China's innovative national plan to combat fungal diseases and antifungal resistance
It was estimated that, worldwide, over 6.5 million people are afflicted with invasive fungal diseases and that these diseases directly contribute to more than 2.5 million deaths each year.1 However, threats posed by fungal diseases remained largely underrecognized on the global scale. To address the deficiencies, concerted efforts have been made to combat fungal diseases and antifungal resistance. For instance, the World Health Organization (WHO) released the first-ever fungal priority pathogens list (WHO FPPL) in late 2022,2 which is considered a game changer in leading the overall response to this crisis globally.
China is among the earliest countries responding to the WHO’s global action plan on antimicrobial resistance and has made significant strides since releasing its first national action plan in 2016.3 In October 2020, the country promulgated its first basic and overarching law in biosafety: the Biosecurity Law of the People’s Republic of China. It is worth noting that the law stipulates tackling antimicrobial resistance, including antifungal resistance, as one of the eight major biorisk categories for regulation, which further strengthened the country’s top-level design for addressing the critical concerns.4 In November 2022, thirteen national ministries of China jointly formulated the second National Action Plan for Containing Antimicrobial Resistance (for 2022–2025), and one of the significant advancements in this plan is the explicit descriptions of addressing fungal diseases and antifungal resistance challenges as a crucial component of future national actions.
As a milestone toward implementing the plans, the National Health Commission of China announced the establishment of the China Fungal Disease Surveillance System (CFDSS) in May 2019. Building on previous efforts (e.g., the CHIF-NET program),5 the CFDSS has five main responsibilities: (1) monitor the epidemiology and resistance of fungi pathogens and clinical consumption of antifungals in China; (2) implement real-time surveillance, early warning, and control measures to address high-risk fungal pathogens and outbreaks of fungal diseases; (3) lead research on fungal diseases, including pathogenicity, transmission, and resistance mechanisms of fungal pathogens; (4) evaluate the economic burden of fungal diseases and antifungal resistance in China and propose preventive measures and recommendations; and (5) develop guidelines and technical specifications for laboratory and clinical practices, ensuring the quality of medical mycology laboratories, and promote the standardized development of laboratory diagnostics. The ultimate goal of the CFDSS is to strengthen China’s overall response to fungal diseases through comprehensive improvements in prevention, diagnosis, treatment, and control.
