"Epidemic" Changes In China'S Disease Control System: Upgrading, Integration, Coordination And Sinking

"As a professional in Beijing health and epidemic prevention station, I have been planning immunization for more than three years, and disinfection work for nearly two years has not known where the value is reflected. The establishment of the National Bureau for Disease Control and prevention should have a clear identity for professionals in this field. " On May 8, a former Beijing CDC staff member told 21st century economic reporter.

On April 28, the official website of the Ministry of human resources and Social Security announced the appointment and removal of personnel under the State Council. Wang Hesheng was appointed director of the State Bureau for Disease Control and prevention, and Chang Jile, Shen Hongbing and Sun Yang were deputy directors of the State Bureau for Disease Control and Prevention.

According to the analysis of industry insiders, this is the first time that the name of the "National Bureau for Disease Control and prevention" (hereinafter referred to as "the National Bureau for Disease Control and prevention") has appeared in publicly disclosed government documents for the first time. Although it has not yet been listed, the appointment and removal news directly announced the establishment of a new institution, the National Bureau for Disease Control and prevention.

In response, Wang Ning, deputy director of the center for STD and AIDS prevention and control of the China Center for Disease Control and prevention, told 21st century economic reporter that the newly established National Bureau for Disease Control and prevention is a vice ministerial general administration directly under the State Council. CDC is still a public institution, the focus of work may be fine tuned. But the CDC has strengthened.

A senior person in the industry who has been paying close attention to the reform of disease control and prevention told the 21st century economic reporter that the disease control reform has been talked about in recent years, and the epidemic has played a catalytic role“ Reform means change and adjustment, and it will not be achieved overnight. However, there is no doubt that disease prevention and control will be promoted to a more important position in the future. The National Bureau for Disease Control and prevention will be mainly responsible for policy and management, while the China CDC will be responsible for technical business

In recent years, people have been calling for the reform of disease control system, and the new epidemic situation may play a catalytic role. IC photo

Function orientation

According to public data, Wang Hesheng has been Secretary of the General Youth League branch of the Department of health of Tianjin Medical College, Secretary of the General Youth League branch of the eight-year Student Office of Tianjin Medical College, deputy secretary of the Youth League Committee of Tianjin Medical College, Secretary of the Youth League Committee of Tianjin Medical University. In August 2016, Wang Hesheng served as deputy director of the national health and Family Planning Commission and director of the health reform office of the State Council. Since March 2018, he has been the deputy director of the National Health Commission and a member of the Party group, responsible for the reform of the medical and health system, medical administration and medical management, publicity, etc. In charge of system reform department, medical administration bureau, publicity department, China Japan Friendship Hospital, China Health Education Center, health development research center, medical management service guidance center, Hospital Management Institute, National Cardiovascular Disease Center, National Cancer Center, etc.

A person close to the National Health Commission told the media that Wang Hesheng is familiar with public hospitals, and the reform of disease control system will cooperate with public hospitals more. Moreover, Wang Hesheng was in charge of medical administration and medical management, which may indicate this direction.

At the press conference of the white paper "China action against the new crown pneumonia epidemic" held on June 7, 2020, Ma Xiaowei, director of the National Health Commission, also said that it was necessary to innovate the mechanism of combining medical treatment with prevention, to connect the system of disease prevention and control and the system of medical treatment in mechanism, so as to realize the communication of personnel, information and resources“ If you are sick, you have to go to the hospital. If you find that you are in the hospital, you should report the disease in the hospital. The system of the center for Disease Control and prevention must be closely integrated with the hospital. In terms of system innovation, mechanism guarantee and personnel management, we will really implement the combination of prevention and treatment. This is a short board for us. It should be said that we have not integrated prevention and control closely for a long time, and there should be room for further improvement in some work. "

The new deputy directors, Chang Jile and Sun Yang, are the heads of the former disease control departments of the National Health Commission. Shen Hongbing, the only deputy director outside the system of the National Health Commission, is an epidemiologist and an academician of the Chinese Academy of engineering. Chang Jile was the director of the disease prevention and Control Bureau of the National Health Commission before assuming his new post. He once served as deputy director of the Department of health of Gansu Province and deputy director of the personnel department of the Ministry of health. Before taking office, Sun Yang was the director of the emergency office of the National Health Commission. He had been a physician for many years. He was the leader of the reform group of the former hospital of the Ministry of health, the director of the medical management center of the former health and Family Planning Commission, and the president of the Sino Japanese Friendship Hospital. Shen Hongbing has been engaged in tumor molecular epidemiology research for 30 years, and was the president of Nanjing Medical University before taking office.

