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OFFICE ES WE VISITED During the e week, we had d meetings with leade ers from the following Chinese in nstitutions.

Health Em mergency Response Office (H HERO) at the Chinese C Ministry o of Health (MO OH) This office e is responsible e for policymakking related to public health eve ents. HERO hass 4 divisions: (1) emerge ency preparedness; (2) emergenccy response; (3)) surveillancce, prewarning, and communiccations; and (4)) a comprehe ensive division for f laws, regulation ns, planning, an nd coordinatiion.

Office off Disease Con ntrol and Emergen ncy Response (ODCER) within the e Chinese Ce enters for Disease C Control China’s CD DC, formed in early 2002, has appro oximately 3,000 staff. It provides ttechnical suppo ort and reports to the MOH. OD DCER’s mission includes countryywide surveillancce of infectiouss diseases, implemen ntation of early--warning systems, field investigation, and developm ment of technica al guideliness for disease prrevention and contro ol of emerging g and reemergin ng infectious diiseases.

Institute of Microbiolo ogy in the Chinese A Academy of Sciences S (CAS) This is the e leading micro obiological institute in n China, with approxima ately 430 facultty and staff.

The CAM MS-Fondation n Mérieux Lab withiin the Chinese e Institute of Pathog gen Biology This institu ute was formed d after SARS and plays an important role r in research for pathogen detection and identiification.

Trip p Reportt Tom Inglesby I and d Anita Cice ero China, like the U.S.., has had to w a range of o disease cope with outbre eaks in recentt years and contin nues to prepare for future emerg ging and reem merging infectious disease threats. t Over the pa ast few years, the Center fo or Bioseccurity has ben nefited greatl y from policy p discusssions with government officials and overnment lea aders in othe r nongo countrries, including g Canada, Israel, the United Kingdom, K and d CCampus of the Insttitute of Microbiolo ogy, Beijing  e. We were eager to be France able to o connect witth Chinese exxperts and leaarn from them m about disea ase detection and co ontrol, as well as healthcarre preparedness and comm munity resilience in the world’’s most populous country. ed to Beijing w with the goal of forging ne ew relationships On July 10-18, 2011, we travele articipating in n a series of in nformative exxchanges with h Chinese public health and pa officials and infectio ous disease sscientists who o have respon nsibilities relatted to the wing: follow      

Planning and re esponse to in nfectious dise ease epidemiccs (eg, pande emic flu, H5N1, ons from SAR RS and H1N1) future pandemics, and lesso Diisease surveillance for earlly warning of outbreaks Diisease contro ol and contain nment efforts De evelopment of o vaccines an nd mediciness for emerging g infectious d diseases Ho ospital preparedness for p public health e emergencies Biosafety and biosecurity b

er’s independ dent analysis of U.S. In our various meettings, we sha red the Cente es, and our ho osts government and private sector aapproaches tto these issue e in thesse areas. The trip exceede ed our high exxpectations fo or a described China’s efforts ble exchange of informatio on on these and other topics. valuab t U.S. Emb bassy in Beijin ng, Melinda Frost, Health C Communicatio ons Officer in n From the the CD DC Section, and a Elizabeth Yuan, HHS H Health Attaché, provided a useful orientation for us and helped to o identify important Chinesse leaders and institutions erson, both o our Chinese h hosts and U.S. Embassy contacts were in this field. To a pe ous and generous with the ir time. gracio

Obs ervations and Highlig ghts ay be interested in U.S.–Ch hina For those who ma actions in pub blic health and the life scie ences, we intera offer the following g observation ns from our triip, with the hope e that they ma ay increase un nderstanding, diminish misperceptions, and encourage future consstructive collaborations.

Life Sciences Are A On the e Rise in China Prom minent Chinesse scientists are returning to t China from labs in the U.S. and elsew where in the world. w The ntists we met seemed quite e positive abo out U.S. scien science e and their colleagues and experie ences in the United States. They arre also eager to be part n wave of the new of Chinese science efforts, which are a respectted, wellfunded,, and a Anita Ciceero, Tom Inglesby, Dr. Gao Xing, U.S.  CDC; C CDC‐GAP China Offfice, Emergency  named priority in Prepareedness and Respon nse Coordinator China’s current “Five-Year Plan.” This Plan guides economic e devvelopment iniitiatives c Plan over a 5-year period, and the current hasizes, amon ng other initia atives, an incrrease in emph spending on resea arch and development to 2.2% of oney is not GDP by 2015. As one scientist told us, “Mo oblem now fo or us—if we ha ave a good id dea, it gets a pro funde ed.” nt in the scien nces and This sstrategic capital investmen publiic health is tangible, especcially with the e current build ding boom in the science sector. s New state-ofthe-a art buildings and a laboratorries are finishe ed, under consttruction, or planned for co onstruction ovver the next year on the beautiful b campuses at the China C, the Institute e of Microbiollogy of the Chinese CDC Acad demy of Scien nces, and the CAMS-Fonda ation Mérie eux Lab and the t greater In nstitute of Patthogen Biolo ogy, among other o places. The T design off the camp puses and the eir buildings seems s though htful, well plann ned, and intended to acco ommodate futture grow wth.

