Science’s COVID-19 reporting is supported by the Pulitzer Center.
Virologist Shao Yiming, chief expert on AIDS at China’s Center for Disease Control and Prevention (China CDC), sees the COVID-19 pandemic through the lens of HIV. A stint at the global program on AIDS at the World Health Organization (WHO) in 1989 led him to help set up a network to track genetic variation in HIV, and the project grew into an international resource. He remembers well the conspiracy theories that for years swirled around the origin of the AIDS epidemic, with accusations hurled at everyone from top researchers to the U.S. military. As a vaccine researcher for more than 2 decades, he intimately understands the difficulty of transforming an idea into a product. And he has seen up close the high costs of misguided responses to HIV in China and other countries.
That background has given Shao a broad perspective when it comes to seeing the similarities—and differences—in how nations, including China and the United States, have responded to the current pandemic. He is unabashedly proud of China’s response to COVID-19 and rejects many criticisms by outsiders. But he also recognizes the real tensions that have emerged both within and between nations over information sharing, transparency, and response tactics—as well as the cultural differences that might be fueling them. “Each country has a different culture,” he recently told ScienceInsider by phone from his Beijing office. “The Chinese do not like face-to-face confrontation. In Western countries, you do everything frank.”
ScienceInsider requested an interview with Shao in March. On 10 May, he offered to provide “independent observations on the Chinese and global control efforts and compare their differences.” This interview has been edited for clarity and brevity.
Q: What’s the situation in Beijing right now?
A: I can go out at any time of day, and I go to work regularly. There’s no restriction at all except on travel. If I visit other parts of China, I have to be quarantined for 2 weeks. I don’t want to stop working so I don’t visit other provinces. We have traffic again and air pollution. Restaurants are open, but you can’t use your own chopsticks when you share dishes. The new normal is people social distance 1 meter with a mask, but if you are alone in the park, you don’t need to wear a mask. Big meetings are still prohibited.
Q: China’s ahead of the rest of the world in terms of responding to COVID-19, so a big question outside of China is how do we best control this without lockdowns?
A: You have to do early finding of cases, which means measuring temperatures all the time, and you have to do an epidemiological investigation and contact tracing of each case within 24 hours. Prevention has to focus on old people and nursing homes, key personnel, larger factories, pregnant women, and university and school campuses. Scale up testing: Testing is going up in China, even though there are no more cases. In order to guarantee a safe opening, you need to test more people.
Q: How do you do such large-scale contact tracing?
A: To help at China’s epicenter, Wuhan, and in its province, Hubei, our CDC network formed 1300 epidemic investigation teams, in addition to the 40,000 doctors and nurses. We also use very clever tracing tools with big data support. Everybody has a smartphone, and you have to have this health card in your phone, it has to be with you. We don’t need to interview people and ask them to remember where they went. This is the new normal: If you travel or come in contact with a case, your health card will switch from green and become yellow or red. When you reach a new city, at the train station or the airport, you have to show your health card is green. That’s how we do very good contract tracing in China, and that’s how you control the virus.
Q: In the United States, we don’t like the type of intensive surveillance that China does. We think that takes away our individual rights and privacy.
A: But you have done that for almost 20 years because of 9/11. Whenever I go to the United States, I have to give your customs agent 10 fingerprints and two irises into the camera. I cannot understand why U.S. customs wants 10 fingerprints. Why not two? And including my two irises?
Q: But we don’t track people with GPS on their phones and give them a green-yellow-red system. We don’t have state surveillance the way China does—we reject that.
A: Any technology can be wisely used and could also be misused. I think China is careful in how it uses that technology.
Q: When you look at the United States today, what do you think about the way we responded?
A: You have responded very badly. You didn’t really have a response at the beginning, or even for a few months in some states, for reasons I could not understand. In China, on the last day of last year there was a report of a pneumonia cluster in Wuhan, the first week of January it was identified as a novel coronavirus, and on 23 January, we locked down the city of 11 million people and soon the rest of Hubei—a province of nearly 60 million. Maybe because we experienced severe acute respiratory syndrome, the memories are still there. Maybe we saw that the people’s lives are more precious than the economy.
