Back before the 2003 SARS outbreak — the first of these novel coronavirus outbreaks — China had a development program that focused almost entirely on economic growth while under-investing in public health and other welfare spending. The result was lost lives, major illness and massive economic disruption. The lesson was clear.
Yet in 2017, the Trump administration came in determined to redress a series of trade grievances with China. Everything else was put on hold. The previous Strategic and Economic Dialogue, founded by President George W. Bush and continued by President Barack Obama, was suspended, eliminating a venue for regular consultation between top Cabinet secretaries in all areas, including health. Even lower-level meetings, such as meetings under the Science and Technology Cooperation Agreement, have been put off.
Both Bush and Obama sent their Health and Human Services secretaries and Centers for Disease Control and Prevention directors to China. These visits have dropped off under President Trump. Without regular high-level meetings and visits to launch new initiatives and deepen existing ties, cooperation at best becomes moribund.
Or worse, it declines — as we are seeing now.
The CDC used to have a robust program in China, with as many as 10 American experts working on the ground in China and a local staff of more than 40, the majority working on infectious diseases. I was the science counselor at the U.S. Embassy in Beijing during and after SARS, and much of my job was processing new-position approval for experts from the CDC, HHS and National Institutes of Health as Bush increased our commitment. The centerpiece of the program — first called Global Disease Detection and then the Emerging Infectious Disease (EID) program — had four U.S. experts and a number of local hires working directly with their Chinese counterparts to identify diseases that have pandemic potential.
But under the Trump administration, the total U.S. CDC program in China went down to three U.S. experts and a handful of local hires. Meanwhile, the Beijing-based EID program was drawn down. Had this program been up and running at full strength, we wouldn’t have needed to offer to send a team of health experts, as the administration did last month; we would have had people available and familiar with relationships of trust right there in China.
These efforts have played a significant role in the past. Well before SARS, the United States worked with China to collect flu samples, since most new flus originate in China. And during the avian influenza outbreaks that occurred in the years subsequent to SARS, American assignees were able to provide formal assistance and, at least as important, have informal channels to assist their counterparts and to better understand the risk to Americans.
In recent years, science cooperation between our countries has been painted as if it only benefited China. But joint research gives U.S. researchers access not only to brilliant partners in China but also to facilities such as clean-energy pilot developments that don’t exist in the United States. And nowhere is the need for cooperation greater than in fields touching on biology. Researchers can’t study disease unless they have access to it, and diseases emerge in different parts of the world. That’s why the NIH funds research worldwide, instead of the more restrictive rules of the National Science Foundation. And that’s why the CDC opened offices around the world to track emerging infections.
We know these joint efforts yield important results. Many have commented on how rapidly the Chinese sequenced and published the COVID-19 genome. That expertise developed when several Chinese labs participated more than 20 years ago in the human genome project. We know the importance of folic acid during pregnancy because of a joint study in China. A large number of studies on diabetes and heart disease prevention are conducted in China.
For decades under both Republican and Democratic presidents, the U.S.-China cooperation on health was nurtured and grew. There are huge opportunities from strategic science cooperation — and huge costs if we fail to work cooperatively on risks such as emerging infections. The world is more crowded and rapidly changing. New infections are going to arise. We neglect the lessons learned from previous epidemics at our peril.