This article is based on an interview with Professor Zhong Nanshan, done on March 8 during his visit to Penang Institute, where he spoke at the 9th Annual Dr. Wu Lien-Teh Public Lecture and received the 4th Dr. Wu Lien-Teh Award for Leadership in Public Health, co-hosted by the Dr. Wu Lien-Teh Society and Penang Institute. The interview was originally conducted in Mandarin by the team: Pan Yi Chieh, Iylia De Silva and Ong Siou Woon.

ZHONG NANSHAN is a renowned respiratory physician and a pivotal figure in China’s public health, best known for his contributions during the SARS and Covid-19 outbreaks. His evidence-based approach to medicine and commitment to truth were shaped early by his upbringing in a medical household, particularly under the influence of his father, Zhong Shifan, a dedicated pediatrician.

Born into modest circumstances and raised by his uncle in Xiamen, Zhong Shifan excelled academically and was admitted to Beijing Medical School in 1924. During this time, he met Zhong’s mother, Liao Yueqin, a nursing student at Xie He Hospital. His discipline, precision and relentless work ethic left a lasting impact on his son, shaping the values that would guide Zhong’s career in respiratory research and public health.

One Sunday afternoon in 1937, one-year-old Zhong Nanshan and his family were at a park when an air raid alarm interrupted the peace. The outbreak of World War II had brought the Japanese army to the city, and relentless bombings soon reduced their home to rubble. Forced to flee, Zhong’s grandmother led the family to safety, eventually settling in Guiyang, the capital of Guizhou province, where they took shelter in a hospital.

In 1946, when Zhong was 10, the family moved to Guangzhou. His father was often called away late at night to treat sick children, and Zhong vividly remembers the gratitude of parents whose children recovered under his care. “My father enjoyed his achievement,” Zhong recalls. “It was my first impression that being a doctor is a respected job.”

The Power of Precision

Zhong studied medicine at Beijing Medical College from 1955 to 1960. After graduating, he began his career as a research teacher in biochemistry. During the Cultural Revolution in 1966, he was sent in a medical team to a village near the Great Wall. They encountered a child suffering from hematuria, suspected to be caused by renal tuberculosis. Confident in his diagnosis, he reported his findings to his father—who immediately challenged him. “Are you sure?” his father asked. “Many diseases cause blood in the urine.” Zhong had no answer.

His father, a man of few words, emphasised precision and proof. “Everything you say must have solid evidence. That was the biggest lesson he taught me.” This instilled in him a strong sense of discipline and precision—especially in reporting medical cases, where accuracy was crucial to prevent misinformation. Even today, he adheres to the same principle: seeking truth above all else. He believes that textbooks are not always accurate, and that true knowledge comes from firsthand observation. As he puts it, “Only believe what you have seen.”

In 1977, after China’s Open Door Policy, he was selected for overseas training. Despite having studied some subjects in Russian, he now had to master English. He first spent six months learning English in China before continuing his studies in London and Edinburgh. Writing in English was difficult, but he persisted. He wrote letters to his father, who meticulously corrected every grammatical and spelling error in red ink. At first, the corrections frustrated him, but over time, fewer red marks appeared, and his English improved.

Challenging the SARS Diagnosis

In 2003, China’s media reported that SARS was caused by Chlamydia pneumoniae and assured the public that antibiotics were effective. Zhong, however, had treated SARS patients firsthand for months and questioned this conclusion—Chlamydia does not spread so rapidly, nor does it resist standard antibiotics.

Zhong stood by his findings, and his team proceeded with their own approach to treatment. Two months later, researchers in Hong Kong and other regions confirmed the real cause: SARS was caused by a coronavirus. This experience reinforced his belief in the importance of truth. As the Chinese proverb says: 不唯书、不唯上、只唯实 (go beyond books, go beyond authority, and follow the facts).

The lesson resonated again in early 2020. On January 18, during a one-day assessment in Wuhan, Zhong and his team identified signs of human-to-human transmission of Covid-19. Two days later, he travelled to Beijing to report their findings directly to the central government. His announcement led to urgent public health measures, including mask mandates and isolation—reminiscent of Dr. Wu Lien-Teh’s strategies during the 1910 Manchurian plague.

