Africa currently accounts for more than 90% of the global malaria cases and deaths, but China is working hard to help Africa end this situation.
html On September 14, the fifth annual "Goalkeepers Report" released by the Bill & Melinda Gates Foundation specifically introduced China's malaria elimination practices and the international cooperation currently being carried out to eliminate malaria globally.2 and a half months ago (June 30), the World Health Organization official website announced a certificate to the world - "China obtained the WHO malaria-free certification." As a result, this ancient infectious disease that had existed in China for more than 3,000 years disappeared.
From the beginning of the fight against malaria in 1949, to the elimination of local malaria in 2019, how did China eliminate malaria step by step over a period of 70 years? China Business News reporters recently visited five provinces in China where malaria was once a high incidence, and explored the details behind this difficult battle to eliminate malaria.
The five provinces of Jiangsu, Shandong, Henan, Anhui, and Hubei were once the main endemic areas of malaria in China. According to epidemic reports, from 1970 to 1973, the annual number of cases in the five provinces ranged from 12.9859 million to 1.984 million, accounting for 86.01% to 91.16% of the national total.
70 Years of War on Malaria
Malaria is commonly known as "miasma disease", "miasma ", " fight ", "cold and heat disease", etc. In China, the awareness rate of these common names is higher. malaria is an vector-borne infectious disease caused by infection with Plasmodium through Anopheles mosquito bites or transfusion of the blood of a person carrying Plasmodium. After people are infected with , they will experience symptoms such as intermittent chills, fever, and sweating. In severe cases, it may cause damage to the brain, liver, kidneys and other organs, and even cause circulatory and respiratory system failure.
"Before the founding of the People's Republic of China, malaria was very prevalent in China. At that time, there were almost 30 million cases every year, and the mortality rate was 1%, which affected about 300,000 people. It was very serious." Deputy Director of the Institute of Parasitic Diseases of the Chinese Center for Disease Control and Prevention Xiao Ning said in an interview.
In the early days of the founding of New China, there were 1,829 malaria-endemic counties (cities) across the country, accounting for approximately 70% to 80% of the number of counties (cities) at that time. Of the total population of 450 million at that time, more than 350 million people were threatened by malaria. According to the "Historical Experience of Preventive Medicine in New China", among the 25 acute infectious diseases reported in the country in 1954, malaria accounted for 61.38%, and the number of malaria cases ranked first among all infectious diseases.
Malaria seriously affected the recovery of production at the beginning of the founding of the People's Republic of China. Zhao Dongyang, deputy director of the Henan Provincial Center for Disease Control and Prevention, said that malaria has a serious impact on industrial and agricultural production. After a patient is infected with malaria, he can only lie in bed, and it is impossible to engage in labor and production.
Malaria is so widespread in most parts of China that it has to be controlled.
htmlThe malaria war in 2070 can be roughly divided into five stages: the first is the key investigation and prevention and control pilot research stage (1949-1959); the second is the epidemic control stage (1960-1979); the third is the incidence reduction stage (1980- 1999); the fourth is the stage of consolidating prevention and control results (2000-2009); the fifth is the stage of malaria elimination (2010-2020). "The first stage is mainly to set up professional institutions to conduct surveys in key areas to find out the prevalence of malaria." Feng Jun, associate researcher at the Institute of Parasitic Disease Prevention and Control of the Chinese Center for Disease Control and Prevention, said that at this stage, national and provincial Many professional institutions were established, and malaria was recognized as a notifiable disease and a national reporting mechanism was established.
In the early days of the founding of the People's Republic of China, China was faced with a severe situation of widespread epidemics, lack of medical treatment, and extremely poor medical conditions. Not only did there not be any drugs to treat malaria, but there was also a lack of knowledge about the incidence of malaria, the characteristics of malaria parasites, the types of mosquitoes, and drug treatment. There is a lack of sufficient awareness and understanding of the laws of the epidemic, etc., and the prevention and control network of infectious diseases is also blank.
In October 1949, the Ministry of Health of the Military Commission held a national health administration conference, which made the prevention and treatment of various acute and chronic infectious diseases the top priority at that time, and determined a prevention-oriented work policy. To accomplish this task, China began to build a comprehensive administrative management system for epidemic prevention. The Ministry of Health of the Central People's Government was established in November 1949. Each province, autonomous region, municipality directly under the Central Government, as well as counties, municipal districts and rural areas have established corresponding health and epidemic prevention institutions.
