Following the 2003 Sars outbreak, Beijing concluded that greater transparency would have helped fight the disease and invested heavily in building an advanced reporting system for infectious diseases to prevent future cover-ups. But following this year’s Covid-19 pandemic , the government has been forced to admit there is still work be in done in improving the country’s response to major epidemics and meeting public expectations. In a rare admission, this year’s work report delivered by Premier Li Keqiang on Friday said that “many weak links have been exposed” in public health emergency management. “People have opinions and recommendations that deserve our attention. We must strive to improve our work, perform our duties effectively and do our best to live up to people’s expectations,” he said. Li promised to uphold the principle that “life is of the utmost importance” and strengthen the public health system. He also pledged to reform the disease prevention and control system, improve infectious disease reporting and early warning systems, and ensure information was released in a timely, open and transparent manner. He also promised to increase investment into the research and development of vaccines and treatments, as well as building more medical facilities. The World Health Organisation China said that applying lessons from Covid-19 “requires Health-in-All policies to be fully implemented, and OneHealth to be enforced by the entire government and the whole of society”. “This requires continuous investment to ensure equitable access to health services, implementation of the essential health care and health promotion law, investment in the infrastructure for disease outbreak management, capacity building and motivating public health and disease control staff,” it said. OneHealth is an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors work together to achieve better public health outcomes, while Health-in-All seeks to improve the accountability of policymakers. Chinese agency world’s biggest funder of coronavirus research, study finds The Covid-19 epidemic, described by Li as “the fastest spreading, most extensive and most challenging public health emergency China has encountered since the founding of the People’s Republic” in 1949, has infected more than 82,000 people and killed more than 4,600 in the country since it was first reported in central city of Wuhan, Hubei in December. But China has faced mounting domestic criticism and an international backlash against its handling of the early stages of the epidemic. Frontline doctors in Wuhan started warning of a mysterious strain of viral pneumonia in late December, but official investigations only began at the end of the month and some medical staff were disciplined for warning their colleagues. The authorities only announced that the disease was contagious on January 20 – raising questions about whether the direct reporting and early warning system was functioning properly. Meanwhile, authorities in Wuhan and Hubei held a series of political meetings between January 6 and 17 – a period when no new cases of Covid-19 were reported – and other events, including a mass banquet ahead of Lunar New Year, went ahead as normal. “Being transparent and open was one of the lessons we learned from handling the Sars outbreak and we mustn’t forget the pain when the wound heals,” said Yang Gonghuan, former deputy head of China’s Centre for Disease Control and Prevention. “We spent a fortune on a direct reporting and early warning system. If it was not properly functioning at the early stage of the outbreak, there must be an investigation to find out who was accountable so that we can continue to improve the system,” she said. Wuhan confirms China’s ban on trade, eating of wild animals Liu Guoen, director of the Peking University China Centre for Health Economic Research, suggested that the way the system is administered should be looked at, rather than just improving the technology. “The current direct reporting system is advanced in the technical sense, but the mechanism of responsibility and obligations is not clear, which affects how the system functions,” Liu said. “Centralised authorisation comes at a price and that is time we can’t afford to lose when an infectious disease epidemic happens.” Liu said a mechanism needed to be set up so that each level of the government was aware of their responsibilities and able to report outbreaks without administrative interference or fear of punishment. Yang said that such change would require a greater shared respect for transparency and openness in the “wider environment”. “The ideal way is to enshrine all aspects in law, such as the law on the prevention and treatment of infectious diseases, so that failing to be open and transparent will be punishable by law,” she said. Meanwhile, the National People’s Congress said it would try to strengthen the system through new legislation. Zhang Yesui, a spokesman for the NPC, told a press conference on Thursday that a special task force had been set up to set up to formulate and revise 17 laws in the next two years, and revise 13 laws in due course, including a biosecurity law to be passed within 12 months.