We have done modeling work. If we locked down 1 week later, we would have had about a sixfold increase in infected cases and a 16-fold increase in deaths. If we locked down 4 weeks later, the number jumps to over 30 million infected cases, and over 3 million deaths. We prevented these tragic things from happening and saved a lots of lives. You had a much longer time to respond.
Q: Many people outside of China think the country in the early days was not honest about the problem, punishing doctors who spoke out, not promptly sharing the fact that there was a new coronavirus, delaying the sharing of the viral sequence, and hiding the fact for weeks that there was human-to-human transmission. What do you think of those criticisms?
A: The first three cases of unknown pneumonia were reported by Dr. Zhang Jixian on 27 December 2019. The Wuhan city government conducted an epidemic investigation and announced 27 cases of pneumonia with an unknown cause. On the 31st, the city informed the public to avoid gathering and to keep social distancing, and China’s National Health Commission informed WHO’s China office. Since 3 January, China has had regular epidemic briefings with WHO in Geneva and with other countries.
China was the country hit first, and when you’re first, you move from unknown to known, and then known to reaction. This takes a much longer time: You first have to rule out other known viral and bacterial pathogens from the clusters of similar pneumonia. You have to understand what’s happening and invest a lot to identify the unknown pathogen.
For all the other countries it’s totally different, since they started with a known disease and preliminary knowledge about how to control it. Even if you insist on saying China delayed for 1 or 2 weeks, other countries have had delays of 4, 6, and even 8 weeks. We should count time with the same scale, not 1 day as a week for China and 1 week as a day for others.
Q: Why did China delay sharing the sequence of the novel coronavirus?
A: When you share that with the world you need to confirm it is accurate. They had to sequence several samples to make sure. A single scientist’s finding cannot be used. Usually in China—as is common practice around the world—for all new pathogens, we have to ask two additional institutes to repeat the results and verify them. We have independent institutions in China, so the ministries have to ask the two independent institutions outside the Ministry of Health to confirm. This all takes time.
Remember, the first reported cases only came in on 27 December, our scientists in about 2 weeks obtained the initial coronavirus signal, isolated live virus, confirmed it as the COVID-19 pathogen and shared the full-length sequences with the world.
Q: WHO currently lists eight COVID-19 vaccines in clinical trials and four are made in China. Of these, three are using the old-fashioned inactivated approach that “kills” the entire virus and mixes it with an immune-boosting adjuvant. Why is China attracted to inactivated vaccines, when Europe, the United States, and Australia are so attracted to more high technology approaches?
A: The inactivated approach is only one of five approaches being developed in China, but it’s promising because its development moves faster than building a viral vector or using recombinant technology to engineer a subunit protein. China’s regulatory agency still requires moving step by step with careful review.
Q: When do you think there will be a vaccine that’s proved safe and effective? Do you think China will be first?
A: Maybe China will be the first with the inactivated vaccines. There are four companies making them, and they can quickly scale up production and provide enough quantity to the whole world. That’s not a problem. But how do we quickly test the vaccine? Maybe we cannot do it inside China because there aren’t enough new infections to determine whether it works, so international collaborations are extremely important.
Q: Is there a discussion in China about the human challenge model that intentionally attempts to infect vaccinated volunteers?
A: No, no. We have never done one in China. With up to a 5% case mortality, I don’t expect that a challenge trial will pass ethical review.
Q: Do you know of any Chinese research groups that are looking into the question of the origin of the virus? There are many studies that could be done with stored samples of nasal swabs, testing at animal farms, and other traditional ways of looking at origin questions.
A: Different research institutes and the China CDC have mobilized a task force.
Q: One big topic in the United States right now is whether the Wuhan Institute of Virology was the origin of this pandemic. What’s the reaction in China to the U.S. government blaming that institute?