We w were told that th he presid dent of the Chine ese Acade emy of Sciencces has been known to he slogan, use th “Tiny bugs, high Dr. Yiping Zhu, Associate Professor, Chinese Academy  u, Professor, CAS; of Science ((CAS); Dr. Frank Liu techn ology, big  Anita Cicero, and Tom m Inglesby  busine ess.” The acade emy, which now ccomprises 103 3 institutes, m more than 100 0 national key y laboraatories, and m more than 54,,000 staff, is e expected to grow to 70,000 staaff within 5 ye ears. There se eemed to be purpose in go overnment-funded science e a stro ng sense of p projeccts and a drivve to use the latest techno ology, invest in advvance development, and ccommercialize e new diagn nostic tools, vaccines, and medicines to o address a eases. wide range of dise

Chinese CCenter for Disease Control and Preveention

We to oured the lab of Dr. Frank Liu at the Insstitute of Micro obiology and learned abou ut the latest re esearch he was d doing on avian n influenza an nd the develo opment of new aantivirals. On the walls outside his and o other labs are e poste ers in English and Mandarin n exhibiting w work from the e ute published d in Science, N Nature, Cell, NEJM, institu Proce eedings of the e National Accademy of Sciiences, and other well-known journals. Therre was a clearr interest in national collab boration in a number of the intern organ nizations we vvisited, with d dedicated offices set up to facilitaate such exch hanges.

China Triip Report, page 2

China a Trip Report: Observat O tions and Highl ights

Advvances in Public Health Prepare edness— the SARS Effect In the e area of pub blic health pre eparedness, the 2003 SARS S outbreak wa as a turning point p for China. We heard d repeatedly about how th he challengess of SARS have led to major concerted effforts to impro ove and r effo orts for mode ernize preparredness and response infecctious disease e outbreaks. Following F SAR RS, the Chine ese government set up a whole w new syystem for emerrgency preparedness and response, wh hich included prepared dness for natu ural disasters,, public a accidentss. The healtth events, soccial security, and Minisstry of Health is the lead ministry m for pu ublic health events. S under-score ed the importance of evide ence-based SARS decission making in controlling outbreaks. In nfectious disea ase laboratoryy capacity gre ew from apprroximately 80 labs to the app proximately 400 labs that exist e today. a’s CDC and other scientiffic and labora atory China resou urces in the country play im mportant role es in utiliziing technolog gies to provid de the MOH and a others with the scientific facts, data, and a expert jud dgments e decisions fo or outbreak co ontrol and necessary to make onse. In the event e of an ep pidemic, MOH H HERO respo would plan to gatther as much information and a ence as possible, both from m the China CDC, C evide laborratories within n the CAS, an nd, as approp priate, the World Health Org ganization. It would w also co onvene pert clinicianss, sociological experts, meettings with exp and o others to asse ess the outbre eak and identtify options for m managing it.

CDC is a China’s C relativelyy young institutio on that has matured d at a rapid pace, an nd its leaders are eager to e its advance capabilitties even more. They invite collaborration with the U.S. CDC, and it dent how was evid much re espect China’s CDC and Dr. Fengg Zijian, China CDCC, ODCER, Executivve  the U.S. CDC have Director, r, China‐U.S. Collabborative Program on  h other. Their Emergingg Infectious Diseasse and Tom Inglessby  for each scientistts are collab borating on in nitiatives rang ging from HIV V and TB to influe nza, emerging infectious d diseases, and d a number problems. The ere is also a cclose and of chrronic health p effecttive cooperation between the U.S. and China CDCs in the e Field Epidem miology and T Training Prog gram (FETP), h provides hig gh-caliber epiidemiology trraining to which Chine ese health officials. eng Zijian, an accomplishe ed public health scientist Dr. Fe and p published scholar on epide emic response e, is Director of OD DCER and Exe ecutive Directtor of the Chiina-U.S. Collab borative Prog gram on Emerrging Infectio ous Disease. He sp pent nearly a yyear—including much of the period of the 20 009 H1N1 ressponse—in A Atlanta working side by side w with his U.S. C CDC counterp parts and sharing ideas and b best practices. His deputy d director will a also take part in n this exchange at the U.S S. CDC. Anoth her marker off the success a and closeness of the collab boration betw ween the U.S. and China C CDCs was the caree r path of one e of our hosts,, Dr. Gao Xing, the gency Preparredness Coorrdinator at the e U.S. CDC Emerg in Beijjing. An acco omplished and d published p physician and sccientist in his own right, he e had earlier worked with the C hina CDC and d now is an im mportant stafff member of eijing. His invvolvement in b both the U .S. CDC in Be nizations clearrly helps to fa acilitate the good working organ relatio onship betwe een the two organizations.