“I insisted on telling the truth, and pushed to create this policy,” Zhong says. “As a result, Wuhan became one of the first places to implement mask protection and isolation policies.”

A Commitment To Global Public Health

Beyond infectious diseases, Zhong has dedicated decades to researching chronic obstructive pulmonary disease (COPD) and asthma. In the 1990s, he became a member of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), and contributed to the development of COPD treatment guidelines. He also served on the executive committee of Global Initiative for Asthma (GINA), working to improve asthma management worldwide.

In 2020, amid accusations from then-US President Donald Trump of bias within the World Health Organisation (WHO), the Independent Panel for Pandemic Preparedness and Response (IPPPR) was formed. As China’s representative on the WHO-organised panel, Zhong and his team spent over 10 months defining Covid-19 and outlining global management strategies. His role was to share insights based on China’s experience, particularly its emphasis on aggressive containment and protection of vulnerable populations.

Through his work, Zhong encountered numerous low-income patients who struggled to afford costly medications. This drove him and his colleagues to simplify treatment protocols and improve accessibility.

The WHO panel categorised government responses into four approaches: aggressive containment, suppression, mitigation and non-intervention. China adopted the principle of “生命至上” (Lives First), prioritising the protection of vulnerable groups and significantly reducing mortality rates. Immuno-compromised individuals received targeted safeguards, with protective measures eventually covering 20 to 30 million people.

The Science of Longevity

Zhong Nanshan highlights six key principles for a healthy body: maintaining psychological balance, exercising regularly, avoiding smoking and limiting alcohol, and eating a balanced diet—while cautioning against overeating and recommending that breakfast make up 30% of daily intake. He also stresses the importance of living in a clean, green environment, and detecting and treating health issues early (早诊早治).

He believes that following these principles can help individuals live to an average of 80 to 90 years old, while those who surpass 100 owe it largely to genetics, which account for about 15% of longevity. Reflecting on his own experiences, Zhong acknowledges the many setbacks he has faced, but sees resilience as a matter of mindset. “It’s okay to feel anxious or sad—just let those emotions pass naturally,” he says. To him, mental strength is the foundation of well-being: “Half of good health comes from one’s mindset—mental well-being is just as important as physical health.”

Even after retiring in 2018 at 82, Zhong remains active in clinical work. When Covid-19 emerged, the Ministry of Public Health called on him to lead the national expert team—a responsibility he decided to take. Now serving as the director of a national research institute, he continues to contribute whenever needed.

A Dream In Progress

Zhong Nanshan has dedicated significant time to researching COPD and asthma. One of his key findings involves potential asthma, a condition linked to bronchial hyperresponsiveness (BHR). His research suggests that individuals with BHR are more susceptible to developing asthma following a respiratory infection. While one aspect of this research has been completed, another remains a future goal.

Zhong’s ongoing mission is to reshape the global approach to COPD by emphasising early intervention. Currently, COPD management worldwide prioritises severe and critical cases, often neglecting mild to moderate patients. Unlike type 2 diabetes, where doctors intervene at the first sign of elevated glucose levels, COPD patients typically seek care only when symptoms become severe.

What happens, Zhong explains, is that both patients and physicians often overlook early symptoms, allowing lung function to deteriorate before seeking treatment. He advocates for a paradigm shift—intervening at the earliest stages to slow disease progression and improve outcome. His team is actively advancing this strategy, a mission he calls “a dream in progress”.

One of Zhong’s former students, now a WHO member, frequently reinforces this point. Some experts initially dismissed early intervention as overtreatment and an unnecessary expense. Western countries also struggle to conduct similar studies, as community-level patients rarely seek hospital care in the early stages. While Zhong acknowledges that not all mild to moderate cases require medication, he stresses that without early screening, many patients miss the window for timely care.

Despite these debates, Zhong remains committed to his vision. “My dream is that after several years, our strategy will be the leading strategy for treating COPD in the world.”

*Note: The author would like to thank Professor Zhong Nanshan and his team for their invaluable contributions to this interview.