PARIS, May 15 (AFP) - "An ounce of prevention is worth a pound of cure" is a simple and ancient proverb, but for China the message is new and has been learnt at a terrible cost.
Just a modest investment in old-fashioned public health a decade ago, while it was dashing headlong for prosperity, would have given China several important barriers against SARS, sparing it a catastrophic blow to prestige and a bill that will ultimately be in the billions of dollars.
China's lethal combination has been national pride and knee-jerk secrecy, a rickety health information network and pitifully inadequate resources for identifying and isolating carriers of Severe Acute Respiratory Syndrome (SARS).
On the front line of China's SARS war are a lack of hospital beds and isolation wards, a paucity of trained doctors and an epidemiology network without any reliable data for tracking an infectious disease.
Worse, the soaring cost of healthcare deters many poor people from seeking help until they become extremely ill, and this helps spread the virus in homes, offices, trains, buses and factories.
"The Chinese government has not invested in public health and in primary care for 20 years. In particular, it has let its rural health care collapse... rural doctors have become drug peddlars to earn a living," William Hsiao, a professor at Harvard School of Public Health, told AFP.
"China could have done more, but not in fact on the high technology end. It's basically in cleanliness, hygiene, public health and on its reporting system that China could have done more...
"[If it had invested in those areas], it could have taken much earlier action to quarantine people. It could possibly even have prevented the development of SARS if it had inspected its food sources more carefully."
In 2000, China spent 5.3 percent of its gross domestic product on health, compared with around 8.0 percent in rich countries, where the biggest spender is the United States, with 13 percent.
Even those figures understate the true gravity of the situation. Most of the money went to the minority of people who live in China's cities and on providing curative care rather prevention, say experts.
"There's no question to me that there has been underinvestment in the [Chinese] health system in the last 25 years," said Siri Tellier, chairwoman of the United Nations Theme Group on HIV/AIDS in China.
China is now harvesting the bitter fruit of this policy, in terms of damage to industrial production, political and social turbulence and loss of confidence in the country as a serious place for investment.
But the problems raised by SARS are not exclusive to China.
Developing countries on a similar level, such as India and Indonesia, are not significantly different in their spending levels or priorities, Hsiao stressed.
In poor nations, basic challenges such as primary healthcare, sanitation and clean water are chronically ignored -- but the bill always come in.
After all, goes the reasoning, if there is no threat from a novel disease like HIV, why spend money on public-health messages about safe sex? And why invest in setting up an effective epidemiology network, given that it will be redundant except at times of crisis?
The most obvious answer: it makes economic sense to do so.
"It's not something that developing countries can safely ignore," said Malcolm Law, a professor at the Wolfson Institute of Preventive Medicine in London.
In sub-Saharan Africa, economic growth has fallen by between two and four percent as a result of AIDS, and the continent would have been about 100 billion dollars wealthier today if malaria had been tackled 30 years ago, when effective control measures first became available, according to UNAIDS and World Health Organisation (WHO) figures.
In rich countries, too, preventive medicine is a country cousin, losing out against revolutionary surgery or genomics in the battle for the health dollar.
True: In the United States, Western Europe and Japan, the richly-funded surveillance and treatment systems have responded so well that there has not been a single death from SARS. Life has carried on without any panic or economic disruption.
But these countries have no cause for complacency.
HIV and mad-cow disease are among the disorders that have slipped through their net, eventually inflicting a huge toll in human misery and economic damage.
And the example of Canada shows how even a rich, well-prepared country can be vulnerable in the era of fast travel. The SARS outbreak in Toronto is likely to cost the city at least 350 million US dollars, according to local forecasts.
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