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“Everybody wanted to do something,” he says.Deng had limited experience in virology,

apart from a short stint working on HIV, andhis students had even less. But like many otherscientists in China, the team saw research onSARS as both an opportunity and a duty, andset about mastering the basics — fast.

Feverish activityFor at least six months, Deng’s lab stoppedworking on stem cells and focused entirely on SARS. It wasn’t alone. Across the country,scientists trained in protein science, anatomy,immunology and biochemistry — almost any-body who could contribute in any way — wereshelving their normal projects. “Everyone wasworking on SARS,” says Deng. “You just had to.”

That commitment has paid off. AlthoughChina still faces a great many hurdles, its gov-ernment and scientific community are becom-ing better prepared to combat epidemics, saysome US scientists. Long after global interestin SARS has waned, Chinese scientists are stillpublishing important work on the disease. InSeptember 2005, for instance, one team iden-tified bats as a natural reservoir of the SARS

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Like anyone who was in Beijing in thespring of 2003, Hongkui Deng remem-bers it vividly. The Chinese governmentcould no longer deny that the country

was in the grip of a new and potentially fataldisease: severe acute respiratory syndrome(SARS). By July, the epidemic would havespread, affecting more than 8,000 peopleworldwide and claiming 813 lives; but in April,the panic was already palpable.

Normally bustling, the streets of Beijing werevirtually deserted. The few people who ven-tured out wore masks and gloves, and avoidedeven eye contact with others. Cinemas, schoolsand shops were closed. It was, as many describeit, frightening and eerie — even apocalyptic.“Everyone was scared,” Deng recalls.

Deng, a cell biologist, had returned home in2001 after more than a decade in the UnitedStates. Now based at Peking University, he waspursuing his research on embryonic stem cells.Returning from a conference in April 2003, he learnt that the mother of one of his studentshad SARS. Once officials had sprayed the lab,Deng’s students began asking if they could workon the disease that was paralysing the nation.

virus1. And in October, another group reporteda molecule that can inhibit the replication of awide range of SARS-like viruses2.

In part, the boom in China’s infectious-disease research reflects the country’s growingactivity in science. Government spending onthe sector in 2004 was up 16% on the previousyear, outpacing the country’s economic growthof about 10% per year. Since the late 1990s, thenumber of Chinese papers published in inter-national journals has risen dramatically3 andthe number of domestic patent applications hasalso gone up. But SARS was in many ways awake-up call. It served as a grim preview of thedisaster — and public humiliation — thatawaited China if it did not take infectious dis-eases seriously4.

Since 2003, two new infectious-disease insti-tutes — one set up by the Chinese Academy ofSciences, the other a joint effort with the PasteurInstitute in Paris — have been set up in China.Plans for another, a collaboration with Colum-bia University in New York, are expected to beannounced next month. Chinese scientists saythat an increasing number of students arechoosing to work in infectious disease, andmany scientific collaborations born during theSARS epidemic are still thriving. “Before SARS,scientists routinely didn’t work together,” saysDeng. “China is doing much better now.”

China is a hotbed of infectious diseases:according to agencies such as the WorldHealth Organization (WHO), hepatitis, tuber-culosis, diarrhoea, encephalitis and HIV are allprevalent at epidemic rates. And with people,

NEWS FEATURE NATURE|Vol 439|26 January 2006

OPEN SEASONSARS caught China unawares. But the ensuing struggle tocharacterize and contain the virus has put the country’s work oninfectious diseases back on target. Apoorva Mandavilli reports.

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poultry and animals of all kinds living in closequarters, there are plenty of opportunities forpathogens to jump between species.

SARS was an unknown entity when it struck,and was probably spread to people by infectedpalm civets in China’s wild-animal markets. In2005, the country also saw an unusual cluster ofinfections from the pig bacterium Streptococcussuis, which jumped from swine to infect morethan 200 people. These days, all eyes are onavian influenza, and the government hasalready banned poultry from markets andculled millions of birds in an attempt to preventthe virus from jumping to humans.

Slow startGiven such dangers, infectious-disease expertsare delighted at the changes in China. “I thinkSARS prepared the ground for being willing towork with emerging infectious diseases,” saysRobert Webster, a leading flu expert at St JudeChildren’s Research Hospital in Memphis, Ten-nessee. Looking at the way China has handledoutbreaks of bird flu, Webster says, the govern-ment seems to be much more transparent andwilling to share information than it was duringthe SARS crisis, when it denied the existence ofthe disease for several months. “There are stillproblems out there but the situation is muchimproved,” he says.

During the initial months of the SARS epi-demic, scientists on China’s mainland con-tributed little to the understanding of thedisease. Even in May 2003, weeks after virolo-gist Albert Osterhaus of Erasmus University inRotterdam, the Netherlands, and his colleagueshad identified a novel form of coronavirus asthe cause of SARS5, some senior Chinese scien-tists still refused to acknowledge that it was theculprit, backing Chlamydia bacteria instead. Infact, researchers at a Chinese military institutein Beijing had come to a conclusion similar tothat of Osterhaus as early as March, but inter-nal politics reportedly stifled their finding.

