focus on specific diseases, notably
HIV/AIDS and little attention has been paid to access to medicines for other high-impact
diseases and health system improvement [24].

In recognition of NGOs’ value, the Millennium Declaration recommends that greater

opportunities be given to NGOs to contribute towards global health goals [21]. NGOs can play a
critical role in campaigning for increased and better-coordinated resources for health care and
promoting sustainable health systems, notably for chronic disease treatment. NGOs should
continue to monitor, and hold accountable, country governments and pharmaceutical
companies with respect to their responsibilities and commitments to improving access to
medicines [10].

Pharmaceutical Industry

Finally, pharmaceutical companies, as the developers and manufacturers of medicines, play a

key role in improving access to medicines. Millennium Development Goal 8 sets out the target
for the international community “in co-operation with pharmaceutical companies, [to] provide
access to affordable, essential drugs in developing countries [27]. ”The corporate right-to-health
obligation is laid out in the preamble to the Universal Declaration of Human Rights: “every
individual and every organ of society… shall strive… to promote respect for these rights and
freedoms and… to secure their universal and effective recognition and observance” [emphasis
added] [28].

There is extensive debate on what the human rights focus should mean for pharmaceutical
corporations, as organs of society. While some criticize today’s pharmaceutical business model
for ensuring “maximum margins” by charging what the market can bear and by “defending
patents unreservedly,” [2] investors and financial analysts who assess pharmaceutical
companies expect nothing less [29].

The common good is best served when all actors in all social subsystems do their best in the
area of their particular responsibility, without losing sight of the ties that bind them [30]. What is
then the “particular responsibility” of the pharmaceutical industry, and how can corporations
fulfill their social contract?

Go to:

Responsibilities of the Pharmaceutical Industry – Evolving Paradigms

The role of a pharmaceutical company in a global economy is to research, develop and produce
innovative medicines that improve quality of life, and it is their duty to do so in a profitable way.
No other societal actor assumes this responsibility. A company can only realize sustained
earnings if and when it uses its resources in a socially responsible, environmentally sustainable,
and politically acceptable way. Given an increasing investor and consumer focus on corporate
social responsibility, it is in the enlightened self-interest of a pharmaceutical company to be part
of the solution to the access to medicines problem. Encouragingly, more companies participate
in the bi-annual Access to Medicines Index which provides “pharmaceutical companies,
investors, governments, academics, nongovernmental organizations and the general public with
independent, impartial and reliable information on individual pharmaceutical companies’ efforts
to improve global access to medicine [31].”

Go to:

Responsibilities of the Pharmaceutical Industry – Controversies around Profits and Patents

Although critics argue for the weakening of intellectual property rights, patents should not be the
focus of the access to medicines debate. Patents provide desirable incentives and are a
precondition for successful research and development of innovative drugs and vaccines. Access
to pharmaceutical innovations for poor patients requires an intelligent mix of public and private
research and incentives. The challenge is to find innovative strategies for the responsible use of
patents under conditions of market failure. Creative ideas are emerging [32], for example, for
the development of new antibiotics [33] and medicines for neglected diseases [34].

Patents are not the reason for lack of access to essential medicines that are already developed.
In 65 LMICs where four billion people live, patenting is rare for products on WHO’s Model List of
Essential Medicines: only 17 of the 319 products were patentable, and only in 1.4% of instances
(300 out of 20,735 essential medicine-country combinations) were essential medicines
patented, mostly in larger markets [35]. However, lack of patents does not guarantee that
generic medicines are available [7] or acceptable [36] in LMICs, confirming that all stakeholders
must do their parts to improve availability, quality, perception, and use of generic products.

Go to:

Responsibilities of the Pharmaceutical Industry – A Framework

There are three levels of corporate responsibility: the “must,” the “ought to,” and the “can”
dimensions [Figure 1] [37].Pharmaceutical firms “must” develop new medicines, make a profit,
and comply with applicable laws and regulations. Voluntary corporate activities to improve
access to medicines can be classified as either corporate responsibility (“ought to”) or
philanthropy (“can”). Exactly which activities fall into each category may be debated, and given
evolving paradigms, companies may increasingly consider access to medicines activities
beyond legal duties consistent with business strategy.
Open in a separate window

Figure 1. The Hierarchy of Corporate Responsibility

Research-based pharmaceutical companies have committed to improving access to medicines

[38,39]. Figure 2 includes corporate activities recommended by the International Federation of
Pharmaceutical Manufacturers Association (IFPMA), [38] the UK Department for International
Development (DFID) [40] and the United Nations [41] to improve access to essential medicines
in LMIC and develop medicines for neglected diseases. While all of these corporate activities
could be viewed as philanthropic (“can”) endeavors, many should also be considered as a part
of a firms’ corporate responsibility (“ought to”) and business model.
Open in a separate window

Figure 2: Promising Corporate Responsibility Tools to Improve Access to Medicines

However, there is no consensus among pharmaceutical companies on which activities they

“ought to” pursue or prioritize. Nor is there evidence about which activities are the most
effective. Differential pricing seems to be a promising strategy [42,43] since it satisfies corporate
responsibility goals by improving access to medicines for the poor and, theoretically, maximizes
profits through price discrimination. However, the success of differential pricing depends on the
ability to regulate arbitrage, accurately forecast the market for medicines, and distribute
medicines through a functioning health system [43].Several companies are applying differential
pricing; it will be important to share successes and set-backs so that the industry can improve
upon this strategy.

In addition to the “must,” “ought to,”and “can” activities, there are activities that industry “must
not” engage in. An important example is inappropriate marketing. Industry must not use
misleading, dishonest, or illegal promotional practices, such as promoting uses of medicines
that will not benefit patients and misrepresenting results from the medical literature and clinical
trials.

Given the human tragedy associated with inadequate access to medicines, strategies to
improve access should be a corporate responsibility priority for the pharmaceutical industry.
Pharmaceutical companies’ business models, and legitimacy, will increasingly depend on being
perceived as a force for good in the fight against poverty-related illnesses and premature
mortality. Corporate initiatives, however, cannot have their optimal impact if other stakeholders
are not also doing their parts. The most sophisticated break-throughs in research and the most
generous offers of low-priced medicines will make little difference for the poorest people if there
is no basic health infrastructure to reach them [44]. Lack of health care infrastructure,
insufficient workforce, logistic challenges, particularly in remote rural areas, and patient factors,
such as misperceptions and stigma about disease and medicines, lack of health education, and
poor adherence, necessitate extensive system investments. The pooling of resources, skills,
experience, and goodwill across multiple stakeholders is necessary for sustainable solutions.
Dialogue and collaborations are needed.

Go to:

Access to Medicines - A Call for Joint Action

Consistent with encouraging multi-stakeholder discussions at the Third International Conference

for Improving Use of Medicines, [45] we recommend the creation of “solution-stakeholder-
teams” that include national governments, the international community, NGOs, pharmaceutical
companies, and academics from multiple disciplines including medicine, public health, business,
and ethics. Each team member brings unique perspectives and strengths to the development
and implementation of collaborative strategies for sustainably improving access to medicines.
Initial collaborations would focus on issues of common interest and win-win strategies.
Examples include developing new antibiotics, increasing access to medicines for non-
communicable diseases, and curbing sales of counterfeit and substandard medicines. While
there are significant differences in opinion over the extent, depth, and breadth of pharmaceutical
corporations’ actions to improve medicines access, there is basic agreement that differential
pricing, donations, licenses, and pro bono research services are important elements.Formal
evaluation of the impacts of joint interventions must be part of the solution-stakeholder-teams’
responsibilities [45].

We believe that awarding “reputation capital” for companies that actively and collaboratively
expand activities in the “ought to” and “can,” and curb activities in the “must not,” categories of
corporate responsibility will eventually encourage more companies to engage in more activities
to improve access to medicines for the poor. Indeed, a “must,” “ought to,” “can,” and “must not”
approach may be valuable to define and assess fulfillment of responsibilities of each
stakeholder in the complex pharmaceutical sector.

We close with a notion of Jeffrey Sachs: “Modern businesses, especially the vast multinational
companies, are the repositories of the most advanced technologies on the planet and the most
sophisticated management methods for large-scale delivery of goods and services. There is no
solution to the problems of poverty, population, and environment without the active engagement
of the private sector [46].”

Go to:

Author Contributions

Klaus Leisinger wrote the first draft of the paper. All authors participated in the collection of
additional research and references and contributed to the writing of this manuscript.Opinions
expressed are solely those of the authors and not of the institutions they represent.

Funding Statement

The Novartis Foundation for Sustainable Development (NFSD), a non-profit organization under
the parent company of Novartis, provided funding for this project. Klaus Leisinger is Professor of
Sociology, Chairman of the Board of NFSD. NFSD provided financial support to Laura
Garabedian and Anita Wagner for their contributions to the development and writing of this
manuscript.

( https://www.independent.co.uk/news/science/disease-x-what-is-infection-virus-world-health-
organisation-warning-ebola-zika-sars-a8250766.html)

China propose solution:

1. Acknowledges the need to address the underlying obstacles to the achievement of the
goal of universal access to prevention, treatment, care and support, including the gap in
available human, technical and financial resources, as well as inadequately functioning
health systems, in order to ensure an effective and successful response to Pandemic
Virus;
 2. Urges Governments, donors and other stakeholders to continue to provide financial and
political support for research and development of an effective Pandemic Viruses
vaccine;

The Centers for Disease Control and Prevention (CDC) has collaborated with public health
institutions in China since the 1980s to address public health priorities that affect China, the
United States, and the global community. In 2005, China and the U.S. established the China-
U.S. Collaborative Program on Emerging and Re-emerging Infectious Diseases (EID), which
acts as one of ten international Global Disease Detection (GDD) Centers.

The GDD Center in China provides technical assistance and partners with China CDC to
identify and contain emerging infectious disease and other threats. Among other efforts, the
Center has provided technical assistance in evaluating China’s surveillance systems, worked to
improve the response and control of zoonotic diseases, helped establish a national norovirus
outbreak surveillance network, and collaborated on responses to influenza.

The GDD Center in China helps contain outbreaks close to the source by building up local
resources, drawing on combined expertise in:

 Emerging infectious disease detection and response

 Field epidemiology and laboratory training
 Pandemic influenza preparedness and response
 Zoonotic disease research and control

Through partnerships with the China National Health and Family Planning Commission
(NHFPC), the Chinese Center for Disease Control and Prevention (China CDC), and the World
Health Organization (WHO), the U.S. CDC is helping to increase the country’s capacity to detect
and control infectious diseases.

From 2006-2016, the Center in China has supported

 Effective response to over 581 outbreaks

 Implementation of population-based pneumonia surveillance in Jinzhou, Hubei Province,
covering one million lives
 Detection of three novel strains and pathogens new to the region or world
 Establishment of in-country diagnostic testing capacity for 17 diseases or pathogens
 Graduation of 288 public health professionals through China’s Field Epidemiology Training
Program
 Training of over 18,366 public health professionals through short-term exercises, including
pandemic preparedness, rapid response, and epidemiology and laboratory training
 Improved health communication through training of nearly 5,188 provincial communicators on
use of risk communication principles, news media channels, and emergency communication
strategies
Case:The SARS virus was carried out of southern China on February 21, when a 64-year-old
medical doctor who had treated patients in Guangzhou and was himself suffering from
respiratory symptoms checked into a room on the ninth floor of the Metropole Hotel in Hong
Kong. Through mechanisms that are not yet fully understood, he transmitted the SARS virus to
at least 16 other guests, all linked to the ninth floor. Those guests carried the disease to
Toronto, Singapore, and Hanoi, or they entered hospitals in Hong Kong. The medical doctor fell
severely ill the following day, was hospitalized immediately, and died on March 4. A global
outbreak was thus seeded from a single person on a single day on a single floor of a Hong
Kong hotel.
A businessman, infected in the Metropole Hotel, traveled to Hanoi, fell ill, and was hospitalized
on February 26. He was attended by a WHO official, Dr. Carlo Urbani, following concerns raised
by hospital staff. Alarmed at the unusual disease and concerned that it could be an avian
influenza, Dr. Urbani contacted the WHO Western Pacific Regional Office (WPRO) on February
28.
Solve: On March 10, the Ministry of Health in China asked WHO to provide technical and
laboratory support to clarify the cause of the Guangdong outbreak of atypical pneumonia. On
March 12, WHO alerted the world to the appearance of a severe respiratory illness of
undetermined cause that was rapidly spreading among hospital staff in Vietnam and Hong
Kong. Three days later, on March 15, it became clear that the new disease was carried along
major airline routes to reach new areas, and WHO issued a further global alert, giving the new
disease its name: severe acute respiratory syndrome, or SARS.
(Adopted at the 6th Meeting of the Standing Committee of the Seventh National People's
Congress on February 21, 1989, revised at the 11th Meeting of the Standing Committee of
the Tenth National People's Congress on August 28, 2004 and promulgated by Order No.
17 of the President of the People’s Republic of China on August 28, 2004)

Article 1 This Law is enacted in order to prevent, control and put an end to the outbreak
and spread of infectious diseases and to ensure the health of the people and public
sanitation.

