BackgroundInfectious diseases remain a leading cause of morbidity and mortality in China. After entering the 21st century, some major outbreaks of infectious diseases in human beings have occurred in China, but little evidence is available on the disease burden because of economic factors. We investigated the burden of infectious diseases on the basis of economic factors in China and made comparisons with data from the UK and the USA. MethodsWe investigated all the independent infectious disease outbreaks in mainland China, the UK, and the USA between 2000 and 2016 (appendix) using the WHO Disease Outbreak News, and we extracted Annual Producer Price Indices (PPI) for livestock meat from the Food and Agriculture Organization Statistics Database. We investigated the economic circumstances under which each independent outbreak of indigenous infectious disease in human beings originating from domestic animals had occurred. FindingsBetween 2000 and 2016, 13 independent infectious disease outbreaks in human beings were recorded in the Chinese Disease Outbreak News, and seven of them were indigenous (not imported). Among these seven outbreaks, four outbreaks were of domestic-animal origin (H5N1, H7N9, and H5N6 avian influenza, and human Streptococcus suis infections). Before these four outbreaks, the corresponding PPI for domestic poultry or pig meat had increased sharply (at least on average more than 10% rise in PPI per year) and reached an unprecedented high price. However, in the same period, among the 11 independent outbreaks in human beings in the UK that were recorded in Disease Outbreak News, only one (H7N2 avian influenza, in 2007) was of indigenous domestic-animal origin, whereas the corresponding PPI for poultry meat in the UK was steady before the outbreak, unlike in China. Furthermore, between 2000 and 2016, none of the 20 independent outbreaks in the USA recorded in Disease Outbreak News originated from domestic animals. InterpretationBy comparison with the UK and the USA, China has had more and worse indigenous outbreaks in human beings, the sources of which were domestic animals. China has a highly diverse animal production throughout the country, as characterised by the diversity of farm sizes, different ways of farm management, and discrepant capabilities of disease prevention and control, along with large backyard feeding operations in rural areas and city suburbs. A sharp increase in PPI for domestic animal meat reflects a steep increase in the production costs. So, before the four independent (or first) outbreaks of indigenous infectious disease of domestic-animal origin in China, related production costs were actually extremely high. Under the circumstances, some animal farmers without economic strength might increasingly resort to irregularities to reduce the effect of steeply rising costs. For example, the domestic animals dying of diseases were likely hidden and illegally processed before entering market circulation. Consequently, a silent generation, reassortment, evolution, or spread of pathogens might come out or be facilitated. Therefore, when production costs rise steeply in China, for the sake of public health, there is a need to ensure economic benefits for animal farmers (particularly for those without economic strength), and also it is necessary to keep the animal farms with weak anti-risk capability phase-out through market mechanisms. Furthermore, to fundamentally reduce the effects of economic factors on the infectious disease burden in China, it is essential to comprehensively strengthen fundamentals for prevention, detection, and control of infectious diseases in animals in China. Thus, this study has implications for policymakers developing strategies for future prevention and control of infectious diseases in China. FundingNone.
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Apr 1, 2019
Robert Garry 
Open Access