Responding to Disease Outbreaks: Is China’s Move Toward Greater Transparency Irreversible?

Yesterday, I testified before the Congressional-Executive Commission on China (CECC) at the  “Food and Drug Safety, Public Health, and the Environment in China” hearing. My testimony focused on China’s response to public health emergencies. As the H7N9 virus appears to be burning itself out, the consensus among public health scholars and practitioners is that China has been much more transparent and open in handing this outbreak than it was in 2003 during the SARS epidemic. In fact, WHO Director-General Margaret Chan thanked China for their speed in sharing relevant information.

There is no doubt that China has made tremendous progress in building core capacities to detect, assess, notify, and respond to public health emergencies. After SARS, China constructed the largest infectious disease surveillance and reporting system in the world and put in place a legal framework aimed at releasing disease-related information in a timely, accurate, and comprehensive manner. Launched in 2004, this Internet-based disease reporting system has enabled hospitals and township health centers to directly report suspected disease outbreaks to central health authorities. Meanwhile, a civil society supported by the spread of social media is increasingly having its voices heard and its action felt in China’s policy process. The growing online vigilantism through Weibo (microblogs) is now powerful enough to force the government to be more responsive to people’s demands for transparency and openness in addressing major disease outbreaks.

But does this mean that China is moving toward greater and irreversible transparency?  My simple answer: not necessarily. At least three factors could derail the process. First, as shown in the H7N9 outbreak, most localities in China still do not have the capability to correctly and swiftly identify emerging infectious diseases. The central-local gaps in epidemiological and laboratory capacities, when coupled with an authoritarian political structure, could contribute to sustained cover-up (intentional or not), underreporting, or misreporting at the sub-national level. Second, as health is increasingly viewed as a “high politics” issue on the government’s agenda, responses to public health emergencies could be hijacked by prominent domestic political concerns, which thankfully have not happened in the current outbreak. However, in 2009 during the 60th anniversary of the founding of the People’s Republic of China, health authorities covered up H1N1 fatalities and stopped updating the disease information until the celebration was over. Third, despite the recognition of the importance of civil society groups in addressing public health emergencies, the government continues to impose constraints that made their engagement in disease surveillance difficult. Most of the health-related NGOs are focused on HIV/AIDS prevention and control. Without an effective civil society to gather information and demand accountability, both upward and downward information flows could still be intercepted or distorted in the bureaucratic hierarchy.

If you would like to learn more about China’s ability to respond to major disease outbreaks, take a look at Chapter 4 of my new book, Governing Health in Contemporary China, which Routledge has kindly made available for download here.