According to industry analysis, from the resumes of one director and three deputy directors, we can see the future orientation of China's disease control system: more cooperation with medical institutions on the basis of equal emphasis on prevention and control mechanism, emergency command and professional research.

Pain of disease control

In fact, in recent years, there have been continuous calls for the reform of the disease control system, and the new epidemic may play a catalytic role.

Academician Zhong Nanshan pointed out at the press conference on February 27, 2020: "the short board exposed by this epidemic situation is that the CDC's status is too low. It is only the technical department under the leadership of the Health Commission, and the special status of the CDC has not been given enough attention. The CDC is just a technical department and can only report to the local government. After reporting to the local government, how the local government decides is the local government's business. The CDC has no power to do more work. "

It is understood that the predecessor of China (National) Center for Disease Control and prevention was the China Center for preventive medicine, which was established on December 23, 1983. It was renamed as Chinese Academy of preventive medicine on January 19, 1986. On January 23, 2002, the Chinese Center for Disease Control and prevention was re established by multiple agencies.

After the outbreak of SARS, China's new infectious disease prevention and control system began to be constructed, and the disease control system was also valued. At that time, the requirements of establishing and improving the disease prevention and control system within three years were put forward. The financial investment of CDCs at all levels increased rapidly, and the hardware conditions of CDCs were greatly improved.

However, the sudden outbreak of the new epidemic situation has tested the ability of prevention and control of major infectious diseases in China, and exposed the problems existing in China's disease control system. For example, the functional orientation of national, provincial, prefecture and county CDC agencies is not clear enough, and the division of work tasks and levels is unreasonable; The separation of prevention and treatment is obvious, and it is difficult to integrate medicine and prevention; Villages and towns, community network is weak, grass-roots team fault aging serious.

In response to the query that the CDC did not report the epidemic situation in time at the early stage of Xinguan outbreak, a former staff member of the national CDC, who did not want to be named, once told the 21st century economic report that "the CDC can't not not report, but you can't ask the CDC to do too much."

It is understood that the state, province, city, county (District), there are CDCs at all levels, subordinate to the health commission at all levels. In the current legal system, the roles of China's (National) centers for Disease Control and prevention and the local centers for Disease Control and prevention still have the shadow of China's centers for preventive medicine. Moreover, the central CDC and provincial, municipal and county CDCs are not a four level structure from top to bottom. China CDC and CDC at all levels are not vertical management.

In September 2020, the state leaders mentioned in the article "building a strong public health system to provide a strong guarantee for the maintenance of people's health." from the perspective of this epidemic prevention and control struggle, China's public health system has played an important role, but in the face of the extraordinary epidemic, problems such as weak capacity, ineffective mechanism, insufficient motivation, and weak combination of prevention and control are exposed. It is necessary to strengthen the reform in straightening out the system and mechanism, clarifying the functional orientation and improving the professional ability. We should optimize and improve the function setting of disease prevention and control institutions, and strengthen the capacity building of national disease prevention and control institutions

Previously, at the above-mentioned press conference, Ma Xiaowei also pointed out that in the national, provincial, municipal and county-level disease prevention and control system, we should further strengthen the ability of prevention and control of acute infectious diseases and emergency disposal, and clarify the functional positioning of the National Centers for Disease Control and prevention, provincial centers for Disease Control and prevention, municipal centers for Disease Control and prevention, and county-level centers for Disease Control and prevention The ability of laboratory detection, professional guidance and etiological analysis; The provincial CDC should strengthen the guidance, supervision, quality evaluation and personnel training of regional prevention and control work; The municipal and county CDCs should further strengthen the field epidemiological investigation and daily supervision and monitoring of the disease spectrum of regional sexually transmitted diseases; County CDCs and community medical institutions should lay a solid foundation, strengthen community management and prevention and control, and build a solid foundation for disease prevention at the grassroots level“ Therefore, we should clarify the respective functions of the four levels of CDC, straighten out the institutional relationship, and form a collaborative mechanism with upper and lower linkage. "

Wang Hufeng, a professor at the school of public management of Renmin University of China, said in an interview with the media that the establishment of the National Bureau for Disease Control and prevention is an important part and key component of the reform of the disease control system, which means that disease prevention and control has been promoted to a more important position.