According to "The Great Achievements of the People's Republic of China in the Past Three Years", by the end of 1951, the coverage rate of county-level health centers across the country had reached 91.2%. At the same time as the township health centers, epidemic prevention stations were built, which was also an important initiative in effectively preventing and controlling infectious diseases. By the end of 1967, there were 22,499 health and epidemic prevention stations and 40,527 health and epidemic prevention technicians across the country, which were 16 times and 11 times the number in 1952 respectively.
As a result, China formed an administrative management system for the prevention and control of infectious diseases, which is also the prototype of China's current medical network and public health system. This system played an important role in China's subsequent 70-year malaria war and other infectious disease prevention and control processes.
Fengjun said that the "National Agricultural Development Program from 1956 to 1967 (Draft)" in January 1956 proposed to basically eliminate several diseases that are most harmful to people's health, including malaria, in all possible places. In August of the same year, the former Ministry of Health formulated the "Malaria Prevention and Control Plan" and listed malaria as a notifiable infectious disease. Since then, malaria epidemic reporting has gradually been on the right track.
Tu Youyou led a team that discovered the antimalarial compound artemisinin from Chinese herbal medicine in 1972. Artemisinin-based combination therapy has become the standard treatment for malaria recommended by WHO. Source: Xinhua News Agency.
Human infection experiment
To start a war against malaria, we must first understand malaria.
"At that time, we didn't know how long the incubation period of malaria was, how many days after infection the onset of disease was, whether there were patients infected in the previous year during the transmission season, whether medication should be taken during the non-infectious season, and within what range the medication should be taken. Different mosquitoes What are the differences between the types of malaria transmitted?" said Shang Leyuan, a 77-year-old veteran expert in Henan who has been fighting malaria and former deputy secretary-general of the Malaria Expert Advisory Committee of the Ministry of Health.
A series of unknowns troubled malaria prevention and control personnel at that time.
Zhang Shaowu, from the Pharmacy Department of the Henan Center for Disease Control and Prevention, said, "I'm here to get infected and see how long the incubation period is." After that, five more researchers proposed to infect themselves.
Shang Leyuan said that this was a very formal scientific research at the time, and the body temperature of infected people was observed every month until the onset of disease. From these human infection experiments, researchers found that the incubation period of malaria can be as long as 443 days and as short as 3 days. "They were not given medicine at first. The purpose was to observe the recurrence after a long incubation period, and how to carry out second-generation transmission, and whether the incubation period would still be long when passed to the next generation." In Shang Leuan's view, in order to defeat malaria, that generation must People are giving with their lives.
This human experiment doesn’t stop there. Shang Leuan said that subsequent comparative studies were conducted on the different numbers of biting mosquitoes, ranging from one mosquito bite, to five or six mosquito bites, to 10 mosquito bites.
"Once we understand the incidence pattern of malaria, and the medication can be targeted, we can take measures against malaria." Shang Leyuan said.
In the absence of a malaria vaccine, drug treatment became an important means to reduce the number of infected people at that time.
Fengjun said that in the 1960s and 1970s, China had two major malaria outbreaks, with the incidence rate exceeding 2600/100,000. "In this case, we can only rely on the whole population to take medicine."
Therefore, in the second stage of malaria prevention and control - the epidemic control stage (1960-1979), China formulated a malaria prevention and control plan, whose scientific name is "Two "Restore the best of both worlds."
Fengjun explained that the so-called "two plus two solutions" means that the infected people start taking medicine when malaria occurs. In order to prevent recurrence, taking medicine again before the epidemic season arrives in the second year is equivalent to killing the parasite again. It’s called telogen telogen cure. The second refers to preventive medication for the entire population during the epidemic season. "This is a prominent feature of the second phase of malaria prevention and control. Regardless of whether they are infected or not, all people taking medicine must be covered."
The management and treatment of existing patients is a measure to cut off the infection path. Early detection and early treatment have become key measures to control the pandemic in the second phase.
With the development of the national economy, the sufficient supply of major antimalarial drugs such as chloroquine, primaquine, and pyrimethamine from 1964 to 1967 set off a national anti-malarial upsurge.With continued and effective prevention and control measures, the incidence of malaria across the country continued to decline, falling to 257.54/100,000 in 1979, a 91.31% decrease from 1970.
