Experts called for strengthening the testing capabilities of grassroots health institutions to improve the country's response to epidemics.

Although China has established a wide network to report epidemics, its functions and roles are restricted by limited abilities to detect and test at the grassroots levels, according to speakers at the Health Emergency Response Forum in Beijing on Nov 28.

After the SARS outbreak in 2003, China established an Internet-based network of epidemics report in January 2004, covering almost all of its public hospitals in both urban and rural areas.

All the hospitals in this network must report to the China Center for Disease Control and Prevention the 39 epidemics singled out by the Law on Epidemic Prevention and Treatment.

"The network covers all public hospitals at the county level and above, and covers almost 95 percent of the township-level healthcare centers. It allows a healthcare institution to report epidemic cases directly to the China CDC," said Wang Liping, an official of the Center of Public Health Information Inspection and Service under the China CDC.

But Yang Weizhong, deputy director of China CDC, said that the network needs to strengthen its function at the grassroots level of early detection.

"The success in early detection depends very much on whether doctors at grassroots levels can diagnose the disease correctly as an epidemic case that needs to be reported immediately."

But Yang said only those large hospitals in cities are well-equipped to determine the pathogen of the epidemic by examining the sample.

"Only a very small proportion of the epidemics reported annually have gone through laboratory detection," he said. "For others, doctors rely on clinical diagnosis to determine the disease."

Wang said the practice could delay the report of epidemic outbreaks.

For example, "we receive many cases of infectious diarrhea from grassroots hospitals, but the cause of the disease is not specified", Wang said. "In case the diarrhea is caused by cholera, it could end up with delaying the report of the epidemic."

The lack of laboratories at grassroots levels poses a challenge to detect and respond to severe epidemics in a timely manner.