How to prevent another outbreak.(how well has China absorbed the lessons of SARS?)

At this time of the year, the animal markets in southern China's Guangdong province are usually crowded with civets, raccoon dogs, snakes and even kittens, destined for local restaurants. Entrees in this part of the world are traditionally kept alive until moments before they land on the dinner table. The practice would be nothing more than a cultural curiosity if it weren't so bad for the world's health: animals and humans living in such close quarters tend to pass around viruses until, once in a while, one turns into an epidemic. Last year one virus happened to cause severe acute respiratory syndrome, or SARS. By the time the world took notice--in March--this new bug had slipped into the countryside, through the airports of Beijing and Hong Kong and beyond.

Now southern China, the world's most efficient virus factory and ground zero for most of the globe's influenza epidemics, is revving up for another cold and flu season. This year, though, SARS has lost the element of surprise. Health authorities are so intent on spotting signs that they're getting skittish. When a Taiwanese man returned last month from a trip to the mainland running a fever, hospital officials put him in isolation. It was a false alarm. But most health authorities agree that a return of SARS this year is all but inevitable. In fact, one official at the World Health Organization lost a $64 bet when the disease hadn't resurfaced by Nov. 18.

Such pessimism might seem surprising. After all, most health workers around the world dealt swiftly and effectively with last year's pandemic. They showed how vigilance, responsiveness and good communication pay off when dealing with a global disease. The wild card this year is China. Of the 774 people who have died of SARS, three quarters lived in mainland China; if SARS is lying dormant, awaiting cold weather and the runny noses that come with it to make a comeback, China is the most likely starting point. How well has this vast country absorbed the lessons of SARS?

Chinese authorities couldn't do worse than repeat last year's performance. Even as SARS patients were inundating emergency wards throughout the country last winter, Beijing withheld information from WHO officials and forbade doctors and other health-care workers to talk publicly about the disease. Since then, "cooperation has been remarkably good," says the WHO's Beijing representative, Dr. Henk Bekedam. China's leaders seem committed to preventing a new outbreak. The new Health minister, Wu Yi, impressed international health officials with her willingness to reform China's woeful health-care system. To prevent the chaos that marked Beijing's handling of the SARS crisis last year--authorities actually worked against the provincial hospitals by insisting that the new illness posed no threat--Wu worked closely with WHO officials to set up a new surveillance network. Three regional labs collect virus samples and track SARS cases with new software.

No doubt China is better prepared to fight SARS than it was six months ago. It's probably also better equipped to fight influenza, AIDS, tuberculosis and other diseases. Last year's SARS outbreak forced China to address weaknesses in its health-care system--particularly in research, monitoring and treatment--that should help it deal with other deadly diseases. That comes as a huge relief to the country's long- suffering neighbors. "China is key in global influenza surveillance," says Dr. Klaus Stohr, head of the WHO's influenza team.

Improvements in data collection are helping China stop the flu and other bugs from migrating across its borders. In April, for example, the mainland cooperated with Hong Kong and Macau to build a reciprocal reporting system to track diseases. In June, officials in Guangdong province used this system to alert Hong Kong to a Japanese encephalitis outbreak. At a regional conference last month ...