Human mosquito traps
"Since 1971, China has implemented comprehensive prevention and control measures focusing on controlling the source of infection, coupled with drug treatment and the use of DDT indoor residual spraying or deltamethrin soaked mosquito nets to kill mosquitoes, Falciparum malaria has achieved good prevention and control results in China," said Shang Leuan.
Mosquitoes are the vector of malaria, but it is very difficult to end the spread of malaria by eliminating mosquitoes. This is also a factor why malaria in Africa has not been well controlled.
In fact, when China began to declare war on malaria, there was still insufficient knowledge about mosquitoes, which have been with humans for more than 5,000 years. "What kind of mosquitoes exist in China? What kind of malaria parasite does each mosquito carry? What are its survival habits? Where are its weak links? Any war can only be won if you know yourself and the enemy." Shang Leuan said.
In the 1950s and 1960s, China launched research on mosquitoes.
"There were no mosquito traps at that time, so we relied on people to catch mosquitoes. To catch mosquitoes, two people were required to set up a double-layer mosquito net on the ground. The person sat in the middle of the mosquito net and used the human body as bait to attract the mosquitoes to the mosquito net. On the mezzanine, another person was catching mosquitoes outside," said Zhou Yihong, a researcher at Changzhou Wujin Center for Disease Control and Prevention.
During an experiment conducted by Shenyang Center for Disease Control and Prevention in Yongcheng, Henan Province, they found that 3,000 mosquitoes were caught and raised for a period of time before they died, so experimental results on their adaptability and drug resistance could not be obtained. So he went to catch larvae in the puddles, and the eggs hatched into adult mosquitoes. Then mark them with fluorescent powder, choose a place to release them, place lights every 100 meters around them, and then use these light strips to catch mosquitoes.
Although scientific research conditions are relatively difficult, the results are still gratifying, and mosquito eradication has entered a targeted stage.
Zhang Hongwei, director of the Institute of Parasitic Diseases at the Henan Provincial Center for Disease Control and Prevention, said that the study discovered the ecological breeding sites, habitats, feeding habits, and seasonal growth and decline characteristics of Anopheles sinensis and Anopheles anthropophila, and then formulated preliminary control measures or Specific methods.
"In fact, Anopheles is a bit squeamish. The water quality in which it lives must be relatively clear, and it must have a suitable environment. And it takes a while for mosquitoes to grow. Once the small ditch is out of water for two days, it has not yet grown into a full-grown adult. The mosquitoes will be killed, this is its weak point," Zhang Hongwei said.
To address this weak link, China has formulated four combat plans based on the characteristics of the entire life cycle of Anopheles mosquitoes.
The first is to eliminate overwintering mosquitoes. The overwintering period is the most vulnerable part of the life of Anopheles sinensis and is the main period for mosquito eradication. Its overwintering places are mainly cattle sheds, cellars, and cave dwellings.
The second is to eliminate adult mosquitoes that have released their overwintering state. When the weather warms up from late February to mid-March every year, Anopheles mosquitoes begin to fly away from their overwintering places, and most of them enter livestock houses to suck blood. In order to kill the adult mosquitoes that have released their overwintering state and live in livestock houses, the livestock houses and carcasses can be swatted or sprayed with insecticides.
The third is to eliminate the first generation of larvae in early spring. After the weather warms up in early spring, overwintering mosquitoes gradually resume sucking blood, breeding and laying eggs. It takes about a month for the larvae to complete their development in water. The larvae are mostly limited to small areas of shallow water, such as leisure rice fields and sump ditches. Killing the first generation of larvae at this time is the second important period for killing Anopheles mosquitoes.
The fourth is to prevent and control Anopheles sinensis in summer and autumn. Using various methods to prevent and repel mosquitoes, raising duckweed in rice fields and swimming net fields, raising cattle, and planting duckweeds is one of the ways to kill Anopheles larvae. Various wild plants such as mugwort leaves, green bamboo shoots, tooth soap bitter admonition, etc. can also be used to kill adults and larvae.
In areas where malaria is severely endemic, in addition to forming a prevention and treatment strategy focusing on population-wide medication and infection source control, a regional malaria joint prevention and control mechanism has also been established. The joint prevention and control mechanism, which has become familiar because of the COVID-19 epidemic, actually first started in 1974. malaria prevention and control in 2016.
Anhui Woyang is separated from Henan by a river, and this river is not too wide, with the mouth of the river 17 or 18 meters at most. When the river freezes in winter, you can walk across it.