Article 2 With respect to prevention and treatment of infectious diseases, the State
implements a policy of putting emphasis on prevention, combining prevention with
treatment, exercising classified control, and relying on science and the masses.

Article 3 The infectious diseases governed by this Law are divided into Classes A, B and C.

Infectious diseases under Class A are plague and cholera.

Infectious diseases under Class B are infectious SARS, AIDS, viral hepatitis, poliomyelitis,
highly pathogenic avian influenza, measles, epidemic hemorrhagic fever, rabies, epidemic
encephalitis B, dengue fever, anthrax, bacillary and amebic dysentery, pulmonary
tuberculosis, typhoid and paratyphoid, epidemic cerebrospinal meningitis, pertussis,
diphtheria, tetanus infantum, scarlet fever, brucellosis, gonorrhoea, syphilis, leptospirosis,
schistosomiasis and malaria.

Infectious diseases under Class C are influenza, epidemic parotitis, rubella, acute
hemorrhagic conjunctivitis, leprosy, epidemic and endemic typhus, kala-azar,
echinococcosis, filariasis, and infectious diarrhea other than cholera, bacillary and amebic
dysentery, typhoid and paratyphoid.
Infectious diseases other than the ones specified in the preceding paragraphs that need to
be included in the infectious diseases under Class B or C, depending on the situation of
their outbreak and prevalence and the extent of the harm done, shall be decided on and
announced by the health administration department under the State Council.

Article 4 With respect to the infectious SARS, pulmonary anthrax in anthrax and highly
pathogenic avian influenza that infects human beings, included in the infectious diseases
under Class B, the measures for prevention and control of infectious diseases under Class
B, the measures for prevention and control of infectious diseases under Class A , as
mentioned in this Law, shall be taken. With respect to the other infectious diseases under
Class B and the infectious diseases the causes for the outbreak of which are uncertain and
for which the measures for prevention and control of infectious diseases under Class A, as
mentioned in this Law, need to be taken, the health administration department under the
State Council shall, without delay, report the matter to the State Council for approval before
making an announcement and take the measures.

With respect to the other endemic infectious diseases, which are common and multiple in
their own administrative areas, the people's governments of provinces, autonomous
regions, and municipalities directly under the Central Government may, in light of the actual
situations, decide to control them the way they do with respect to the infectious diseases
under Class B or C, make announcements, and report the matter to the health
administration department under the State Council for the record.

Article 5 People's governments at various levels shall direct the work of preventing and
treating infectious diseases.

People's governments at or above the county level shall draw up programmes for
prevention and treatment of infectious diseases and arrange for their implementation, and
establish a sound system for prevention and control of diseases, medical treatment and
supervision and control for prevention and treatment of infectious diseases.

Article 6 The health administration department under the State Council shall be in charge
of the work of preventing and treating infectious diseases as well as exercising supervision
and control over such diseases nationwide. The health administration departments under
the local people's governments at or above the county level shall be in charge of the work
of preventing and treating infectious diseases as well as exercising supervision and control
over such diseases within their own administrative areas.

The other departments under the people's governments at or above the county level shall
be in charge of the work of preventing and treating infectious diseases within the scope of
their respective duties.

The prevention and treatment of infectious diseases in the People's Liberation Army shall
be carried out in compliance with this Law and the relevant regulations of the State and
shall be supervised and controlled by the department in charge of health in the Army.

Article 7 Diseases prevention and control institutions at all levels shall do the work of
monitoring and forecasting infectious diseases, and of making epidemiological investigation
and reporting on epidemic situation as well as the work of preventing and controlling other
diseases.
Medical agencies shall do the work of preventing and treating infectious diseases that is
related to medical treatment and the work of preventing infectious diseases within their own
responsibility areas. Medical agencies in urban communities and rural areas at the grass-
roots level shall, under the direction of disease prevention and control institutions, do the
work of preventing and treating infectious diseases for the corresponding urban
communities and rural areas at the grass-roots level.

Article 8 The State develops modern medical science and such traditional medical science
as traditional Chinese medicine and pharmacology, and supports and encourages scientific
research in prevention and treatment of infectious diseases with a view to raising the
scientific and technological level of preventing and treating infectious diseases.

The State supports and encourages international cooperation in preventing and treating
infectious diseases.

Article 9 The State supports and encourages units and individuals to participate in the work
of preventing and treating infectious diseases. People's governments at all levels shall
improve relevant systems to facilitate the units and individuals' participation in such
activities as publicity and education in the importance of prevention and treatment of
infectious diseases, report on epidemic situation, voluntary services and donation.

Residents' and villagers' committees shall get the residents or villagers organized to
participate in prevention and control of infectious diseases in the urban communities and
rural areas.

Article 10 The State conducts health education in respect of prevention of infectious

diseases. The news media shall publicize gratis for the public good the importance of
prevention and treatment of infectious diseases and public sanitation.

Schools of various kinds at different levels shall disseminate among their students
knowledge on health and on prevention of infectious diseases.

Medical colleges and universities shall improve education on and research in preventive
medicine and conduct education on and training in preventive medicine among the
students and people working for prevention and treatment of infectious diseases, in order
to provide technical assistance to the work of preventing and treating infectious diseases.

Disease prevention and control institutions and medical agencies shall regularly conduct
among their staff members training in the knowledge and skills of prevention and treatment
of infectious diseases.

Article 11 Units and individuals that have made remarkable achievements in or

contributions to the work of prevention and treating infectious diseases shall be
commended or awarded.

Persons who contract diseases, are disabled or die due participation in the work of
preventing and treating infectious diseases shall be subsidized or compensated in
accordance with relevant regulations.

Article 12 All units and individuals within the territory of the People's Republic of China
shall accept the preventive and control measures taken by disease prevention and control
institutions and medical agencies for investigation, testing, collection of samples of
infectious diseases and for isolated treatment of such diseases, and they shall provide
truthful information about the diseases. Disease prevention and control institutions and
medical agencies shall not divulge any information or materials relating to personal privacy.

Where health administration departments and other relevant departments, or disease

prevention and control institutions and medical agencies infringe upon the lawful rights and
interests of any units or individuals when exercising administrative control or taking
preventive and control measures in violation of law, the units or individuals concerned may
apply for administrative reconsideration or initiate legal proceedings according to law.

Chapter II Prevention of Infectious Diseases

Article 13 People's governments at all levels shall arrange for mass health activities,
conduct health education regarding prevention of infectious diseases, promote a civilized
and healthy way of life, enhance the awareness of the public in the importance of
prevention and treatment of infectious diseases and their ability of coping with such
diseases, improve environmental sanitation and eliminate the hazards of rodents and
vector organisms such as mosquitoes and flies.

Administrative departments for agriculture, water conservancy and forestry under the
people's governments at all levels shall, in accordance with the division of their duties, take
charge of directing and coordinating efforts to eliminate the hazards of rodents and
schistosomiasis from the farmlands, lake regions, rivers, livestock farms and forest regions
as well as the hazards of other animals and vector organisms that transmit infectious
diseases.

Administrative departments for railways, communications and civil aviation shall take
charge of coordinating efforts to eliminate the hazards of rodents and vector organisms
such as mosquitoes and flies from the means of transport and relevant places.

Article 14 Local people's governments at all levels shall establish or reconstruct public
sanitary facilities in a planned way, improve the sanitary condition of drinking water, and
take measures for the innocent treatment of sewage, wastes and feces.

Article 15 The State practices a planned prophylactic vaccination system. The health
administration department under the State Council and such departments under the
people's governments of provinces, autonomous regions, and municipalities directly under
the Central Government shall, in accordance with the requirements of prevention and
control of infectious diseases, draw up plans for prophylactic vaccination against infectious
diseases and coordinate efforts for their implementation. Vaccines used for prophylactic
vaccination shall conform to the quality standards of the State.

The State practices a system by which certificates are issued to children who have
received prophylactic vaccination. The prophylactic vaccination under the item of the State
immune program shall be free of charge. Medical agencies, disease prevention and control
institutions and guardians to children shall cooperate with each other to ensure that
children receive prophylactic vaccination in time. The measures in this regard shall be
formulated by the State Council.

Article 16 The State and the community shall show concern about and help the infectious
disease patients, pathogen carriers and suspected infectious disease patients and make it
possible for them to receive timely medical treatment. No units or individuals shall
discriminate against infectious disease patients, pathogen carriers and suspected
infectious disease patients.

The infectious disease patients, pathogen carriers and suspected infectious disease
patients shall, before they are cured or cleared of suspicion, be barred from jobs which
laws or administrative regulations or the health administration department under the State
Council prohibit them from doing because of the likelihood of causing the spread of
infectious diseases.

Article 17 The state establishes the system for monitoring infectious diseases.

The health administration department under the State Council shall draw up plans and
schemes of the State for monitoring infectious diseases. The health administration
departments under the people's governments of provinces, autonomous regions, and
municipalities directly under the Central Government shall, in accordance with the said
plans and schemes, draw up plans and work schemes for monitoring infectious diseases in
their own administrative areas.

Disease prevention and control institutions at different levels shall monitor the outbreak and
prevalence of infectious diseases as well as the factors affecting their outbreak and
prevalence; and they shall monitor the infectious diseases which have broken out abroad
but have not yet broken at home or have newly broken out at home.

Article 18 Disease prevention and control institutions at all levels shall, in the work of
prevention and control of infectious diseases, perform the following duties:

(1) to carry out the programs, plans and schemes for prevention and control of infectious
diseases;

(2) to collect, analyse and report monitored information about infectious diseases and to
forecast the outbreak and epidemic trend of infectious diseases;

(3) to conduct epidemiological investigation on the epidemic situation of infectious diseases

and on public sanitation emergencies as well as on-the-spot treatment, and to assess the
effects;

(4) to conduct laboratory testing of infectious diseases and to make diagnosis and
etiological appraisal;

(5) to carry out immunization programs and to be responsible for control of the use of
preventive biological products;

(6) to conduct education and provide consultancy on health and to disseminate knowledge
about prevention and treatment of infectious diseases;

(7) to direct and train disease prevention and control institutions at lower levels and their
staff members in respect of the monitoring of infectious diseases; and

(8) to conduct application research in prevention and treatment of infectious diseases and
make health assessment, and to provide technical consultancy.
Disease prevention and control institutions at the central and provincial levels shall take
charge of monitoring the outbreak, prevalence and geographical distribution of infectious
diseases, forecasting the epidemic trend of deadly infectious diseases, putting forth
preventive and control measures, participating in and directing the investigation on and
handling of the epidemic situation that arises, making etiological appraisal of the infectious
diseases, establishing a testing system for quality control, and conducting application
research and making sanitation assessment.

Disease prevention and control institutions of cities divided into districts and of counties
shall take charge of the implementation of the programs and schemes for preventing and
controlling infectious diseases, coordinating efforts in immunization and disinfection as well
as the control of hazards of vector organisms, disseminating the knowledge about
prevention and treatment of infectious diseases, monitoring and reporting the epidemic
situation and the outbreak of public sanitation emergencies in their own areas, and
conducting epidemiological investigation and testing of common pathogenic
microorganisms.

Article 19 The State establishes an early warning system for infectious diseases.