D Dr. Feng Zijian and d his staff with Tom m Inglesby, Anita C Cicero,  and Drr. Gao Xing at the C Chinese CDC 

ge 3 China Trip Report, pag

oving risk com mmunications is another arrea of focus Impro in Chiinese prepare edness effortss. We were to old that there is a concerte ed intention to o increase tra ansparency ons, both befo ore and durin ng future and c ommunicatio

China a Trip Report: Observat O tions and Highl ights

ateral converssations on He haas represented CAS in bila dual-u use research w with the National Science Advisory Board d for Biosecurrity (NSABB); he participattes in WHO worksshops on biorrisks; and he iis a member o of the InterAcade emy Panel on n Internationa al Issues Workking Group on Bio osecurity.

Dr. Wu Jiing, Director, Divission of Precaution,,   Office o of Health Emergen ncy, and his staff,   with Anita C Cicero, Tom Inglessby, and Dr. Gao X Xing 

emics. There appeared to be a particular epide awareness of the need for effective communications overnments and the media a. As in the with both local go d an outb break are U.S., many of the key players during e community level in China. at the Both the MOH and China’s CD DC are working hard to bility of determine the besst ways to improve availab ence-based data d that will give g local lead ders the evide inform mation they need n for good d decision ma aking durin ng public health crises. had a numberr of candid exxchanges with h our hosts We h abou ut the tensions that exist both in the U.S S. and China d public health a between evvidence-based recom mmendationss on the one hand h and the e political realitties of manag ging large pub blic health em mergencies on th he other. To some s extent, this tension will w always exist,, but there wa as agreementt that a well-rresourced and e expert publicc health infrasttructure is critical in proviiding decision n makers with h the best evidence and toolss for good decisions.

Sha red Conce erns about Dual Use Science S We a also had the opportunity o to o speak with the t Direcctor of the Insstitute of Micrrobiology, Drr. Li Huang, abou ut the efforts in i China, the U.S., and inte ernationally to ed ducate the life e sciences community abo out dualuse rresearch and to promote a culture of respo onsibility amo ong scientists who research and publiish in the life sciences. Like e the biosecu urity policy comm munity in the U.S., Dr. Hua ang and his co olleagues appreciate that tre ends and advvances in science and nology are relevant to ong going concern ns about techn biose ecurity and diiscussions und der the Biological Weap pons Conventtion. Dr. Huang actively parrticipates in intern national forum ms to addresss dual-use issues.  

We diiscussed with h Dr. Huang im mportant tren nds in the life scciences that m may have dual-use potentia al, including system ms biology, syynthetic biolo ogy, genomiccs, bioinfformatics, and d gene silenccing, among o others. He shared d our concern n that the dua al-use potenttial of variou us technologies is not wide ely appreciate ed by many in the e science com mmunity, and we agreed th hat our counttries have a shared respo onsibility to raisse aware eness of these issues. We diiscussed the vi ew that, while regulaation has an im portant Audreyy Li, Interpreter; Dr. Gao Xing,  o play in role to Anitta Cicero, and Tom m Inglesby  researrch with dual-u use potential,, care should be taken to a avoid unduly inhibitting the practtice of good science by im mposing onero ous security m measures.

Valu e of Conti nuing Exch hanges We le eft China with an interest in n furthering th hese and other scientific and d health exchanges. The im mproved d practices underrstanding we have of China’s policy and in pub blic health em mergency resp ponse gave u us valuable persp pectives and id deas that willl inform our th hinking aboutt U.S. prepare edness effortss. We look forward to new o opportunities to share view ws with our Chinese colleaagues and to finding ways to work toge ether in the future e. These kindss of exchange es help us to become more familiar with each other’s patterns of th hinking and oaches to new w epidemics a and crises. In the next flu appro pande emic or otherr international infectious disease emerg gency, we willl have these relationships and comm mon understandings to dra aw upon as w we work in comm mon purpose to respond.

China Trip Report, pag ge 4

Center for Biosecurity Meets with Chinese Public Health and Science Leaders