Zhang Jianjun of Henan Yongcheng Center for Disease Control and Prevention said that not only the movement of people at the junction will spread malaria between the two provinces, but also for Anopheles sinensis, which can fly as far as 100 meters, the 18-meter estuary cannot limit it. .
As a result, the five provinces have achieved synergy in preventing and controlling malaria, which has become an important measure in China's elimination of malaria.
Joint prevention and control areas are composed of administrative areas that are adjacent to each other, have close physical and geographical conditions, have consistent epidemic factors and similar epidemic levels. Provinces in these regions jointly formulate joint prevention and control strategies and measures, implement unified planning, synchronize actions, conduct joint training, mutual inspections, information sharing, and regular exchange of experience.
Shang Leuan, who participated in the implementation of joint prevention and control of malaria in the five provinces, said that in order to strengthen malaria prevention and control in the five provinces, in accordance with the instructions of the State Council, the Ministry of Health organized the five provinces to implement regional joint prevention at the end of 1973. "The joint prevention agreement stipulates that joint prevention inspections will be carried out every year, malaria prevention and control experiences will be exchanged, and implementation indicators of various technical measures will be revised in a timely manner."
The joint prevention of malaria in the five provinces began in 1974 and will continue until 2020. It is very important to promote disease control in New China. The development of work has had a huge impact.
During this period, the epidemic situation of malaria in the country has changed significantly, and the incidence rate of malaria has steadily declined. The national malaria incidence rate in 1999 (2.34/100,000) dropped by 99.31% compared with 1980 (337.83/100,000); the proportion of national malaria incidence in the total number of reported infectious diseases decreased. In 1980, the number of malaria incidence accounted for the proportion of reported infectious diseases. 16.24% of the total, which dropped to 1.30% in 1998; the number of counties (cities) with high malaria incidence decreased, while the number of counties (cities) with no case reports and low incidence increased; more than a thousand counties (cities) reached the standard of basically eliminating malaria.
But the hidden dangers have not been eliminated.
The epidemic is on the rise again
After the malaria incidence rate has remained at a low level for nearly 10 years, after 2000, the malaria epidemic in some villages (towns) along the Huaihe River and Huaibei areas in Anhui and in Yongcheng City, Henan, has increased year by year.
Taking Woyang County in Anhui Province as an example, the malaria incidence rate was as high as 18.17% in 1970. From 1987 to 1996, the incidence rate dropped to less than 1/100,000 for 10 consecutive years, reaching the standard of basically eliminating malaria. From 1997 to 2002, the incidence rate dropped to less than 1/100,000 for 6 consecutive years. The malaria epidemic began to rise in 2003. By 2006, a total of 7,946 cases were reported online, ranking first in the number of reported cases in county-level units across the country.
As for the reasons for the rebound, Sun Jince, director of the Office of the Center for Disease Control and Prevention in Woyang County, Anhui Province, explained that first, because there have been no malaria cases for a long time, doctors’ diagnostic awareness has declined, and the diagnostic skills of inspectors have also declined, resulting in delays in the disease. Second, the supply of malaria drugs is insufficient. Because there have been no cases for a long time, many drugs have been discontinued. Third, the three-level network of the health system is no longer complete. Without certain incentives and subsidies, it is difficult to implement malaria prevention and control measures.
The prevention and control of infectious diseases pays attention to the four early stages, such as "early detection, early diagnosis, early isolation and early treatment" that has been proposed in the new coronavirus pneumonia prevention and control. In fact, as early as 1982, the Chinese Center for Disease Control and Prevention proposed "early diagnosis and early treatment" for malaria prevention and control.
As the first step in the detection of malaria infection, microscopy is particularly important as the gold standard for malaria diagnosis. It determines subsequent treatment, the scope of risk groups and the treatment of epidemic sites.
Zhou Xiaonong, director of the Institute of Parasitic Disease Prevention and Control of the Chinese Center for Disease Control and Prevention, said that the use of microscopy for malaria diagnosis in China dates back to the 1980s. At that time, township health centers were equipped with microscopic examination equipment and personnel, and the personnel were screened. received training. But in the past 10 years before 2000, the power of to inspect has almost disappeared.