The health administration department under the State Council and the people's
governments of provinces, autonomous regions, and municipalities directly under the
Central Government shall, on the basis of the forecast of the outbreak and epidemic trend
of infectious diseases, issue early warning of infectious diseases in a timely manner, and
make an announcement, depending on the circumstances.

Article 20 Local people's governments at or above the county level shall make preliminary
plans for prevention and control of infectious diseases and report to the people's
governments at the next higher level for the record.

A preliminary plan for prevention and control of infectious diseases shall include the
following main points:

(1) composition of the headquarters for prevention and control of infectious diseases, and
the duties of relevant departments;

(2) systems of monitoring, collecting of information about, analyzing, reporting and

circulating of a notice of infectious diseases;

(3) tasks and duties of disease prevention and control institutions and medical agencies in
case of the occurrence of the epidemic situation of infectious diseases;

(4) classification of the outbreak and prevalence of infectious diseases and the necessary
emergency work plan; and

(5) prevention of infectious diseases and on-the-spot control over epidemic-stricken places
or areas, emergency facilities, equipment, medicines for medical treatment, medical
apparatus and instruments as well as the storage and transfer of other materials and
technologies.

After receiving early warning of infectious diseases issued by the health administration
department under the State Council or the people's governments of provinces,
autonomous regions or municipalities directly under the Central Government, local people's
governments and disease prevention and control institutions shall, in accordance with their
preliminary plans for prevention and control of infectious diseases, take necessary
preventive and control measures.

Article 21 Medical agencies shall strictly adhere to the control system and operation
procedures laid down by the health administration department under the State Council to
prevent iatrogenic and hospital infection of infectious diseases.

Medical agencies shall assign special departments or persons the task of reporting the
epidemic situation of infectious diseases, preventing and controlling infectious diseases
with their own units, and preventing infectious diseases within their responsibility districts,
and the tasks of monitoring dangerous factors related to hospital infection in medical
activities and of safe protection, disinfection, isolation, and disposal of medical wastes.

Disease prevention and control institutions shall designate special persons to take charge
of directing and appraising the work of prevention of infectious diseases within medical
agencies and to conduct epidemiological investigation.

Article 22 Laboratories of disease prevention and control institutions and medical agencies
and units engaged in experimentation of pathogenic microorganisms shall measure up to
the requirements and technical standards specified by the State, establish strict
supervision and control systems and exercise strict supervision and control over the
samples of the pathogens of infectious diseases in accordance with the specified
measures, in order to strictly prevent laboratory infection of the pathogens of infectious
diseases and the spread of pathogenic microorganisms.

Article 23 Blood collectors and suppliers and manufacturers of biological products shall
strictly abide by the relevant regulations of the State to guarantee the quality of blood and
blood products. Illegal collection of blood and getting other persons to sell their blood are
prohibited.

When using blood or blood products, disease prevention and control institutions and
medical agencies shall observe the relevant regulations of the State, in order to prevent the
transmission of diseases via blood transfusion or the use of blood products.

Article 24 People's governments at all levels shall improve their work in preventing and
treating the AIDS and take preventive and control measures to guard against the spread of
the AIDS. The specific measures in this regard shall be formulated by the State Council.

Article 25 The administrative departments for agriculture and forestry and other relevant
departments under the people's governments at or above the county level shall, in
compliance with their respective duties, take charge of the prevention, treatment and
control of infectious diseases of animals related to infectious diseases common to human
beings and animals.

Wild animals, domestic animals and fowls related to infectious diseases common to human
beings and animals shall be sold or transported only after they have passed quarantine.

Article 26 The State establishes the storage of bacterial and virus strains of infectious
diseases.
The collection, preservation, carrying, transportation and use of bacterial and virus strains
of infectious diseases and the samples of infectious diseases for testing shall be controlled
in a classified manner, and a sound and rigorous control system shall be established.

Where it is really necessary to collect, preserve, carry, transport or use bacterial and virus
strains of infectious diseases and the samples of infectious diseases for testing that may
cause the spread of the infectious diseases under Class A or that are specified by the
health administration department under the State Council, the matter shall be subject to
approval by the health administration department under the people's government at or
above the provincial level. The specific measures in this regard shall be formulated by the
State Council.

Article 27 With respect to the sewage, wastes, places and objects contaminated with the
pathogens of infectious diseases, the units or individuals concerned shall carry out strict
disinfection under the direction of the disease prevention and control institutions or in
accordance with the sanitary requirements put forth by them; and in case of refusal to
undergo disinfection, local health administration departments or disease prevention and
control institutions shall carry out compulsory disinfection.

Article 28 Where plans are made for the construction of such large projects as water
conservancy, communications, tourism and energy projects in an area of a natural focus of
infection confirmed by the State, sanitary investigation of the construction environment
shall, in advance, be conducted by the disease prevention and control institution at or
above the provincial level. The construction unit shall, in accordance with the proposals of
the disease prevention and control institution, take necessary measures for prevention and
control of infectious diseases. During the period of construction, the construction unit shall
assign special persons to take charge of sanitation and anti-epidemic work at the
construction site. After completion of the construction project, the disease prevention and
control institution shall monitor the possible occurrence of infectious diseases.

Article 29 Disinfectant products used for prevention and treatment of infectious diseases,
drinking water provided by drinking water suppliers and products related to sanitary safety
of drinking water shall measure up to the sanitary standards and specifications of the State.

Any drinking water supplier engaged in production or supply activities shall obtain a
sanitary license according to law.

Manufacturers of disinfectant products to be used for prevention and treatment of infectious

diseases and disinfectant products to be manufactured for prevention and treatment of
infectious diseases shall be subject to examination and approval by the health
administration department under the people's governments at or above the provincial level.
The specific measures in this regard shall be formulated by the State Council.

Chapter III Reporting on, Releasing Information on and Announcing the Epidemic Situation

Article 30 When disease prevention and control institutions, medical agencies, blood
collectors and supplies or their staff members on duty find the epidemic situation of
infectious diseases specified in this Law or the outbreak and prevalence of other infectious
diseases or the infectious diseases the causes for the sudden outbreak of which are
uncertain, they shall report in adherence to the principle of territorial control in respect of
report on epidemic situation and in accordance with the contents, procedure, form and time
limit prescribed by the State Council or by the health administration department under the
State Council.

When medical agencies of the Army, in the course of providing medical services to the
general public, find the epidemic situation of infectious diseases specified in the preceding
paragraph, they shall report in accordance with the regulations of the health administration
department under the State Council.

Article 31 When any unit or individual finds an infectious disease patient or a suspected
one, they shall promptly report to the nearby disease prevention and control institution or
medical agency.

Article 32 When disease prevention and control institutions at ports, airports and railway
stations or the frontier health quarantine organs find patients of the infectious diseases
under Class A or pathogen carriers or suspected patients of infectious diseases, they shall,
in accordance with relevant regulations of the State, promptly report to the disease
prevention and control institution located at the frontier port or to the health administration
department under the local people's government at or above the county level where they
are located and release such information to each other.

Article 33 Disease prevention and control institutions shall take the initiative to collect,
analyse, investigate and verity information on epidemic situation of infectious diseases. As
soon as they receive reports on epidemic situation of infectious diseases under Classes A
and B or find the outbreak and prevalence of infectious diseases, they shall report to local
health administration department, which shall immediately report to the local people's
governments and, at the same time, to the health administration department at a higher
level and to the health administration department under the State Council.

Disease prevention and control institutions shall set up or assign special departments and
persons the task of controlling information on the epidemic situation of infectious diseases
and making timely verification and analysis of reports on epidemic situation.

Article 34 Health administration departments under the local people's governments at or

above the county level shall, without delay, release the epidemic situation of infectious
diseases and information on such situation they have monitored or issued an early warning
against to the disease prevention and control institutions and medical agencies within their
own administrative areas. Upon receiving such information, the disease prevention and
control institutions and medical agencies shall immediately inform the persons concerned
in their own units.

Article 35 The health administration department under the State Council shall, without
delay, release the national epidemic situation of infectious diseases and information on
such situation, which it has monitored or against which it has issued an early warning, to
the relevant departments under the State Council and the health administration
departments under the people's governments of provinces, autonomous regions, and
municipalities directly under the Central Government.

Health administration departments under the neighboring or relevant people's governments

shall, without delay, release to each other information on the epidemic situation of
infectious diseases in their own administrative areas and information on such situation they
have monitored or against which they have issued an early warning.
When the relevant departments under the people's governments at or above the county
level find epidemic situation of infectious diseases, they shall immediately report to the
health administration departments under the people's governments at the corresponding
level.

When the competent health department of the Chinese People's Liberation Army finds
epidemic situation of infectious diseases, it shall report to the health administration
department under the State Council.

Article 36 Animal anti-epidemic agencies and disease prevention and control institutions
shall keep each other informed without delay of the epidemic situation of infectious
diseases common to animals and human beings that occurs among animals and human
beings as well as relevant information.

Article 37 The relevant departments under people's governments, disease prevention and
control institutions, medical agencies, blood collectors and suppliers and their staff
members that are in duty bound to report the epidemic situation of infectious diseases in
accordance with the provisions of this Law shall not conceal the truth about, make a false
report on or delay report on the epidemic situation of infectious diseases.

Article 38 The State establishes the system for announcing information on epidemic
situation of infectious diseases.

The health administration department under the State Council shall regularly announce
information on the national epidemic situation of infectious diseases. Health administration
departments under the people's governments of provinces, autonomous regions, and
municipalities directly under the Central Government shall regularly announce information
on the epidemic situation of infectious diseases in their own administrative areas.

When an infectious disease breaks out and prevails, the health administration department
under the State Council shall be responsible for announcing to the public information on
the epidemic situation of the infectious disease, and may authorize the health
administration departments under the people's governments of provinces, autonomous
regions, and municipalities directly under the Central Government to announce to the
public information on the epidemic situation of the infectious disease in their own
administrative areas.

Information on epidemic situation of infectious diseases shall be announced without delay

and accurately.

Chapter IV Control of the Epidemic Situation

Article 39 When finding an infectious disease under Class A, the medical agency shall
immediately take the following measures:

(1) to isolate the patients and pathogen carriers for treatment, and to determine the period
of isolation according to the results of medical examination;

(2) to treat suspected patients individually in isolation at designated places until a definite
diagnosis is made; and
(3) to keep the persons in close contact with the patients, pathogen carriers or suspected
patients in medical agencies under medical observation at designated places and to take
other necessary preventive measures.

With regard to the persons who refuse treatment in isolation or, before the expiration of the
period of isolation, break away from treatment in isolation without approval, the public
security organs may assist the medical agencies by taking compulsory measures for
treatment in isolation.

When medical agencies find patients of infectious diseases under Class B or C, they shall
take necessary measures for treatment and for control of their spread according to the
patients' conditions.

With regard to the places and objects contaminated by pathogens of infectious diseases as
well as the medical wastes within their own units, medical agencies shall, in accordance
with the provisions of laws and regulations, carry out disinfection and innocent treatment.

Article 40 When finding epidemic situation of infectious diseases or receiving reports on

such situation, the disease prevention and control institutions shall immediately take the
following measures:

(1) to make epidemiological investigation on the epidemic situation of infectious diseases

and, on the basis of the findings after such investigation, to put forth proposals for the
delimitation of epidemic spots and areas; to give sanitary treatment to the contaminated
places, to keep the persons in close contact under medical observation at the designated
places and to take other necessary preventive measures, and to put forth schemes for
control of the epidemic situation to health administration departments;

(2) when an infectious disease breaks out and prevails, to give sanitary treatment to
epidemic spots and areas, to put forth schemes for control of the epidemic situation to the
health administration departments, and to take measures in accordance with the
requirements of health administration departments; and

(3) to direct the disease prevention and control institutions at lower levels in implementing
the measures for prevention and control of infectious diseases and to coordinate efforts
and direct relevant units in handling the epidemic situation of infectious diseases.

Article 41 With respect to the places where there are cases of infectious diseases under
Class A or to the persons in the special areas within such places, the local people's
governments at or above the county level where the above places are located may carry
out isolation measures and, at the same time, report the matter to the people's
governments at the next higher level; and upon receiving such report, the people's
governments at the higher level shall immediately make a decision on whether to approve
the measures or not. Where the people's governments at the higher level decide not to
approve the measures, the people's governments that have taken isolation measures shall
immediately withdraw such measures.