A: Before your politicians began attacking the Wuhan institute, Chinese people were the first group to challenge the Wuhan institute scientists. There are conspiracy theorists in China too. The institute’s geographical location is very close to the seafood market [where an early cluster of cases surfaced]. And there also happened to be a biosafety level-4 (BSL-4) lab there. [BSL-4 labs are for the most dangerous pathogens.] For ordinary people with limited information and knowledge of science, when they are in danger, they are afraid, and they become curious about conspiracy theories. This is understandable. But for a government and top officials with lots of good information to say this? I can’t understand that. We should stop all these conspiracies and we should focus on fighting the virus. We should reunite the world’s efforts to monitor to these viruses at a global level.
Q: Do you think international collaboration has been harmed by COVID-19 and the politics?
A: I think so. Unfortunately.
Q: Do you think China should allow an international team of scientists to come to China to help do origin investigations?
A: When we have the resources and the time, when the epidemic has calmed down, why not? International collaboration should be continued. We are totally open for international collaboration on research. Since the origin of many emerging viral diseases are not clear, these types of international research investigations can prevent future epidemics.
Q: There’s a sense that China’s not open about allowing research to occur into the questions of origin.
A: No, no, no, that’s not correct. This is very unfair to say China is not open. China is quite open for international collaboration. My experience is that some other countries are not open. The U.S. Centers for Disease Control and Prevention had a fixed office at the headquarters of China CDC. U.S. scientists working in China CDC had a pass, and they could get into any place in China CDC—there were no restricted areas. About 1 year ago, the United States cut the budget and they withdrew their team in China CDC. They had been there for nearly 20 years. We never had a chance to put a China CDC office in the U.S. CDC. We are not allowed.
Q: When U.S. scientists wanted to come from CDC and the U.S. National Institutes of Health, the Chinese government didn’t welcome them. And it took a lot of negotiations with WHO to create a visiting team of international scientists. This was high-level politics and it was not welcoming to outside scientists. It was very restricted.
A: This is not really true. At the beginning, the U.S. CDC wanted to send a team, and in my view it was not a proper request. It’s like the U.S. CDC was a professor and China was the student—they were not equal. When students have problems, the professor has to come help. These are equal agencies that are guiding the health of two big countries. We also were so busy at the beginning—it’s like the house was on fire. The U.S. guests who wanted to come at that time could not provide substantial help. They just wanted to know information, and they could get that information on the regular telephone conferences we held about COVID-19 control since early January.
Q: Part of the concern about not welcoming international scientists early is linked to the origin investigations. The seafood market in Wuhan was shut down and disinfected without the sort of rigorous sampling of animals that researchers wanted to see, and there wasn’t a clear epidemiological study of the earliest cases and how they linked to each other. To this day, those data don’t exist.
A: We cannot blame the local government and say they did a bad thing. As an emergency response, they shut down this infection source to prevent its further spread, and that was the top priority—research is second, maybe third. If they had enough human resources to do three things at the same time it would have been better, I agree. But every market has regulations. They have to register where every animal comes from, and they have to keep records, which are still there, so we can trace back to the source of the animals sold in the market. The possibilities are still there.
Q: One big difference between China and the United States is that we criticize very strongly the mistakes that our leadership makes. Journalists, doctors, and other dissenting voices in China were silenced. It’s not a question of one culture versus another. It’s a value that this is right or wrong, and I think that’s a tension that the outside world has about China. Truth is truth.
A: I totally agree that truth is truth. But aside from cultural differences, if you look at the local response in Wuhan, many people were not satisfied—there’s a lot of criticism on the initial responses at the local level on Chinese websites. A huge amount. And the central government immediately took over the leadership and removed the top officials in both Wuhan and Hubei province. Nobody is perfect. No government is perfect. No country was well prepared for the COVID-19 pandemic.
Q: What’s your vision for the future?
A: We need a stronger global health surveillance network, and we need to build a health emergency task force at the global level. The United Nations after World War II created a peacekeeping force to work with the Security Council to control wars and maintain the peace in the world. But nowadays, conventional war is not the top danger of mankind anymore. Emerging and re-emerging epidemics are. Prevention is the most effective way to fight epidemics, not the rescue plan afterward. We have to get ahead of viruses, and today, we’re behind them.