"In the 1960s and 1970s, universal medication was closely related to the fact that the diagnostic capabilities at that time could not keep up. However, microscopy can be more accurate, narrowing the scope of universal medication to risk groups." A CDC Staff said that the resurgence of the malaria epidemic in 2003 and its peak in 2006 were directly related to the weakening of professional prevention and control teams and microscopic examination capabilities.
Cao Jun, deputy director of the Jiangsu Provincial Schistosomiasis (Parasite) Disease Prevention and Control Research Institute, also said that when the incidence of malaria decreases, China faces various challenges.No manufacturer is willing to produce anti-malarial drugs, which is a constant headache. Unused malaria drugs will expire soon. The price of malaria drugs to be purchased has increased 10 times, and manufacturers are unwilling to produce them.
Faced with the resurgence of malaria infection cases, Woyang quickly formulated a series of malaria prevention and control measures, including universal rest and treatment, universal participation, vector control, and patient management. Compared with the outbreaks in the 1960s and 1970s, the prevention and control measures this time are more precise.
"Since there was not much scientific research, the 'two-pronged' measure was adopted in the 1950s and 1960s, that is, all people take medicine. Although we are also 'all people taking medicine' this time, it is not that all people in the affected areas take medicine. Large-scale medication for risk groups,” said Wang Jianjun, former deputy director of the Anhui Provincial Center for Disease Control and Prevention.
Wang Jianjun introduced that based on the relationship between the patient's epidemic point and the water body, Guoyang delineated the drug-taking groups. According to National Center for Disease Control and Prevention research, 80% of mosquitoes fly within a distance of about 100 meters. Therefore, the risk groups were also set within 100 meters at that time.
According to the defined medication scope, Woyang County determined the objects of preventive medication, and implemented the principle of "delivering medicine to the hand, seeing and taking it to the mouth", and established a medication work team, composed of village cadres, rural doctors and township health centers ( It is composed of personnel drawn from the prevention and security station). The Woyang County Health Bureau dispatches no fewer than two technical instructors and drug side effects handlers to each town. Personnel should be divided into tasks and responsibilities should be assigned to each person.
Zhang Jian, director of the Chengxi Community Health Service Center in Woyang County, who was the deputy director of the township health center at the time, was a parcel contractor at that time. "Malaria drugs are very bitter and many people cannot take them. Even if you see him putting it in his mouth, if you turn around, he may spit it out. So we have to see the swallowing action and see the drugs actually being eaten. Only then can I check the box," Zhang Jian said.
Malaria treatment requires taking medicine for 8 consecutive days, otherwise the treatment will not be effective. "It's very difficult to find people. We need to arrive before they have breakfast, otherwise they will go to work. If they can't take the medicine in the morning, we have to wait until they get off work to deliver the medicine at home in the evening. If you don't keep an eye on them, they won't be able to take the medicine. If it is in place, if the malaria parasite cannot be killed, the purpose of malaria prevention and control will not be achieved," Zhang Jian said.
Compared with finding a doctor, the side effects of taking malaria drugs pose greater obstacles to taking preventive drugs.
"The drugs used to treat malaria include chloroquine, primaquine and piperaquine phosphate. At that time, because chloroquine and primaquine were insufficient, piperaquine phosphate was used, which has very large gastrointestinal reactions." Zhang Jian said that the risk groups are not If they are not sick people, it will be very difficult to get them to take medicine.
On November 30, 2007, after two rounds of medication, the Woyang County Center for Disease Control and Prevention discovered problems in this round of malaria prevention and control: the first and second rounds of medication coincided with the high temperature season, and the high temperature weather caused problems for work and people taking medication. Due to the development of market economy and high population mobility, it is inconvenient to implement the work of eliminating the source of malaria infection; the drug targets a wide range of people, piperaquine has certain side effects, and some drug users have poor medication compliance; individual village-level epidemic prevention networks It is not perfect. Some village anti-epidemic workers do not engage in medical activities, have no income and no remuneration, and are not very motivated to work. A small number of village-level doctors have low economic income and go out to work, so no one takes on the task of malaria prevention.
"We can get a reward of 2 yuan for one person who completes 8 days of medication. If it is done by 10 people, it will only cost 20 yuan, which is too low and too little. Later, it was 20 yuan a day, and the incentive increased slightly." Zhang Jian said.
data shows that Woyang County delineated risk ranges based on the distribution of cases and water bodies in natural villages where malaria cases occurred in 2006 and 2007, and implemented three rounds of piperaquine phosphate preventive medication for people within the range, with a total of 838,631 people taking the medication.