During the period of isolation, the people's governments that take isolation measures shall
guarantee the daily necessities of the persons under isolation; and if such persons have
their own units, the units, which they belong to, shall not stop the payment of their wages
during the period of isolation.
Withdrawal of isolation measures shall be subject to decision and announcement by the
organ that originally makes the decision to take the measures.

Article 42 When an infectious disease breaks out and prevails, the local people's
government at or above the county level shall immediately get people organized to control
and treat the disease in accordance with its preliminary plan for prevention and control and
cut off the route of transmission; and when necessary, they may take the following
emergency measures, subject to reporting to and decision by the people's government at
the next higher level, and make the measures known to the public:

(1) restricting or suspending fairs, cinema shows, theatrical performances and other types
of mass gathering;

(2) suspension of work, business and school classes;

(3) closing or sealing off public drinking water sources, foodstuffs and relevant objects
contaminated with the pathogens of infectious diseases;

(4) controlling or wiping out wild animals, domestic animals and fowls infected with
epidemics; and

(5) closing the places where the spread of infectious diseases may be caused.

When receiving the report of the people's government at a lower level proposing to take the
emergency measures as mentioned in the preceding paragraph, the people's government
at the higher level shall immediately make a decision.

Withdrawal of the emergency measures shall be subject to decision and announcement by

the organ that originally makes the decision to take the measures.

Article 43 When an infectious disease under Class A or B breaks out or prevails, the local
people's government at or above the county level may, subject to decision by the
government at the next higher level, announce part or the whole of its administrative area
as an epidemic area; and the State Council may decide and announce areas across
provinces, autonomous regions, and municipalities directly under the Central Government
as epidemic areas. The local people's governments at or above the county level may take
the emergency measures as specified in Article 42 of this Law in an epidemic area, and
carry out sanitary quarantine of persons, goods and materials and means of transport
entering or leaving the epidemic area.

People's governments of provinces, autonomous regions, and municipalities directly under

the Central Government may decide to blockade an epidemic area of an infectious disease
under Class A in their own administrative areas; however, the blockade of an epidemic
area in a large or medium-sized city or the blockade of an epidemic area across a
province, autonomous region, or municipality directly under the Central Government, as
well as the blockade of an epidemic area leading to the interruption of the traffic along a
main line of communications, or the blockade of frontiers shall be subject to decision by the
State Council.

Termination of the blockade of an epidemic area shall be subject to decision and

announcement by the organ that originally makes the decision.
Article 44 When an infectious disease under Class A breaks out, transport sanitary
quarantine may be carried out in order to prevent the spread of such disease through the
means of transport as well as the persons, goods and materials carried by them. The
specific measures in this regard shall be formulated by the State Council.

Article 45 When an infectious disease breaks out and prevails, the State Council shall, in
light of the need to control the epidemic situation of the infectious disease, have the power,
within the whole country or in areas across a province, autonomous region, or municipality
directly under the Central Government, and the local people's governments at or above the
country level shall have the power, in their own administrative areas, immediately to
mobilize people or transfer stored goods and materials, and provisionally requisition
houses and means of transport as well as relevant facilities and equipment.

To persons who are immediately mobilized, reasonable remunerations shall be paid in

accordance with relevant regulations. For the houses and means of transport as well as
relevant facilities and equipment that are provisionally requisitioned, compensation shall be
made according to law; and whatever can be returned shall be returned in a timely manner.

Article 46 The body of a person who dies of an infectious disease under Class A or anthrax
shall immediately be given sanitary treatment and cremated at a nearby place. The body of
a person who dies of other infectious diseases shall, when necessary, be cremated after
sanitary treatment or buried deep as required by relevant regulations.

In order to find out the cause of an infectious disease, medical agencies may, when
necessary, perform autopsy on the corpses of patients or suspected patients of infectious
diseases for examination in accordance with the regulations of the health administration
department under the State Council, and shall inform the family members of the dead of
the matter.

Article 47 Where the objects contaminated or likely contaminated with the pathogens of
infectious diseases in epidemic areas can be used again after disinfection, they shall be
used, sold or transported only after being subjected to disinfection under the direction of
local disease prevention and control institutions.

Article 48 When the epidemic situation of an infectious disease occurs, the disease
prevention and control institutions or other professional technical agencies related to
infectious diseases that are designated by the health administration departments under the
people's governments at or above the provincial level may enter the epidemic spots or
areas of infectious diseases to make investigation, collect samples and make technical
analysis and examination.

Article 49 When an infectious disease breaks out and prevails, manufacturers and
suppliers of medicines and medical instruments shall immediately produce and supply the
medicines and medical instruments for prevention and treatment of the infectious disease.
Railway, communications and civil aviation services shall give priority to transportation of
the persons for handling of the epidemic situation of the infectious disease and the
medicines and medical instruments for prevention and treatment of the infectious disease.
The relevant departments under the people's governments at or above the county level
shall do a good job of coordinating efforts in this endeavor.

Chapter V Medical Treatment

Article 50 People's governments at or above the county level shall strengthen and improve
the establishment of their service networks for medical treatment of infectious diseases,
assign medical agencies with the conditions and capability for treating infectious diseases
the task of treating such diseases, or set up hospitals for infectious diseases in light of the
need to treat the diseases.

Article 51 The basic standards, construction design and service process of medical
agencies shall be in conformity with the requirements for prevention of hospital infection of
infectious diseases.

Medical agencies shall, in accordance with relevant regulations, have the medical
instruments in use disinfected; with respect to the medical apparatus that can be used only
once according to regulations, they shall be destroyed after they are used.

Medical agencies shall, in accordance with the standards of diagnosis and requirements of
treatment for infectious diseases specified by the health administration department under
the State Council, take necessary measures to enhance their capability for medical
treatment of infectious diseases.

Article 52 Medical agencies shall give medical treatment and on-the-spot rescue to the
patients or suspected patients of infectious diseases or provide outpatient service to them,
keep written records of the cases and other relevant materials and preserve them properly.

Medical agencies shall practise a system of preliminary and separate examination in

respect of infectious diseases; and patients or suspected patients of infectious diseases
shall be led to separate, relatively isolated spots for preliminary examination. A medical
agency that does not have the capability needed for treatment shall transfer the patients
and the copies of their medical records to a medical agency that has such capability. The
specific measures in this regard shall be formulated by the health administration
department under the State Council.

Chapter VI Supervision and Control

Article 53 Health administration departments under the people's governments at or above

the county level shall perform the following duties of supervision and examination regarding
prevention and treatment of infectious diseases:

(1) to supervise and inspect the health administration departments under the people's
governments at lower levels as to their performance of the duties prescribed by this Law
regarding prevention and treatment of infectious diseases;

(2) to supervise and inspect the work of preventing and treating infectious diseases done
by the disease prevention and control institutions and medical agencies;

(3) to supervise and inspect the collection and supply of blood done by blood collectors and
suppliers;

(4) to supervise and inspect disinfectant products used for prevention and treatment of
infectious diseases as well as the manufacturers of such products, and supervise and
inspect the production or supply engaged in by drinking water suppliers as well as the
products related to sanitary safety of drinking water;
(5) to supervise and inspect the collection, preservation, carrying, transportation and use of
bacterial and virus strains of infectious diseases as well as the samples of infectious
diseases for testing; and

(6) to supervise and inspect the sanitary conditions of public places and the units
concerned as well as the measures for preventing and controlling infectious diseases.

Health administration departments under the people's governments at or above the

provincial level shall take charge of arranging for the handling of important matters
regarding prevention and treatment of infectious diseases.

Article 54 When performing their duties of supervision and inspection, health administration
departments under the people's governments at or above the county level shall have the
right to enter the units subjected to inspection and the places where the epidemic situation
of infectious diseases occurs to make investigation and collect evidence, consult or
duplicate relevant materials and collect samples. The said units shall cooperate with them
and shall not refuse to do so or create obstacles.

Article 55 Where, when performing their duties of supervision and examination, health
administration departments under the local people's governments at or above the county
level find that public drinking water sources, foodstuffs and relevant objects are
contaminated with the pathogens of infectious diseases, which, if no timely control
measures are taken, may lead to the spread and prevalence of infectious disease, they
may take temporary control measures of closing the public drinking water sources, sealing
off the foodstuffs and relevant objects or suspending their sale, and have them tested or
disinfected. Foodstuffs which testing proves to be contaminated shall be destroyed; and for
foodstuffs which are not contaminated or objects which can be used after disinfection, the
control measures shall be withdrawn.

Article 56 When staff members of health administration departments perform their duties
according to law, there shall not be less than two of them, and they shall show their law-
enforcement certificates and fill out sanitation law-enforcement document.

After the sanitation law-enforcement document is verified, the sanitation law-enforcement

persons and the parties concerned shall sign their names. If the parties concerned refuse
to sign their names, the sanitation law-enforcement persons shall make a note of it.

Article 57 Health administration departments shall, according to law, establish a sound

system for internal supervision to supervise the performance of duties by their staff
members in accordance with the statutory functions and powers as well as the statutory
procedure.

Where the health administration departments at higher levels find that such departments at
lower levels fail to handle matters within the scope of their duties in time or fail to perform
their duties, they shall order them to rectify or directly handle the matters.

Article 58 When performing their duties, health administration departments and their staff
members shall subject themselves to supervision by the community and citizens. Units and
individuals shall have the right to report violations of this Law to the people's governments
at a higher level and the health administration departments under such departments. The
people's governments or the health administration departments under them that receive
such reports shall immediately conduct investigation and handle the violations.
Chapter VII Guarantee Measures

Article 59 The State incorporates the work of preventing and treating infectious diseases
into the national economic and social development plan and local people's governments at
or above the county level incorporate such work into the national economic and social
development plan of their own administrative areas.

Article 60 Local people's governments at or above the county level shall, in compliance
with their own duties, be responsible for allocating funds for the daily prevention and
control of and supervision over infectious diseases within their own administrative areas.

The health administration department under the State Council shall, in conjunction with the
relevant departments under the State Council and on the basis of the prevalent trend of
infectious diseases, determine the items for national prevention, control, treatment,
monitoring, forecast, early warning, supervision over and inspection of infectious diseases.
The Central Government shall offer subsidies to financially difficult areas in their efforts to
prevent and treat deadly infectious diseases.

People's governments of provinces, autonomous regions, and municipalities directly under

the Central Government shall, in light of the prevalent trend of infectious diseases within
their own administrative areas and within the scope of the items determined by the health
administration department under the State Council, determine the items for prevention and
control of and supervision over infectious diseases, and guarantee funds for the items.

Article 61 The State strengthens the establishment of the system of prevention and
treatment of infectious diseases at the grass-roots level and gives assistance to the
poverty-stricken areas and areas inhabited by ethnic peoples in their efforts to prevent and
treat infectious diseases.

Local people's governments at all levels shall guarantee funds for prevention and treatment
of infectious diseases in urban communities and rural areas at the grass-roots level.

Article 62 In matters of medical treatment, the State gives aid to the groups of people with
financial difficulties who suffer from special infectious disease by reducing their medical
expenses or exempting them from such expenses. The specific measures in this regard
shall be formulated by the health administration department under the State Council in
conjunction with the department of finance and other departments under the State Council.

Article 63 People's governments at or above the county level shall take charge of storing
medicines, medical instruments and other materials for prevention and treatment of
infectious diseases to keep them ready for distribution.

Article 64 For persons engaged in prevention, medical treatment, scientific research and
teaching of infectious diseases as well as on-the-spot handling of epidemic situation of
infectious diseases and for other persons who are in contact with pathogens of infectious
diseases in production and other work, the units concerned shall, in accordance with the
relevant regulations of the State, take effective sanitary and protective measures and
medical care and health measures, and give them reasonable allowances.

Chapter VIII Legal Responsibility

Article 65 Where local people's governments at different levels fail to perform their duties of
making report in accordance with the provisions of this Law, or conceal the truth about or
make a false report on or delay report on the epidemic situation of infectious diseases or,
when an infectious disease breaks out and prevails, fail immediately to coordinate efforts in
its treatment and to take control measures, the people's governments at the higher level
shall order them to rectify and criticize them in a circular; where their failures or mistakes
cause the spread and prevalence of the infectious disease or other serious consequences,
the persons in charge who should be held responsible shall be given administrative
sanctions according to law; and if a crime is constituted, criminal responsibility shall be
investigated according to law.