Advanced organization

Previous discussions on the direction of the reform of the disease control system have mainly extended two viewpoints: one is to attribute the early problems of epidemic prevention and control to excessive administration, and advocate transforming the CDC into an independent public organization rather than an administrative department, so as to reduce unnecessary intervention of improper administration on professional ability. The second is to attribute the early problems of epidemic prevention and control to the lack of administrative power, advocating that the CDC should be stripped of its basic research functions to universities, and be integrated with the disease control bureau of the National Health Commission to become a high-level central functional department with administrative law enforcement power.

It is understood that China's earliest infectious disease prevention and control system followed the model of the former Soviet Union, and established health and epidemic prevention stations from provinces to prefectures, cities and counties since 1953. By 2000, after the reform, a two line parallel system was established. The National Center for Disease Control and prevention was divided from the former Ministry of health to establish the China Center for Disease Control and prevention, and set up centers for Disease Control and prevention at all levels and institutes for health supervision on the basis of the health and epidemic prevention station.

At present, many media reports said: "the establishment of the National Bureau for Disease Control and prevention means that the" two parallel "system of the disease control system will be broken, and there will be a trend of merging into one."

In response, Wang Ning, deputy director of the center for STD and AIDS prevention and control, told 21st century economic reporter that the National Center for Disease Control and prevention has always been in the health system. The Chinese Center for Disease Control and prevention, which is separated from the Chinese Academy of Medical Sciences, has always been a public institution under the direct control of the Ministry of Health (Mohc). The provincial, municipal and county epidemic prevention stations have been renamed centers for Disease Control and prevention at all levels, and they are still public institutions managed by the health authorities of governments at all levels.

Wang Ning further pointed out that the newly established State Bureau for Disease Control and prevention is a vice ministerial general administration directly under the State Council. CDC is still a public institution, the focus of work may be fine tuned. But the CDC has strengthened.

Luan Rongsheng, a professor at West China School of public health, Sichuan University, also said in an interview with the media that the status of the National Bureau of disease control and prevention may be equivalent to the State Administration of traditional Chinese medicine (the National Bureau managed by the National Health Commission). However, with more independent functions and greater authority, it will integrate the corresponding resources scattered in other departments. In case of major epidemic and public health emergencies, the response can be more rapid and efficient, and the consumption of internal coordination can be reduced.

At the same time, the establishment of the National Bureau for Disease Control and prevention will also promote medical and preventive coordination. This year's "government work report" also clearly pointed out that we should deepen the reform of disease prevention and control system and innovate the medical prevention coordination mechanism.

Wang Hufeng, a professor at the school of public management at Renmin University of China, said that for a long time, the implementation of "combination of prevention and treatment" was not effective. It was often focused on treatment, and prevention work lagged behind. It was also difficult to communicate and coordinate or issue effective policies. After the establishment of the National Bureau for Disease Control and prevention, we can expect to change this situation“ The new organization will further strengthen the prevention and control of major infectious diseases, chronic diseases, occupational diseases and endemic diseases as well as the formulation of public health policies, and the functional institutions of relevant departments will be further integrated. "

In the view of the industry, it is also an important step to strengthen China's public health construction.

Previously, at the 13th healthy China Health Forum, Liang Wannian, executive vice president of the school of public health and health of Vanke, Tsinghua University, and head of the National Health Commission's expert group on new crown pneumonia, said that in the face of a major epidemic, the public health system and personnel played the role of discoverer, verifier, consultant, implementer, advocate and communicator, Even evaluators“ I think these "six" are the main functions of the public health system and talents. These functions are irreplaceable by other systems, including other personnel in the health system. "

But Liang also stressed that the establishment of a national CDC is not enough“ How to further connect the public health system, how to effectively connect the upper and lower institutions, including professional institutions and social governance, how to realize the effective communication of personnel, information and resources between the public health and medical service system, and how the public health system is in line with the international standards, so as to truly tell the Chinese story in the international context and background, and have the right to speak, This is also an important aspect. "

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