The indirect causes of the logic failure of village pandemic prevention and control are the inadequately equipped teams in the rural pandemic prevention system. For example, village-barefoot doctors are growing older and gradually withdrawing from front-line health work. Young college graduates are unwilling to stay in the countryside, and there is a shortage of talent in rural areas. In 2018, doctors aged 60 or older represented more than a quarter of rural doctors in China and even 80% in some townships, and only 5% of rural doctors were under 35 years old. Moreover, the phenomena of low medical history, low professional title and low professional level are common among village healthcare personnel. In 2018, only 15% of personnel had a bachelor's degree or above. Rural doctors account for more than 1/3 of the grassroots medical staff, and they are the main force of rural grassroots health prevention and control by virtue of their familiarity with villagers. However, it is undeniable that elderly grassroots medical workers offer little support for the prevention and control of infectious diseases. Elderly individuals are susceptible to COVID-19, and the probability of cross infection is high in the process of door-to-door service. Second, elderly village doctors find it difficult to operate the many new information technologies for prevention and control, which reflects the deep weakness of the rural public health system.
The prevention and control of the pandemic ultimately needs the establishment of a multidimensional and deep governance system. In the post-pandemic era, the reconstruction of multiple prevention and control strategies and promotion of the modernization of public healthcare governance are important to address many risks in the future. It is suggested to reform the medical service supply system in rural areas, improve the emergency response mechanism for major public health events and strengthen health publicity and education.
During the outbreak of a major pandemic, the efficient and orderly operation of medical emergency treatment systems is very important to improve the admission rate and reduce the infection rate and mortality. Primary medical institutions, as basic public health services in China, are responsible for the reporting and management of infectious diseases and public health emergencies. Therefore, it is necessary to consolidate the "gatekeeper" role of primary medical institutions. In the case of major public health emergencies, the hierarchical diagnosis and treatment system should be enforced, the medical order should be optimized, and hierarchical, separate treatment should be implemented. Therefore, it is necessary to increase investment and strengthen the construction of primary medical institutions. First, in the construction of primary medical institutions, pre-screening triage and fever clinics are necessary to undertake the functions of disease screening and patient classification management during health emergencies. Second, the use of electronic health records and the grid management of residents' health and the cooperation between the community and pandemic prevention and control institutions can support community pandemic prevention and control.
Second, it is important to strengthen the public health function of medical institutions, promote the linkage of prevention control treatment and develop synergistic effects. Medical institutions themselves are also an integral part of the disease prevention and control system. They are responsible for the monitoring, reporting, emergency treatment of infectious diseases and public health issues, and prevention and control of infectious diseases in their responsible areas. Unfortunately, these public health functions have not been strictly defined at the legal level and have not been emphasized in the reform of public hospitals. The awareness of infectious disease prevention and control of medical institutions and clinicians needs to be strengthened; moreover, the medical service system and the public health system lack regular joint working mechanisms. Therefore, the public health function of the medical service system should be strengthened and supplemented by incentive mechanisms. Moreover, it is necessary to improve the communication and coordination mechanism within the public health system, realize information exchange and sharing, and build the working mode of medical prevention integration. For the prevention and control of infectious diseases and public health emergencies, the sequence of prevention, control, and treatment is formed, involving information sharing, personnel training, emergency drills, and scientific research cooperation, to develop synergistic effects.
First the unitary management pattern should be eliminated and replaced with a mechanism for public, social and market participation. In the past four decades, social forces have developed unprecedentedly and played an increasingly important role in the social and economic life in China. However, the existing emergency management mechanism is designed based on the concept of an omnipotent government, and emergency management mainly depends on the actions of the government and relevant departments. In practice, due to the poor participation mechanism, economic and social organizations and the public cannot effectively cooperate with the government but play a limited role. Therefore, the unitary management pattern must be replaced by a social governance mechanism for major public health emergencies to enable the participation of the market, society and citizens. The public, society and market participation mechanism should be established for support during major public health emergencies. It integrates vertical social integration with horizontal social cooperation under the guidance of the government. In the whole chain of emergency management, a pattern of interaction among the government, the market and society should form a mutually complementary and efficient coordination under the guidance of the government. In the prevention and control of a pandemic, mass prevention and treatment measures represent an innovative mechanism of social participation. After the pandemic crisis, these measures need to be further refined and improved to become an important part of the emergency mechanism for major public health emergencies.,2
Second, a modern emergency material reserve system needs to be built. For example, in January 2021, citizens of Tonghua City, Jilin Province, reported on major media and network platforms that the closed management was caught off guard, daily necessities and food were seriously lacking, basic life could not be guaranteed, and hotlines were inaccessible. In response to the query, at a press conference held on the morning of January 24th, Vice Mayor Jiang Haiyan of Tonghua City apologized on behalf of the municipal party committee and the municipal government for the inconvenience caused by the untimely distribution of people's living materials. This highlights the importance of addressing the shortcomings of the existing classification, establishing special reserves for various departments and scientifically determining the demand for reserve materials by category, scale and structure based on big data technology and comprehensive risk analysis. Utilizing the unified national emergency material procurement and supply system, integrating all special reserve resources, stocking emergency supplies in central locations, and improving and guaranteeing the operational efficiency of the material reserve system are important steps.
First, it is strongly suggested to build a national health education system and advance emergency management. The key to dealing with major public health emergencies is prevention. Emergency management is the most economical and effective method to build a national health education system and improve national health literacy. Health education has long been one of the important contents of public health services in China, but in practice, it is often a mere formality. Government investment should be increased and adequate funding be guaranteed to support the organizational system of health education institutions and provide health education to the whole population, and health education should be integrated into schools at all levels. Starting from childhood, health education should be strengthened for primary and secondary school students. Second, the prevention and control of major infectious diseases and emergency education should be strengthened, and publicity and education work should be normalized. In recent years, the focus of health education has gradually shifted from early infectious disease prevention and control to chronic disease prevention and health management. The pandemic represents a tragic warning: major infectious diseases have not left the stage of history. In particular, urbanization, ageing and globalization have made infectious diseases more active, and their return is inevitable. It is important to start from the source, strengthen publicity and education, improve awareness of protection, and change individuals' behaviour. Therefore, routine propaganda and education should pay equal attention to the prevention and control of major infectious diseases, chronic diseases and health management. In addition, emergency education on major infectious diseases should be strengthened to improve people's health literacy in emergencies.