Integrated health surveillance and early warning systems in China under the One Health perspective: progress and challenges
Shanghai Jiao Tong University Journal Center
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The One Health surveillance system integrates climate, wildlife, livestock, and human health monitoring through a central hub to identify zoonotic disease spillover pathways and enable early warning and rapid public health response.
view moreCredit: Zhichao Li, Dongliang Li, Jinwei Dong, Qixu Zhu, Youyi Zuo, Juan Pu, Lu Wang, Weipan Lei, Jun Cai, Qu Cheng, Yuzhe Li, Jing Yang, Yang Ju, Zhirui Wu.
From the 2002–2003 outbreak of Severe Acute Respiratory Syndrome (SARS) to the COVID-19 pandemic, highly pathogenic avian influenza (HPAI) H5N1, and hand, foot, and mouth disease (HFMD), China has experienced multiple emerging infectious disease (EID) events that have profoundly impacted public health and society. These outbreaks have underscored the urgent need for early detection, surveillance, and effective public health responses to prevent and control the occurrence and spread of EIDs. In the face of these increasingly complex health threats, traditional single-domain surveillance networks have proven inadequate. In the systematic review titled "Integrated health surveillance and early warning systems in China under the One Health perspective: progress and challenges," a research team from more than 10 institutions outlines the "environment–animal–human" integrated health surveillance and early warning framework that China is constructing. This framework aims to break down data silos between meteorological, wildlife, livestock, and human health sectors, enabling early warning, precise monitoring, and coordinated responses to public health emergencies—particularly zoonotic diseases.
Current structure of China's surveillance system
Meteorological monitoring network: Based on the Global/Regional Assimilation and Prediction System (GRAPES) model, the China Meteorological Administration has established a comprehensive numerical prediction system. This system includes global deterministic forecasting, regional ensemble forecasting, high-resolution mesoscale forecasting, and specialized typhoon forecasting, providing early warnings for climate-related health risks.
Animal disease surveillance network: The National Forestry and Grassland Administration has established 742 national terrestrial wildlife epidemic source and disease monitoring stations across the country, forming a multi-level surveillance network. The Ministry of Agriculture and Rural Affairs conducts systematic monitoring and compulsory vaccination for livestock and poultry through national, provincial, municipal, and county-level veterinary agencies.
Human disease surveillance network: China's National Notifiable Infectious Disease Reporting System (NIDRIS) was launched nationwide, enabling real-time online reporting of notifiable infectious diseases. Building upon this, the China Infectious Disease Automated-alert and Response System (CIDARS) automatically detects abnormal signals based on historical data models and sends alert messages to grassroots disease control agencies.
Challenges and data barriers
Despite its extensive scale, the current system faces multiple challenges: inefficient data sharing mechanisms and persistent information barriers between departments; insufficient real-time early warning capabilities, especially in remote areas where monitoring technology and equipment lag; low integration of technical platforms, with meteorological, animal, and human health surveillance largely relying on independent systems, lacking intelligent comprehensive analysis and warning capabilities. Additionally, professional training, public participation, and cross-departmental policy coordination require strengthening.
Pathway to the future: building an Intelligent Integrated Early Warning System
The study outlines a clear upgrade path:
Enhance multi-source surveillance capacity: optimize the existing infectious disease reporting system, with the goal of establishing a comprehensive online reporting network covering all medical institutions by 2030. The surveillance scope will be expanded to include vectors, host animals, and environmental risk factors.
Advance digital intelligent early warning: develop a national integrated platform for disease surveillance, early warning, and emergency command. Utilize big data, artificial intelligence, and cloud computing technologies to develop models for anomaly detection, outbreak prediction, and decision support.
Strengthen technical and human resource foundations: establish interdisciplinary expert teams, enhance laboratory testing capacity (aiming for BSL-3 laboratories at the provincial level and BSL-2 coverage at the municipal level), and provide cross-departmental "One Health" joint training for frontline personnel.
Reinforce governance and international cooperation: strengthen government leadership and clarify cross-departmental responsibilities, prioritize investment in high-risk regions and critical infrastructure, and enhance global health security collaboration through data sharing, joint surveillance, and personnel exchanges with global and regional partners.
Bridging concept to practice
Currently, China is exploring the establishment of a National Intelligent Syndromic Surveillance System (NISSS). This system aims to integrate diverse real-time data streams—including hospital information systems, internet data, and multi-sector information flows—and employ geographic information systems and artificial intelligence analytics modules. The goal is to achieve early assessment and warning of potential outbreaks before cases receive laboratory confirmation.
Learning from experiences in responding to outbreaks like SARS and COVID-19, China is committed to transforming the "One Health" concept from an academic idea into operational surveillance and early warning infrastructure. This path toward a more resilient public health system is not only crucial for China but also offers a reference for integrated solutions to complex global health threats.
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Science in One Health
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Integrated health surveillance and early warning systems in China under the One Health perspective: progress and challenges
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