Article 66 Where the health administration departments under the people's governments at
or above the county level commit any of the following acts in violation of the provisions of
this Law, the people's governments at the corresponding level or the health administration
departments under the people's governments at a higher level shall order them to rectify
and criticize them in a circular; where their violations cause the spread and prevalence of
the infectious disease or other serious consequences, the persons in charge who should
be held responsible and the other persons who are directly responsible shall be given
administrative sanctions according to law; and if a crime is constituted, criminal
responsibility shall be investigated according to law:

(1) failing to perform their duties of circulating a notice of, making a report on or
announcing the epidemic situation of an infectious disease, as required by law, or
concealing the truth about or making a false report on or delaying report on the said
situation;

(2) when an infectious disease breaks out or is likely to spread, failing immediately to take
preventive and control measures;

(3) failing to perform their duties of supervision and inspection according to law, or failing
immediately to investigate and punish violations of law when they find such violations;

(4) failing immediately to investigate and deal with the reports made by units or individuals
about the failures of the health administration departments at lower levels to perform their
duties of prevention and treatment of infectious diseases; and

(5) violations of this Law such as negligence of dereliction of duty.

Article 67 Where the relevant departments under the people's governments at or above the
county level fail to perform their duties of prevention and treatment of and protection
against infectious diseases in accordance with the provisions of this Law, the people's
governments at the corresponding level or the relevant departments under the people's
governments at a higher level shall order them to rectify and criticize them in a circular;
where their failures cause the spread and prevalence of infectious diseases or other
serious consequences, the persons in charge who should be held responsible and the
other persons who are directly responsible shall be given administrative sanctions
according to law; and if a crime is constituted, criminal responsibility shall be investigated
according to law.

Article 68 Where the disease prevention and control institutions commit any of the following
acts in violation of the provisions of this Law, the health administration departments under
the people's governments at or above the county level shall order them to rectify within a
time limit, criticize them in a circular and give them a disciplinary warning; the persons in
charge who should be held responsible and the other persons who are directly responsible
shall be demoted, dismissed from office or discharged according to law, and the practicing
certificates of the persons concerned who are responsible may, in addition, be revoked
according to law; and if a crime is constituted, criminal responsibility shall be investigated
according to law:

(1) failing to perform their duty of monitoring infectious diseases according to law;

(2) failing to perform their duties of making a report on and circulating a notice about the
epidemic situation of an infectious disease, as is required by law, or concealing the truth
about or making a false report on or delaying report on the epidemic situation of an
infectious disease;

(3) failing to take the initiative to collect information about the epidemic situation of
infectious disease, or failing immediately to analyse, investigate and verify the information
about and report on the epidemic situation of infectious diseases;

(4) when finding the epidemic situation of an infectious disease, failing immediately to take
the measures prescribed by this Law in compliance with their duties; and

(5) purposely divulging information and materials relating to personal privacy of an

infectious disease patient, a pathogen carrier, a suspected infectious disease patient, or
persons in close contact with such patients.

Article 69 Where medical agencies commit any of the following acts in violation of the
provisions of this Law, the health administration department under the people's
governments at or above the county level shall order them to rectify, criticize them in a
circular and give them a disciplinary warning; where their failures cause the spread and
prevalence of the infectious disease or other serious consequences, the persons in charge
who should be held responsible and the other persons who are directly responsible shall
be demoted, dismissed from office, or discharged according to law, and the practicing
certificates of the persons concerned who are held responsible may, in addition, be
revoked according to law; and if a crime is constituted, criminal responsibility shall be
investigated according to law:

(1) failing to perform the tasks of prevention and control of infectious diseases in their own
units, of control of hospital infection and of prevention of infectious diseases within their
responsibility areas in accordance with relevant regulations;

(2) failing to report the epidemic situation of an infectious disease in accordance with
relevant regulations, or concealing the truth about, making a false report on or delaying
report on the epidemic situation of an infectious disease;

(3) when finding the epidemic situation of an infectious disease, failing to give infectious
disease patients or suspected infectious disease patients medical treatment, on-the-spot
rescue, or outpatient treatment or to transfer such patients to other hospitals for treatment
in accordance with relevant regulations, or refusing to accept transferred patients;

(4) failing to disinfect the places, objects and medical wastes of their own units that are
contaminated with the pathogens of infectious disease or give them innocent treatment in
accordance with relevant regulations;
(5) failing to disinfect medical apparatus and instruments in accordance with relevant
regulations, or reusing disposable medical apparatus, instead of destroying them in
accordance with relevant regulations;

(6) in the course of medical treatment, failing to preserve medical records and materials in
accordance with relevant regulations; and

(7) purposely divulging information and materials relating to personal privacy of an

infectious disease patient, a pathogen carrier, a suspected infectious disease patient, or
persons in close contact with such patients.

Article 70 Where blood collectors and suppliers fail to report the epidemic situation of
infectious diseases in accordance with relevant regulations, or conceal the truth about or
make a false report on or delay report on such situation, or fail to implement the relevant
regulations of the State, leading to the contracting of blood transmission diseases via blood
transfusion, the health administration departments under the people's governments at or
above the county level shall order them to rectify, criticize them in a circular and give them
a disciplinary warning; where their failures cause the spread and prevalence of infectious
diseases or other serious consequences, the persons in charge who should be held
responsible and the other persons who are directly responsible shall be demoted,
dismissed from office or discharged according to law, and the practicing certificates of the
blood collectors and suppliers may, in addition, be revoked according to law; and if a crime
is constituted, criminal responsibility shall be investigated according to law.

Any agency that illegally collects blood or gets other persons to sell their blood shall be
banned by the health administration department under the people's government at or
above the county level, its unlawful gains shall be confiscated and it, may, in addition, be
fined not more than RMB 100,000 yuan; and if a crime is constituted, criminal responsibility
shall be investigated according to law.

Article 71 Where frontier sanitation quarantine organs or animal epidemic prevention

organs fail to perform their duty of circulating a notice of the epidemic situation of infectious
diseases according to law, the departments concerned shall, within the scope of their
duties, order them to rectify and criticize them in a circular; where their failures cause the
spread and prevalence of the infectious diseases or other serious consequences, the
persons in charge who should be held responsible and the other persons who are directly
responsible shall be demoted, dismissed from office or discharged according to law; and if
a crime is constituted, criminal responsibility shall be investigated according to law.

Article 72 Where railway, communications and civil aviation services fail to give priority to
the transportation of the persons for handling the epidemic situation of an infectious
disease or of the medicines, medical apparatus and instruments for prevention and
treatment of the infectious disease in accordance with the provisions of this Law, the
departments concerned shall instruct it to rectify within a time limit and give them a
disciplinary warning; and where serious consequences are caused, the persons in charge
who should be held responsible and the other persons who are directly responsible shall
be demoted, dismissed from office or discharged according to law.

Article 73 Where a unit commits any of the following acts in violation of the provisions of
this Law, which leads to or may likely lead to the spread and prevalence of infectious
diseases, the health administration departments under the people's government at or
above the county level shall order them to rectify within a time limit, confiscate its unlawful
gains and may, in addition, impose a fine of not more than 50,000 yuan; if it has obtained a
license, the department that originally issued the license may suspend or revoke the
license according to law; and if a crime is constituted, criminal responsibility shall be
investigated according to law:

(1) for a drinking water supplier, failing to keep the drinking water supplied in conformity
with the sanitary standards and norms of the State;

(2) failing to keep the products relating to sanitary safety of drinking water in conformity
with the sanitary standards and norms of the State;

(3) failing to keep the disinfectant products used for prevention and treatment of infectious
diseases in conformity with the sanitary standards and norms of the State;

(4) selling or transporting the objects which are contaminated or are likely contaminated
with pathogens of infectious diseases in epidemic areas without having them disinfected;
and

(5) for a manufacture of biological products, failing to keep the blood products
manufactured in conformity with the quality standards of the State.

Article 74 Any unit that commits one of the following acts in violation of the provisions of
this Law, the health administration department under the local people's government at or
above the county level shall order it to rectify, criticize it in a circular and give it a
disciplinary warning; if it has obtained a license, the license may be suspended or revoked
according to law; if its act causes the spread and prevalence of an infectious disease or
other serious consequences, the persons in charge who should be held responsible and
the other persons who are directly responsible shall be demoted, dismissed from office or
discharged according to law, and the practicing certificates of the persons concerned who
are held responsible may, in addition, be revoked according to law; and if a crime is
constituted, criminal responsibility shall be investigated according to law:

(1) for a disease prevention and control institution, medical agency or unit engaged in
pathogenic organism experiments, failing to meet the requirements and technical
standards prescribed by the State and failing to keep strict control of the samples of
infectious disease pathogens in accordance with relevant regulations, thus causing
laboratory infection and the spread of pathogenic micro-organisms;

(2) in violation of the relevant regulations of the State, collecting, preserving, carrying,
transporting and using bacterial and virus strains of infectious diseases as well as the
samples of infectious diseases for testing; and

(3) for a disease prevention and control institution and medical agency, failing to comply
with the relevant regulations of the State, thus leading to the outbreak of blood
transmission diseases due to blood transfusion or the use of blood products.

Article 75 Where a unit sells or transports wild animals, domestic animals and fowls related
to infectious diseases common to human beings and animals without quarantine, the
animal husbandry and veterinary administration departments under the local people's
government at or above the county level shall order it to desist from such illegal act, and
impose on it an administrative penalty according to law.
Article 76 Where a unit, without sanitary investigation, constructs such large projects as
water conservancy, communications, tourism and energy projects in an area of a natural
focus of infection confirmed by the State or fails to take the necessary measures for
prevention and control of infectious diseases in accordance with the proposals of the
disease prevention and control institution, the health administration department under the
people's government at or above the county level shall order it to rectify within a time limit,
give it a disciplinary warning, and impose on it a fine of not less than 5,000 yuan but not
more than 30,000 yuan; and if it fails to comply at the expiration of the time limit, the said
department shall impose on it a fine of not less than 30,000 yuan but not more than
100,000 yuan, and may, in addition, request the people's government concerned, on the
strength of its functions and powers, to order discontinuation of construction or close the
area.

Article 77 Where a unit or individual violates the provisions of this Law, thus leading to the
spread and prevalence of infectious diseases or causing harm or property losses to
another person, it/he shall bear civil responsibility according to law.

Chapter IX Supplementary Provisions

Article 78 The meanings of the following terms used in this Law are:

(1) Infectious disease patients and suspected infectious disease patients are persons who
conform to the diagnostic standards for infectious disease patients and suspected
infectious disease patients, as provided for in the Diagnostic Standards for Infectious
Diseases Governed by the Provisions of the Law of the People's Republic of China on
Prevention and Treatment of Infectious Diseases promulgated by the health administration
department under the State Council.

(2) Pathogen carriers are persons who, infected with the pathogens of infectious diseases,
have no clinical symptoms but can discharge pathogens.

(3) Epidemiological investigation refers to investigation and research conducted among

groups of people on the geological distribution of diseases and health conditions as well as
the decisive factors in order to put forth disease prevention and control measures as well
as health care policies.

(4) Epidemic-stricken spots refer to smaller areas within which pathogens spread from the
source of infection or to a single focus of infection.

(5) Epidemic-stricken areas refer to the areas where pathogens can reach when they
spread after infectious diseases break out and prevail among groups of people.

(6) Infectious diseases common to human beings and animals refer to infectious diseases
which human beings and vertebrates commonly suffer from, such as plague, rabies
schistosomiasis.

(7) Natural focus of infection refers to an area where certain pathogens that may cause
infectious diseases to human beings exist and circulate over a long period of time among
wild animals in the natural world.

(8) Vector organisms refer to organisms that can transmit pathogens from human beings or
other animals to human beings, such as mosquitoes, flies and fleas.
 (9) Iatrogenic infection refers to infection caused by the transmission of pathogens in the
process of medical services.