At a May meeting in Beijing organized bythe Chinese Academy of Sciences, Ian Lipkinwitnessed the disagreements firsthand. “Evenat this point, there was this argument back andforth about who was right and who waswrong,” recalls Lipkin, director of ColumbiaUniversity’s Jerome L. andDawn Greene Infectious Dis-ease Laboratory. Ultimately,several government officialswere sacked over the handlingof the crisis.

But after its initial failures —for which China was openlychastised by the internationalcommunity — things changeddramatically. Lipkin says thatan enormous medical facility,intended to quarantine andtreat those infected, was builtabout 50 kilometres outsideShanghai in just a few months.

At the May meeting, Lipkin

had presented a roadmap for the governmentto help it combat SARS, covering drugs, vac-cines and research on the basic biology of thevirus. By the time he returned to China in July,“they had virtually finished everything therewas on this roadmap”, he says. “I can’t tell youhow impressed I was. It was extraordinary.”

The government also realized the need forcooperating both with the international healthagencies and with its own scientists. The min-istries made special concessions. They createdfunding pools, extended grants that wereabout to expire and forgave deadlines so thatresearchers could focus on SARS.

The incentives worked, drawing some ofChina’s most successful scientists to the field.Among them was Zihe Rao, a structural biolo-gist who heads the Institute of Biophysics inBeijing. By October 2003, Rao’s team had pub-lished the structure of a SARS protein6 and hassince designed a molecule that inhibits thereplication of SARS and several related corona-viruses2. These days, more than half of Rao’s labstill works on infectious diseases. “These areemerging and re-emerging diseases. This isresearch that will be very useful,” says Rao.

Learning curveWill SARS come back? Quite possibly. Zhi-hong Hu, director of the Wuhan Institute ofVirology, is tracking the SARS coronavirus inpalm civets, looking in particular for a strainwith the two mutations required for the virusto jump to humans7. She says there is someevidence that the strain is already circulatingin farm civets, but is waiting for confirmationbefore publishing her findings.

Hu says her work is progressing slowly, inpart because research on SARS now faces moreobstacles than it did initially, which to somedegree results from a shift in government atti-tudes. At the height of the epidemic, the gov-ernment had few restrictions on who couldwork with the coronavirus. But that stopped

abruptly in April 2004, after it was discoveredthat the virus had escaped the previous monthfrom the Chinese National Institute of Virologyin Beijing. Although the lab was among the fewin China equipped to work with dangerouspathogens, the incident prompted the govern-ment to introduce strict regulations.

During the SARS epidemic, the ChineseCenter for Disease Control and Prevention(CDC) freely shared samples of the SARSvirus with various scientists, including Guo-Ping Zhao, executive director of the ChineseNational Human Genome Center in Shanghai.Zhao had never worked with viruses beforebut he and his team quickly learned enough totrack the evolution of the virus throughsequence analysis. In just four months, theyhad completed their analysis and soon after,published a paper showing the molecular evo-lution of the virus during the epidemic8. Apartfrom a crash course in epidemiology, Zhaosays the group learned to sequence virusesfrom tissue samples. This expertise, he adds,could prove useful with bird flu.

But that is if China can straighten out theremaining kinks in its research structure. Notsurprisingly, the Chinese CDC and the Min-istry of Agriculture keep a tight rein on SARSand avian flu viruses and allow only the fewlabs that have biosafety level 3 facilities to workwith them. But tissue samples, such those usedby Zhao, are similarly controlled.

“I think the key issue in China now is all thegovernment agencies,” says Zhao. The govern-ment may have learned to share more openlywith the WHO and with international experts,but it is not open enough with Chinese scien-tists, he says. “The government agencies shouldlearn how to work together with research insti-tutes,” he says. “I think Dr Webster in theUnited States knows much more informationthan I do.” That may be so, but the internationallines of communication are not trouble-free:the WHO, for example, has complained onseveral occasions that it has yet to be grantedaccess to virus samples from last year’s out-break of bird flu.

Still, Zhao and others say that they are opti-mistic about China’s growing expertise ininfectious diseases. “I think we are learning,

Researchers including Ian Lipkin (far right) discuss the 2003 SARS outbreak.

“These are emerging and re-emerging diseases. This is

research that will be very useful.”— Zihe Rao

but it’s not so easy to change inone night,” Zhao says. “Thingshave improved a lot; I hopethey improve more.” ■

Apoorva Mandavilli is seniornews editor of Nature Medicine.1. Li, W. et al. Science 310, 676–679

(2005).2. Yang, H. et al. PLoS Biol. 3, e324 (2005).3. Cyranoski, D. Nature 431, 116 (2004).4. Ho, D. Nature 435, 421–422 (2005).5. Drosten, C. et al. N. Engl. J. Med. 348,

1967–1976 (2003).6. Yang, H. et al. Proc. Natl Acad. Sci. USA

100, 13190–13195 (2003).7. Qu, X.-X. et al. J. Biol. Chem. 280,

29588–29595 (2005).8. The Chinese SARS Molecular

Epidemiology Consortium Science303, 1666–1669 (2004).

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