"There were many people taking medicine and few village doctors. We visited 20 villages every day. These villages were 15 kilometers apart from the east and west and 18 kilometers from the north and the south. There were no cars at that time, only bicycles and motorcycles." Zhang Jian said. While
was taking the medicine, Woyang also took measures to clear the source. Based on the flow of cases, the treatment of epidemic spots was carried out. Under the guidance of the county CDC and the cooperation of towns and villages, every patient could be dealt with in a timely manner.The treatment of the epidemic spot includes basic situation investigation of the epidemic spot, designated area residual spraying, health education for surrounding people, screening of fever patients, distribution of anti-mosquito salmonella and long-lasting drug bed nets, and biological sterilization of Bacillus globus in surrounding water bodies.
After comprehensive prevention and control measures focusing on the removal of infection sources, the malaria epidemic in Guoyang has been effectively contained. Since 2014, there have been no reports of locally infected malaria cases in Anhui Province.
The malaria epidemic was brought under control in 2006 with the help of the Global Fund (Global Fund to Fight AIDS, Tuberculosis and Malaria Fund). Fengjun said that the malaria epidemic centered in Anhui and Henan reached its highest incidence in 2006. The Global Fund has strengthened timely diagnosis, standardized treatment and effective protection of malaria in project areas, strengthened malaria management of floating populations in Yunnan border areas, and carried out health care Education and health promotion, strengthening malaria surveillance and project management capabilities, etc., to curb the prevalence of malaria in the project provinces and effectively control the spread and spread of multi-resistant falciparum malaria . The
Global Fund has launched five rounds of assistance projects in China. It has carried out relevant prevention and control activities targeting the weak links in malaria prevention and control in my country, and provided strong financial support and material guarantees. It has become an important part of my country's malaria prevention and control plan and malaria elimination action plan.
Xiao Ning said that on the road to eliminating malaria in China, it has benefited from many new foreign concepts, including the training of institutional personnel, a large amount of funds, equipment, and management concepts for project implementation, so that China's malaria can be eradicated in the later stages. be steadily advanced.
Foreign prevention will still be needed in the future.
After malaria is eliminated in China, is the story over? not at all. Like COVID-19, China is also faced with imported malaria.
"After eradicating malaria, we need to ensure that there is a lot of funding, the team does not withdraw, and the intensity does not decrease. Why? Because there are still a lot of imported malaria cases, 2,600 to 3,000 cases every year, 96% of which are from Africa, and some from Southeast Asia ." Zhou Xiaonong said.
Data released by the WHO show that there were an estimated 229 million malaria cases globally in 2019, and an estimated 409,000 deaths.
"Once a Mars comes in, it will be amplified, so now the country must strengthen the monitoring of imported cases, requiring the '1-3-7' strategy to be adopted in the elimination stage. In the later stages of elimination, we need to strengthen this aspect. Work, especially blocking passes accurately," Xiao Ning said.
"1-3-7" strategy, that is, reporting to the National Infectious Disease Information Reporting System within 1 day; conducting epidemiological case investigation and verification of reported malaria cases within 3 days; completing investigation and disposal within 7 days.
Zhu Guoding, director of the Malaria Office of the Jiangsu Provincial Institute of Medical Sciences, said that "1-3-7" is an important strategic measure and norm in the management stage of imported malaria. Once included in this management system, as long as patients receive early diagnosis and standardized treatment in a timely manner, generally It is less likely to cause serious illness or even death, and cause local infection.
"So for every case that comes in, we have to deal with the epidemic point. We treat one case as one epidemic point or even two epidemic points. Both the current place of residence and the place of immigration need to carry out epidemic point treatment and screen the surrounding people. After screening, some prevention and control measures should be taken to ensure that imported malaria cases do not become new epidemic points or new sources of infection.
Zhou Xiaonong also expressed his concern that after malaria is eliminated, there may not be any major problems in the next two years. However, as time goes by, people will forget about malaria and there will be problems with diagnosis.
"So our team still needs to be maintained, and at the same time we must pay attention to the brain drain. We hope that the talent team can be maintained and maintain its capabilities. This is a bit challenging and a bit stressful." Zhou Xiaonong said.
column editor: Gu Wanquan Text editor: Fang Ying Title picture source: Shangguan picture editor Picture editor: Yong Kai
source: Author: China Business News Ma Xiaohua