(10) Hospital infection refers to infection which inpatients contract in hospitals, including
infection contracted during the period of hospitalization and infection contracted in hospital
but manifests itself after the patient is discharged from hospital, but excluding infection
which is contracted before hospitalization or is already in incubation period at the time of
hospitalization. Infection which hospital workers contract in hospital also belongs to hospital
infection.

(11) Laboratory infection refers to infection caused through contact with pathogens when
working laboratories.

(12) Bacterial and virus strains refer to bacterial and virus strains which may cause the
outbreak of the infectious diseases specified in this Law.

(13) Disinfection refers to the killing and elimination of pathogen microorganisms in the
environment by chemical, physical or biological methods.

(14) Disease prevention and control institutions refer to the disease prevention and control
centers engaged in disease prevention and control as well as the units engaged in
professional activities similar to those of the said institutions.

(15) Medical agencies refer to the agencies engaged in disease diagnosis and medical
treatment, which have obtained the practicing certificates of medical institutions in
accordance with the Regulations on Administration of Medical Institutions.

Article 79 Where there are no provisions in this Law for the control of foodstuffs, medicines,
blood, water, medical wastes and pathogenic microorganisms in the process of prevention
and control of infectious diseases, for epidemic prevention among animals and for frontier
health quarantine, the provisions of other relevant laws and administrative regulations shall
be applicable respectively.

Article 80 This Law shall go into effect as of December 1, 2004.

Abstract
The severe acute respiratory syndrome crisis exposed serious deficiencies in China's public
health system and willingness to report outbreaks of threats to public health. Consequently,
China may be one of the weak links in global preparedness for avian influenza. China's rural
health care system has been weakened by 20 years of privatization and fiscal decentralization.
China plays a huge role in the global poultry industry, with a poultry population of 14 billion
birds, 70%–80% of which are reared in backyard conditions. Although surveillance has been
strengthened, obstacles to the timely reporting of disease outbreaks still exist. The weakened
health care system prevents many sick people from seeking care at a health care facility, where
reporting would originate. Inadequate compensation to farmers for culled birds leads to
nonreporting, and local officials may be complicit if they suspect that reporting might lead to
economic losses for their communities. At the local level, China's crisis-management ability and
multisectoral coordination are weak. The poor quality of infection control in many rural facilities
is a serious and well-documented problem. However, traditions of community political
mobilization suggest that the potential for providing rural citizens with public health information
is possible when mandated from the central government. Addressing these issues now and
working on capacity issues, authority structures, accountability, and local reporting and control
structures will benefit the control of a potential avian influenza outbreak, as well as inevitable
outbreaks of other emerging infectious diseases in China's Pearl River Delta or in other densely
populated locations of animal husbandry in China.

The threat of an avian influenza pandemic is the next chapter in a story that began with the
severe acute respiratory syndrome (SARS) epidemic. The common thread of both epidemics
would be their likely origin in China. With SARS, the Chinese government went from being a
global pariah for its initial failure to alert the world about the outbreak, which resulted in a
worldwide epidemic, to being a global hero for successful containment. However, China's lack of
transparency at the outset of the SARS epidemic was troubling, and there is no guarantee that it
would not happen again.

Even before the global SARS epidemic in 2003, the threat of emerging infectious diseases
already had the world's attention. In 2003, the Institute of Medicine of the US National Academy
of Sciences issued a report, Microbial Threats to Health, that noted that, “in the highly
interconnected and readily traversed ‘global village’ of our time, one nation's problems soon
become every nation's problems”" [1, p. 1]. The rapid global response to the SARS epidemic
was impressive and, fortunately, succeeded in averting a worse outcome. This response was
possible because post—September 11 investments in global health-information systems,
surveillance, and rapid-response planning paid off. Strategies for infection control, as well as
therapeutic information, were quickly shared worldwide. The good news is that these already-
effective global infrastructures have been strengthened further since the SARS epidemic and
are being deployed to prepare for and control an outbreak of avian influenza.
Opinions differ about the reality of the threat of an avian influenza pandemic. Human deaths
have been confirmed in 12 countries, including some countries outside Asia, but the number of
cases of avian influenza in humans is still small, even though the mortality rate is high, at >50%.
No clusters of cases in humans in any country have been documented conclusively as being
caused by human-to-human transmission. Past influenza pandemics, such as that caused by
the influenza A(H1N1) virus in 1918–1919, resulted in large numbers of deaths, which were
likely caused by a combination of virus virulence and other factors not yet fully understood. One
factor leading to the high mortality rate was the unavailability of antibiotics at that time [2], which
resulted in deaths from secondary bacterial infections after acute viral illness [3]. Some public
health professionals suggest that the number of deaths during a similar epidemic today would
be unlikely to be so high, although the widespread use of antibiotics in poultry in southern China
and other parts of Asia may contribute to antibiotic resistance.

China may be one of the weak links in global preparedness for 2 main reasons: it lacks
transparency in acknowledging outbreaks, and its health care system is not up to the task of
putting in place systems to ensure preparedness or the capability to contain the epidemic if it
begins in China's rural areas. The SARS crisis exposed serious deficiencies in China's public
health system. Consequently, since then, strengthening China's public health system has
topped China's public policy agenda. The central government and the Chinese Communist
Party have made equity and social investments in rural health and education top priorities in
their agenda for a harmonious society [4]. The SARS crisis also highlighted the importance of
political will and national financial resources in the mobilization of public health action [5]. Are
enough resources and political accountability being mustered for avian influenza preparedness?
Is China's government and China's health system now prepared for controlling avian influenza?
What areas of the health system, including transparency in reporting outbreaks, must be
strengthened further so that the system is up to the urgent task of preparedness and rapid
response? This article provides a critical review of the major health-system and governance
challenges facing China's potential to respond to avian influenza and highlights areas that may
need strengthening.

Background on China's Health System

Over the past 50 years, China has achieved remarkable progress in improving the health of its
population. Life expectancy is >70 years, and the major causes of morbidity and mortality are
now noninfectious and chronic infectious diseases, rather than acute infectious diseases.
China's basic health infrastructure, put in place 30 years ago, consists of a 3-tiered medical
system in rural areas and corresponding structures in cities. Competent, trained health care
personnel staff this infrastructure, and many of them are trained vocationally in 3-year medical
colleges or by county health institutions and are certified to provide basic care at the local level.

China's health care system, however, has been seriously weakened by 20 years of relaxed
government support and inadequate regulation in the health sector, along with overall fiscal
decentralization. China's primary health care system was held up as a model at the time of the
call for “health for all by the year 2000” at the World Health Organization (WHO) conference in
Alma-Ata, Kazakhstan, in 1978. However, in 2000, China ranked 188 of 191 countries in terms
of fairness in financial contributions to health [6], and, in 2001, 21.6% of poor rural households
fell below the poverty line because of medical expenses. In China, the average cost of
hospitalization at the township or county level is approximately equal to the per capita annual
income of a rural farmer [7]. Health care is provided mainly on a fee-for-service basis at rural
health clinics, and most provided health care is curative.

China's problems are less related to infrastructure than to equity and affordability. Huge
disparities in health care investment and access exist between urban and rural areas and
between the developed eastern coastal part of the country and the more-underdeveloped west.
The health care system in rural areas has become a mainly privatized fee-for-service system,
with facilities maintained by the government but services and drugs provided for a fee and for
profit. Although many urban residents have some health care insurance to defray costs, there
was virtually no system of health care insurance in rural areas until recently. Preventive health
care services and health-education outreach have been seriously weakened by 20 years of
China's market-oriented economic policies [8]. Health care access in China today is determined
by wealth, with debt from a major illness identified as one of the major reasons for poor rural
households to drop below the poverty line. In 2005, China's own State Council published a
scathing report that castigated the state of China's health system, noting that 49% of the
population cannot afford to see a doctor when ill and that 30% are not hospitalized when
necessary [9]. This report prompted increased funding and attention to deficiencies and
inequities in China's rural health system. The central government and the Communist Party
have made equity and social investments in rural health care, as well as education, top priorities
in their agenda for a harmonious society [4].

In rural areas, the government is piloting a new system of health care insurance for major
medical expenses, but investment in basic disease prevention has yet to follow. For China's 150
million economic migrants, an increasingly large segment of the population that comprises the
urban poor, there is little to no coverage for seeking health care services. These huge numbers
of the rural and urban poor who cannot afford to seek care when ill represent a worrisome threat
to controlling avian influenza.

Although serious efforts are under way to revitalize health care financing and equity in rural
areas, the urgent and heavy requirements of avian influenza preparedness cannot wait until
these efforts are completed. Any epidemic is likely to take hold in China's poorer areas, where
there is only a limited amount of local financing for health care, which will create shortages of
trained staff and quality services, including standard infection- control measures, as a result of
chronic underfunding. In addition to institutional constraints on the horizontal collaboration
between different programs, especially between different government sectors (e.g., animal
husbandry and infectious diseases), there are a number of challenges facing the capacity of
China's health system to respond to avian influenza.

Decentralized Authority and Accountability for Disease Reporting

China's Law on Preventing and Treating Infectious Diseases, enacted in September 1989,
requires mandatory reporting of many infectious diseases. Between October 2005 and February
2006, China's Ministry of Agriculture, Ministry of Finance, and State Council published 15
regulations, guidelines, and policies related to avian influenza and disease prevention and
control, cost reimbursement during disease control, and financial assistance for poultry
production [10]. However, this clear legislation regarding mandatory disease reporting for
specified infectious diseases is hampered by a structure of decentralized authority that impedes
its realization. China's ability to respond to emergency disease outbreaks surely will be
complicated by decades of political decentralization and by its own governance system, which
will be compounded by weakness in the power and authority of the national Ministry of Health.

In 1978, China began fiscal decentralization from the national level to the provinces and from
the provinces to the counties. The new approach of “every tub on its own bottom” shifted major
financing for province-level government operations and services to the provinces themselves
and substantially reduced centralized transfers. Unfunded mandates (directives and policies)
are set at the level of the central government, but financing depends on local resources,
allocation, and priority setting. However, with privatization of the health care system that began
in the early 1980s and the focus on economic investment in infrastructure and industry, local
governments, especially poor ones, have greatly reduced investment in social sectors. Although
the government owns health care facilities, government contributions for health at the local level
are scant, and sometimes the only funds provided are for partial salary support, with nothing
allocated for public health programs. As a result, the focus of the delivery of health care services
in China is almost exclusively on the provision of curative services. User payment as a
percentage of health care spending has been rising steadily for 20 years, from 20% to 54% [11].

Moreover, the Ministry of Health is bureaucratically weak, and it is hard for it to mobilize other
ministries. This was a major problem during the SARS epidemic, because the Ministry of Health
did not have the authority or ability to require direct reporting from lower levels of government or
even from military hospitals. Provincial governments have greater control over provincial health
bureaus than does the Ministry of Health. The Ministry of Health has limited authority within any
particular province outside the Bureau of Heath or its associated Centers for Disease Control.
The Ministry of Health may formulate national policies, but these policies serve merely as
guidelines or unfunded mandates for the lower levels of government, which must generate and
allocate the funding needed to support their implementation. This weakness limits the ability of
the Ministry of Health to manage health crises.

Moreover, health resources in China are managed by many sectors, and coordination is difficult
if not impossible, further complicating any urgent crisis-management situation. For example, in
addition to the more-general functions of the Ministry of Health, numerous other ministries and
departments are involved in health-related matters. The National Development Research Center
controls health infrastructure and financing, the Ministry of Finance controls routine budgets and
national programs, the State Food and Drug Administration controls pharmaceuticals, the
Ministry of Labor and Social Security deals with basic medical insurance for urban employees,
and the Ministry of Civil Affairs handles medical financial assistance to the poor. Provincial
control over financing, personnel decision making and allocation, and new initiatives within each
province complicate coordination and accountability even more. In 2005, the Minister of Health,
Gao Qiang, identified key healthsystem challenges facing China, and the need for a health
emergency—response network was at the top of the list.

China as the Incubator for a Global Epidemic of Avian Influenza

Recent events related to the global avian influenza threat included a massive dying off of >6000
wild migratory birds in the Qinghai Lake nature reserve in northwestern China in April 2005.
Following this, the number of countries reporting disease outbreaks due to avian influenza
A(H5N1) virus increased dramatically through the end of 2006, with 55 countries reporting
outbreaks of H5N1 virus infection in wild birds and/or poultry. China has had several confirmed
cases of infection in humans; the first 2 were reported in November 2005.

