China has a long history of contagious infections that have ravaged its population. The 1957 Asian Flu, 1968 Hong Kong flu, and 1977 Russian flu all had their origins in China. In mid-November 2002, a mysterious virus (SARS-CoV) was first detected in Foshan city of Guangdong province. Because of the information blackout that characterizes Chinese society, news about the SARS epidemic was not made public until February 2003. Even after making a public announcement about the outbreak, the Guangdong provincial government underplayed its severity, by claiming that the epidemic is under control. The Ministry of Health (MOH) also failed to act decisively despite being informed about the epidemic outbreak in Guangdong, as early as January 2003. While the MOH notified the World Health Organisation (WHO) about the outbreak without any delay, WHO officials were denied field access by the Guangdong provincial government until April 2003.
In a similar cover-up, the Beijing municipal government kept the news about the local SARS outbreak under wraps until the end of the National People’s Congress (NPC) session in March 2003. It was only after a retired surgeon from Beijing’s PLA 301 hospital exposed the cover-up did the central government take decisive action. Faced with a severe crisis of legitimacy immediately after assuming office, President Hu Jintao promised more openness in reporting on the epidemic. By the time China brought the epidemic under control in August 2003, the SARS-CoV virus infected more than 5000 people and caused 349 deaths.
Post-SARS Reform in China
In 2003, the Chinese government was completely unprepared for the SARS epidemic. SARS exposed various deficiencies in China’s existing framework for disease prevention and control, information collection, epidemic reporting, and emergency response. A new round of reform was immediately launched in response, which was aimed towards establishing a sound public health system with disease control and prevention, health supervision, and emergency response as priorities. Thus, in the post-SARS era, public health was once again taken seriously by the Chinese government signaled by a manifold increase in public health spending.
A series of response plans, laws, and regulations related to epidemic emergencies were promulgated. Firstly, the Law of Prevention and Treatment of Infectious Diseases originally enacted by the People’s Congress in 1989 was amended in 2004 to include SARS in category B. It also specified measures to be taken by the public health institutions in the event of public health emergencies. The law also placed legal responsibilities on health authorities in disease surveillance and reporting. Secondly, the Regulations on Contingent Public Health Emergencies were promulgated by the State Council in May 2003. The regulations mandated the development of contingency plans to deal with health emergencies. Thirdly, the Emergency Response Law adopted in 2007 empowers the State Council or the NPC Standing Committee to declare a state of emergency when serious health emergencies occur.
In anticipation of a future pandemic, China reinforced its disease prevention and control, and public health emergency response systems, covering urban and rural areas, with the help of financial support from both national and local governments. With regard to early warning, an infectious disease reporting system was put in place that would enable any local hospitals to report directly to Beijing about a possible epidemic situation. The reporting system, which became operational in 2004, aimed to prevent reporting delays that had hampered the Chinese response to the SARS epidemic. However, on the political side, initial promises on media freedom and more openness did not translate into a marked change in the Chinese political system.
China’s Response to SARS and Covid-19
Here are the parallels between the Chinese government’s response to the current COVID-19 outbreak and the SARS outbreak of 2003. In both the cases, the provincial government initially took measures to sweep things under the rug, and was therefore slow to report on the outbreak of a new infection. Therefore, in both instances, the responsibility to draw the attention of the central government to the imminent health crisis fell upon the whistleblower community. During both the epidemics, the center’s reaction to bureaucratic inaction was to remove the top officials from their positions. In 2003, then Minister of Health, Zhang Wenkang, and the Mayor of Beijing, Meng Xuenong, were replaced. In a similar turn of events, recently, the Hubei’s health commission, chief Zhang Jin and director Liu Yingzi were axed for inaction with respect to the impending novel coronavirus epidemic. Though China starkly failed on the reporting side, significant improvements were seen on the response side to the Covid-19 epidemic. Since the beginning, China was seen to have well-coordinated its epidemic responses with the WHO. Unlike in 2003, it rightly identified the origin of disease, quickly sequenced its genome, and immediately shared it with the global community. Though strict quarantine measures and large scale mobilization played the key like in the past, the recent Covid-19 epidemic saw the efficient use of artificial intelligence, big data, facial recognition, drones, and other mass surveillance technologies. All these measures enabled China to quickly bring the outbreak under control. On the prevention side, the Chinese pharmaceutical companies are already in the race to discover a vaccine for the novel coronavirus.
China’s Early Warning System and COVID-19
Just last year, Gao Fu, Director of the Chinese Center for Disease Control and Prevention (China CDC), claimed that “viruses like SARS could emerge anytime, but there will never be another SARS incident”. This he claimed is made possible by the well-functioning infectious disease surveillance system put in place post-SARS. However, the COVID-19 epidemic in China has proven that the system is not fail-safe. According to Yanzhong Huang, Senior Fellow for Global Health at CFR, the “fragmented authoritarianism” model of the Chinese political system, as posited by Lampton and Lieberthal, as the reason behind obstructions to information flow and lack of interdepartmental cooperation during a health emergency. The problem is also compounded by the “reward system” put in place in the post-Mao era. Therefore, Huang argued in 2004 that absent of a fundamental change in the Chinese political system; it is likely that cover-up and inaction will be repeated in the future. As the Chinese political system has changed very little since 2003, it is no wonder that Huang’s prediction has come true even in 2020.
*** The author is currently pursuing his Ph.D. as a Junior Research Fellow (JRF) in the Centre for Canadian, US, and Latin American Studies, School of International Studies, JNU, New Delhi, India. ***