Communicable disease control in China: From Mao to now

Hipgrave, David

Schistosomiasis control has been prioritized in China since the 1950s, with various strategies involving coordination between public health, pharmaceutics, agriculture, hydrology, geospatial mapping and animal husbandry experts. The success of this coordination indicates the level of associated political support, but as explained above, this was not always a given. Researchers have also highlighted the impact of farming practices, population movement and China' s economic progress on control of this disease (44) . In the 1950s, hundreds of millions in 12 southern provinces were at risk of this disease, and around 2% of China' s population was infected (45, 46) . Early control efforts focused on transmission control, especially by early mass mobilization of people to alter snail habitats (45) . With the introduction of praziquantel in the early 1980s (47) the focus changed to morbidity control, and mass treatment funded by a World Bank loan and other activities from 1992-2000 (45) . In each case the observed reduction in infection numbers was at risk when priority and funding for control programs declined (46) . After completion of the World Bank project, case numbers rose again in certain areas (48) ; the concentration of cases in poor rural areas and the lack of funding for preventive health care in general led to diminished control efforts, leading national health authorities to rate schistosomiasis control, tuberculosis, hepatitis B and HIV as equally critical priorities, in contrast to its status as a neglected tropical disease in other nations (49) . Schistosomiasis persists in seven provinces, in a much smaller area of the upper and lower Yangtze River catchment and particularly in villages whose population totals around three million people (41) . National funding was required to kick-start new control efforts including periodic mass chemotherapy, reduction of infection sources (animal management, mechanization of farming, water supply and sanitation measures) and public education, supported by a 2004-2015 government-funded vertical project (49) (50) (51) . Based on infection rates among the population and cattle in the affected areas, this is apparently the most successful combination of activities yet, and the screening program being undertaken has also demonstrated an impact on rates of infection with the soil-transmitted helminths Ascaris lumbricoides and Trichuris trichiuria, probably as a result of the sanitation and public education components (51).