It is not surprising that the current culprit in the global avian influenza threat is likely to have
originated in China. The H5N1 virus was first isolated in China in 2003 from diseased pigs on
farms in southern China [12]. This was the first documented infection of pigs by any H5 subtype
of avian influenza virus. Historically, densely populated southern China has been a breeding
ground for new influenza viruses, because of the large numbers of animals and people living in
close proximity; the ubiquity of backyard animal husbandry of pigs, chickens, and ducks; and
the presence of live-animal markets. All these factors were implicated in the SARS outbreak of
2003. However, other factors also are at play in the current avian influenza threat. China plays a
large role in the global poultry industry and, according to the WHO, has a poultry population of
14 billion at any one point in time, 70%–80% of which is reared in backyard conditions [13].
Individual poultry farmers have little incentive to report sick birds.

Avian Influenza Preparedness and the Requirements for an Effective Response

The WHO has taken a lead role in defining the steps that will be required for the prevention of
an avian influenza epidemic and has been working with countries to put in place systems to
ensure early identification and containment. These steps include (1) recognizing the possible
event of an avian influenza outbreak through detection of clusters of cases, investigation of
suspected clusters, and reporting of early signals to the scientific community for comparative
studies of virus isolates and in-depth investigation of sources of reservoirs of the virus; (2)
verifying an outbreak event and then making an assessment of that event and putting in place
immediate infection-control measures; and (3) containing the outbreak event through a rapid
response that entails active case finding and contact tracing and the administration of antiviral
drugs. If necessary, exceptional measures such as quarantine, the wider prophylactic
administration of drugs, and social distancing measures such as staying home from work and
home schooling should be used.
Ideally, all countries should put in place systems to successfully implement these steps. To do
this, however, countries must invest in building the institutional and operational capacity to
reach rural areas, where an outbreak is likely to begin. In addition, there is a need to create
multisectoral, integrated authority and control systems that can be activated if an outbreak is
detected or an epidemic begins.

Prior to an outbreak, however, there is a critical need for the institutional and operational
capacity to implement educational outreach aimed at prevention and containment, through a
focus on birds and poultry-industry practices, to minimize the opportunity for the avian influenza
virus to mutate into a type that can easily infect humans (T. Kane, personal communication).
The widespread mobilization of people (especially rural farmers) is needed to reduce practices
that increase the odds of an epidemic and to prepare the population for what to do if an
outbreak or epidemic occurs.

China's Avian Influenza Preparedness: Key Issues

Full surveillance, timely reporting, and transparency in reporting avian influenza cases in birds
and humans are very important. Containment and effective quarantine and culling after a
reported outbreak also are essential. In addition, the need for communication about basic
hygiene practices for humans and for the poultry and animals in their care are key prevention
measures. Is China up to the task?

China's surveillance system has been strengthened during the post-SARS era, which is perhaps
one of the biggest lessons learned from that mishandled epidemic. Both the US Centers for
Disease Control and Prevention and the WHO's Beijing office have been working closely with
the Chinese Ministry of Health and Centers for Disease Control during the post-SARS era to
strengthen and computerize routine disease reporting of many infectious diseases, in
accordance with China's newly strengthened Law and Regulations on Infectious Disease
Reporting. By mid-2005, all 2800 counties in China had direct Internet connections to a Ministry
of Agriculture monitoring system, and 93% of county or higher-level hospitals and 43% of
township hospitals had direct connections to the diseasereporting system of China's Centers for
Disease Control [10]. The WHO is working with China to develop an integrated surveillance
system, to strengthen laboratory diagnostic capacity, and to create a reporting system that will
allow epidemiological, clinical, and laboratory information from both human and animal
surveillance, the environment, and other sectors to be analyzed and shared with decision
makers in all sectors. The WHO and China also are working on strengthening early response to
an outbreak event and on fostering better collaboration between the animal sector and the
health sector and are working with health institutions on the surveillance and control of facility-
acquired infections. China's capacity to accomplish these goals with its current infrastructure is
high. The communications infrastructure and the designated personnel exist throughout the 3-
tiered medical system, down to the county level. China's laboratory and science infrastructure,
pharmaceutical research, and biotech sector are strong. Owing to the political will that resulted
from the acknowledgement of failures in the timely reporting of SARS cases, there now exists a
strong mandate, as well as financial support, for a strong diseasesurveillance infrastructure for
avian influenza.

However, the challenges for surveillance are great, and a number of factors might interfere with
the verification of disease events in both birds and humans. Farmers and government officials
have economic reasons for not reporting suspected avian influenza outbreaks in an area. If the
government does not properly compensate farmers for culled birds, farmers may hide the birds.
The weakened and privatized health care system prevents many sick people from seeking care
at a health care facility, where reporting would originate (i.e., at the township level). Moreover,
local officials, who control the work of the sectors under their jurisdiction, may hide cases of
disease if they suspect that reporting might result in economic losses for their communities.
Many suspect that unreported deaths of fowl have occurred on a large scale in many places in
China, because similar events among poultry have occurred across China's borders, in Hong
Kong, Vietnam, and other neighboring countries, with no plausible explanation other than an
origin in China [14].

Moreover, China is still poorly prepared for a rapid response to an outbreak event. Its crisis-
management capability and ability to coordinate different agencies, such as the Ministry of
Agriculture and the Ministry of Health, is weak, especially at the local level. During the SARS
epidemic, the Ministry of Health was unable to put in place the needed interventions at either
the national or local level. To support the recently strengthened response to AIDS, a new State
Council Working Committee on AIDS was created to manage the needed multisectoral
collaborations [15], but no such similar agency exists for a potential outbreak of a communicable
disease. The weakness of the health sector in mobilizing other sectors must be addressed and
an emergency-response agency and plan formulated, to avoid the problems that occurred
during the early response to SARS. For example, an obvious failure in response to SARS
occurred when millions of migrants fled Beijing because they feared being unreasonably
quarantined without concern for their personal rights. Fortunately, this mass exodus did not
result in a widespread rural epidemic, owing to a combination of luck and strong, albeit belated,
local action [5]. Rural communities in China quickly built local infectious-disease hospitals
modeled after the SARS hospital that was built in Beijing. Staff was seconded from all health
institutions in the county, and training in infection-control measures, including quarantine and
reporting procedures, was provided. These hospitals still exist in rural communities in China and
would likely be mobilized during another infectious disease emergency. In the event of a much
more contagious influenza epidemic, stronger measures to ensure quarantine and social
distancing would be needed.

However, the challenges for surveillance are great, and a number of factors might interfere with
the verification of disease events in both birds and humans. Farmers and government officials
have economic reasons for not reporting suspected avian influenza outbreaks in an area. If the
government does not properly compensate farmers for culled birds, farmers may hide the birds.
The weakened and privatized health care system prevents many sick people from seeking care
at a health care facility, where reporting would originate (i.e., at the township level). Moreover,
local officials, who control the work of the sectors under their jurisdiction, may hide cases of
disease if they suspect that reporting might result in economic losses for their communities.
Many suspect that unreported deaths of fowl have occurred on a large scale in many places in
China, because similar events among poultry have occurred across China's borders, in Hong
Kong, Vietnam, and other neighboring countries, with no plausible explanation other than an
origin in China [14].

Moreover, China is still poorly prepared for a rapid response to an outbreak event. Its crisis-
management capability and ability to coordinate different agencies, such as the Ministry of
Agriculture and the Ministry of Health, is weak, especially at the local level. During the SARS
epidemic, the Ministry of Health was unable to put in place the needed interventions at either
the national or local level. To support the recently strengthened response to AIDS, a new State
Council Working Committee on AIDS was created to manage the needed multisectoral
collaborations [15], but no such similar agency exists for a potential outbreak of a communicable
disease. The weakness of the health sector in mobilizing other sectors must be addressed and
an emergency-response agency and plan formulated, to avoid the problems that occurred
during the early response to SARS. For example, an obvious failure in response to SARS
occurred when millions of migrants fled Beijing because they feared being unreasonably
quarantined without concern for their personal rights. Fortunately, this mass exodus did not
result in a widespread rural epidemic, owing to a combination of luck and strong, albeit belated,
local action [5]. Rural communities in China quickly built local infectious-disease hospitals
modeled after the SARS hospital that was built in Beijing. Staff was seconded from all health
institutions in the county, and training in infection-control measures, including quarantine and
reporting procedures, was provided. These hospitals still exist in rural communities in China and
would likely be mobilized during another infectious disease emergency. In the event of a much
more contagious influenza epidemic, stronger measures to ensure quarantine and social
distancing would be needed.

Other significant concerns are the limited potential for proper case management and
shortcomings in infection-control practices in hospitals. By some estimates, >70% of the health
care visits in China that do occur (many individuals do not seek care at all) occur at village-level
clinics. These clinics are staffed by village-level rural doctors and doctors of traditional medicine.
Although they are certified to practice and capable of dealing with common illnesses and first
aid, these doctors may not be capable of recognizing and dealing with the early symptoms of
avian influenza during an epidemic. However, as a step in the right direction, rural doctors now
are required to report, by telephone, to township health centers all cases of suspicious
pneumonia or serious influenza. Infection-control measures in many rural facilities leave much
to be desired, and facility-acquired infection is a serious and well-documented problem in China.

The capacity for outreach to and mobilization of the population threatens to be a major limitation
of any effort at avian influenza preparedness. China's outreach system for public health
information has been seriously weakened by the privatization of the rural health care system,
which has driven service providers to focus on income-earning curative care. As a result, the
capacity for health education (in terms of human resources and responsible institutions) has
been seriously weakened. However, a tradition of community political mobilization suggests that
the potential for reaching rural citizens with public health information exists when mandated
from the central government. China's ability to mobilize its population has been an enduring
feature of its single-party system of governance for the past 50 years. Early patriotic health
campaigns were responsible for important public health achievements during the “barefoot
doctor” era (i.e., the 1960s and 1970s, until the end of the Cultural Revolution). The patriotic
health campaign was resurrected during the SARS epidemic, and its success in mobilizing and
reaching the public with critical prevention information was impressive. In the event of an avian
influenza outbreak, it could be used to reach rural citizens with communications about behavior
change and hygiene. An important question is why it is not already being used to its fullest
extent to deal with the repeated outbreaks of epidemics among poultry, to reach out to the rural
population to communicate the necessary hygiene measures mentioned above and, thus,
minimize the potential of infection in humans? In this area, China's preparedness for avian
influenza could easily be strengthened.

Another area of concern is China's veterinary surveillance and its ability to control its
widespread live-animal markets or to apply restrictions and controls to its backyard poultry- and
duck-raising industries. A matter of some concern is the fact that, in parts of Asia, mammals that
were thought to not be susceptible to H5N1 virus infection have developed disease (WHO,
unpublished data) [12]. Live-animal markets were implicated in the emergence of the SARS
epidemic, when the civet cat, which is sold in live-animal markets in southern China, was
identified as the likely source of the mutated human SARSassociated virus. Many of the live-
animal markets were shut down in the immediate aftermath of the SARS epidemic, but many
have reopened or operate behind closed doors, catering to traditions for food preparation and to
traditional health beliefs about the consumption of certain foods. How these markets are
monitored is far from clear, and the possibility of animal-to-human transmission of infection
remains high. A recent analysis pointed to direct and indirect factors that facilitate the spread of
avian influenza virus and discussed 8 highrisk farming practices related to poultry and farm
animals, 5 unsafe poultry-transport practices, and 11 high-risk practices at “wet” markets (i.e.,
live-animal markets) that are common in China, Vietnam, and other Asian countries.

Complicating veterinary infection-control measures is the fact that the Chinese government has
chosen chicken immunization, rather than restrictions on backyard poultry- and duck-raising that
would minimize the possibility of wild fowl infecting poultry and duck flocks. After confirmation of
a human case of H5N1 virus infection in Anhui Province, the provincial government decreed that
all backyard poultry must be kept in cages, but this localized response was neither sufficient to
deal with the problem nor easy to enforce. It is difficult to ensure the implementation and
monitoring of restrictions to prevent the intermingling of these 2 populations in China's backyard
ponds. Moreover, there are questions about the effectiveness of the vaccination of poultry.
China has vaccinated 120% of its chickens [13], and many suspect that infection control through
poultry vaccination is only mildly successful and may be leading to the selection of more-virulent
viruses. A recent article in the Proceedings of the National Academy of Sciences of the United
States (PNAS) [16] suggested that a more dangerous “Fujian-like” variant of the H5N1 virus had
been strengthened as a result of poultry vaccination (a response noted that 95% of domestic
birds had been vaccinated [17]). The Chinese government vehemently denied this suggestion
[18], but doubt remains. The WHO noted that its ability to assess the accuracy of the PNAS
report had been hampered by China's refusal to share avian influenza virus samples with the
international scientific community, which uses such samples for the development of human
avian influenza vaccines [17]. China's resistance to sharing information and virus samples with
Hong Kong and the United States impedes efforts to document the mutations occurring in the
virus in cases of infection in both birds and humans. China claimed that such virus samples had
been misused previously but agreed to share 20 virus samples from 2004 and 2005 with the
WHO, to support its claim that no new strain of H5N1 virus had emerged in southern China [17].
If an avian influenza pandemic among humans were to emerge, its likely source would be
China. The good news is that China has a reasonably good health infrastructure and a
demonstrated ability to mobilize for action, given the political authority of its single-party system
of governance, as proved by its quick turnaround during the SARS epidemic. However, China's
crisis-management procedures for epidemic threats currently are very weak, its authority
structures are unclear and potentially dysfunctional, and it is difficult, if not impossible, for the
Ministry of Health to exercise local control, as a result of decentralized financing and authority.
Moreover, China has a long history of and an incentive system that leads to the concealment of
sensitive and negative information, by lower levels of government from higher levels, which
does not bode well for the timely reporting and containment of disease outbreaks among poultry
and humans. Many incentives exist for concealment, but the main incentive is a supervision and
promotion system based on the achievement of targets and an expectation of negative
consequences for the reporting of bad news. The example of the response to SARS shows that
these problems can be overcome with an infusion of strong political will. However, given the
worldwide importance of preventing avian influenza viruses from mutating to adapt to human
hosts, this political will should be mobilized now, not after an epidemic begins, since
preparedness can help prevent the virus reassortment that happens in the type of backyard-
farming conditions present in rural China today. Moreover, it is essential that Chinese scientists
and officials exhibit greater transparency in sharing virus information, so that global efforts to
develop influenza vaccines are as efficient and effective as possible. Addressing these issues
now and working on issues related to institutional and operational capacity; authority structures;
accountability; and more local surveillance, reporting, and infection-control structures will benefit
the response to not only a potential avian influenza outbreak but also the inevitable future
outbreak of another emerging infectious disease that will be likely to originate in China's Pearl
River Delta or in other densely populated locations of animal husbandry in China.

Article 1 This Law is formulated in order to prevent infectious diseases from spreading into or
out of the country, to carry out frontier health and quarantine inspection and to protect human
health.

Article 2 Frontier health and quarantine offices shall be set up at international seaports, airports
and ports of entry at land frontiers and boundary rivers (hereinafter referred to as "frontier
ports") of the People's Republic of China. These offices shall carry out the quarantining and
monitoring of infectious diseases, and health inspection in accordance with the provisions of
this Law.

Health administration departments under the State Council shall be in charge of frontier health
and quarantine work throughout the country.

Article 3 Infectious diseases specified in this Law shall include quarantinable infectious
diseases and infectious diseases to be monitored.

Quarantinable infectious diseases shall include plague, cholera, yellow fever and other
infectious diseases determined and announced by the State Council.

Infectious diseases to be monitored shall be determined and announced by health

administration departments under the State Council.

Article 4 Persons, conveyances and transport equipment, as well as articles such as baggage,
goods and postal parcels that may transmit quarantinable infectious diseases, shall undergo
quarantine inspection upon entering or exiting the country. No entry or exit shall be allowed
without the permission of a frontier health and quarantine office. Specific measures for
implementation of this Law shall be stipulated in detailed regulations.

Article 5 On discovering a quarantinable infectious diseases or a disease suspected to be

quarantinable, a frontier health and quarantine office shall, in addition to taking necessary
measures, immediately notify the local health administration department; at the same time, it
shall make a report to the health administration department under the State Council by the
most expeditious means possible, within 24 hours at the latest. Post and telecommunications
departments shall give priority to transmissions of reports of epidemic diseases.

Messages exchanged between the People's Republic of China and foreign countries on the
epidemic situation of infectious diseases shall be handled by the health administration
department under the State Council in conjunction with other departments concerned.
Article 6 When a quarantinable infectious disease is prevalent abroad or within China, the State
Council may order relevant sections of the border to be blockaded or adopt other emergency
measures.

Chapter II Quarantine Inspection

Article 7 Persons and conveyances on entering the country shall be subject to quarantine
inspection at designated places at the first frontier port of their arrival. Except for harbour pilots,
no person shall be allowed to embark on or disembark from any means of transport and no
articles such as baggage, goods or postal parcels shall be loaded or unloaded without the
health and quarantine inspector's permission. Specific measures for the implementation of this
Law shall be stipulated in detailed regulations.

Article 8 Persons and conveyances exiting the country shall be subject to quarantine inspection
at the last frontier port of departure.

Article 9 When foreign ships or airborne vehicles anchor or land at places other than frontier
ports in China, the persons in charge of the ships or airborne vehicles must report immediately
to the nearest frontier health and quarantine office or to the local health administration
department. Except in cases of emergency, no person shall be allowed to embark on or
disembark from the ship or airborne vehicle, and no articles such as baggage, goods and
postal parcels shall be loaded or unloaded without the permission of a frontier health and
quarantine office or the local health administration department.

Article 10 When a quarantinable infectious disease, a disease suspected to be quarantinable

or a death due to an unidentified cause other than accidental harm is discovered at a frontier
port, the relevant department at the frontier port and the person in charge of the conveyance
must report immediately to the frontier health and quarantine office and apply for provisional
quarantine inspection.

Article 11 According to the results of an inspection made by quarantine doctors, the frontier
health and quarantine office shall sign and issue a quarantine certificate for entry or exit to a
conveyance either uncontaminated by any quarantinable infectious disease or already given
decontamination treatment.

Article 12 A person having a quarantinable infectious disease shall be placed in isolation by the
frontier health and quarantine office for a period determined by the results of the medical
examination, while a person suspected of having a quarantinable infectious disease shall be
kept for inspection for a period determined by the incubation period of such disease.

The corpse of anyone who died from a quarantinable infectious disease must be cremated at a
nearby place.

Article 13 Any conveyance subject to entry quarantine inspection shall be disinfected, deratted,
treated with insecticides or given other sanitation measures when found to be in any of the
following conditions:

(1) having come from an area where a quarantinable infectious disease is epidemic;

(2) being contaminated by a quarantinable infectious disease; or

(3) revealing the presence of rodents which affect human health or insects which are carriers of
disease.

Apart from exceptional cases, when the person in charge of the foreign conveyance refuses to
allow sanitation measures to be taken, the conveyance shall be allowed to leave the frontier of
the People's Republic of China without delay under the supervision of the frontier health and
quarantine office.

Article 14 A frontier health and quarantine office shall conduct sanitation inspections and
disinfect, derate, treat with insecticides or apply other sanitation measures to articles such as
baggage, goods and postal parcels that come from an epidemic area and are contaminated by
a quarantinable infectious disease or may act as vehicle of a quarantinable infectious disease.

A consignor or an agent for the transportation of a corpse or human remains into or out of the
country must declare the matter to a frontier health and quarantine office; transport thereof, in
either direction across the border, shall not be allowed until sanitary inspection proves
satisfactory and an entry or exit permit is given.

Chapter III Monitoring of Infectious Diseases

Article 15 Frontier health and quarantine offices shall monitor persons on entry or exit for
quarantinable infectious diseases and shall take necessary preventive and control measures.

Article 16 Frontier health and quarantine offices shall be authorized to require persons on entry
or exit to complete a health declaration form and produce certificates of vaccination against
certain infectious diseases, a health certificate or other relevant documents.

Article 17 For persons who suffer from infectious diseases to be monitored, who come from
areas in foreign countries where infectious diseases to be monitored are epidemic or who have
close contact with patients suffering from infectious diseases to be monitored, the frontier
health and quarantine offices shall, according to each case, issue them medical convenience
cards, keep them for inspection or take other preventive or control measures, while promptly
notifying the local health administration department about such cases. Medical services at all
places shall give priority in consultation and treatment to persons possessing medical
convenience cards.

Chapter IV Health Supervision

Article 18 Frontier health and quarantine offices shall, in accordance with State health
standards, exercise health supervision over the sanitary conditions at frontier ports and the
sanitary conditions of conveyances on entry or exit at frontier ports. They shall:

(1) supervise and direct concerned personnel on the prevention and elimination of rodents and
insects that carry diseases;

(2) inspect and test food and drinking water and facilities for their storage, supply and delivery;

(3) supervise the health of employees engaged in the supply of food and drinking water and
check their health certificates; and

(4) supervise and inspect the disposal of garbage, waste matter, sewage, excrement and
ballast water.
Article 19 Frontier health and quarantine offices shall have frontier port health supervisors, who
shall carry out the tasks assigned by the frontier health and quarantine offices.

In performing their duties, frontier port health supervisors shall be authorized to conduct health
supervision and give technical guidance regarding frontier ports and conveyances on entry or
exit; to give advice for improvement wherever sanitary conditions are unsatisfactory and factors
exist that may spread infectious diseases; and to coordinate departments concerned to take
necessary measures and apply sanitary treatment.

Chapter V Legal Liabilities

Article 20 A frontier health and quarantine office may warn or fine, according to the
circumstances, any unit or individual that has violated the provisions of this Law by committing
any of the following acts:

(1) evading quarantine inspection or withholding the truth in reports to the frontier health and
quarantine office;

(2) embarking on or disembarking from conveyances upon entry, or loading or unloading

articles such as baggage, goods or postal parcels, without the permission of a frontier health
and quarantine office and refusing to listen to the office's advice against such acts.

All fines thus collected shall be turned over to the State Treasury.

Article 21 If a concerned party refuses to obey a decision on a fine made by a frontier health
and quarantine office, he may, within 15 days after receiving notice of the fine, file a lawsuit in a
local people's court. The frontier health and quarantine office may apply to the people's court
for mandatory enforcement of a decision if the concerned party neither files a lawsuit nor obeys
the decision within the 15-day term.

Article 22 If a quarantinable infectious disease is caused to spread or is in great danger of

being spread as a result of a violation of the provisions of this Law, criminal responsibility shall
be investigated in accordance with Article 178 of the Criminal Law of the People's Republic of
China.

Article 23 The personnel of frontier health and quarantine offices must enforce this Law
impartially, perform duties faithfully and promptly conduct quarantine inspection on
conveyances and persons upon entry or exit. Those who violate the law or are derelict in their
duties shall be given disciplinary sanctions; where circumstances are serious enough to
constitute a crime, criminal responsibility shall be investigated in accordance with the law.

Chapter VI Supplementary Provisions

Article 24 Where the provisions of this Law differ from those of international treaties on health
and quarantine that China has concluded or joined, the provisions of such international treaties
shall prevail, with the exception of the treaty clauses on which the People's Republic of China
has declared reservations.

Article 25 In cases of temporary contact between frontier defence units of the People's
Republic of China and those of a neighbouring country, of a temporary visit at a designated
place on the frontier by residents of the border areas of the two countries and of entry or exit of
conveyances and persons of the two sides, quarantine inspection shall be conducted in line
with the agreements between China and the other country or, in the absence of such an
agreement, in accordance with the relevant regulations of the Chinese Government.

Article 26 Frontier health and quarantine offices shall charge for health and quarantine services
according to State regulations.

Article 27 The health administration department under the State Council shall, in accordance
with this Law, formulate rules for its implementation, which shall go into effect after being
submitted to and approved by the State Council.

Article 28 This Law shall go into effect on May 1, 1987. On the same day, the Frontier Health
and Quarantine Regulations of the People's Republic of China promulgated on December 23,
1957, shall be invalidated.