The Chinese government is being put to the test in yet another public health crisis. But unlike with
Ebola,
swine flu, avian flu or anything else in the past decade, this looming epidemic is of a much larger scale and severity, and potentially more catastrophic. In China alone, the number of infections for this novel coronavirus has already
surpassed that of the severe acute respiratory syndrome (Sars) in 2003.
Part of the nerve-racking threat is that this virus, unlike Sars, is infectious
even during its incubation period, before symptoms present, which means infected people have been travelling and spreading the disease without knowing they have it. The mayor of Wuhan, the epicentre of the outbreak, recently
admitted that five million residents, equivalent to Singapore’s entire population, had left the city before the lockdown began on January 23.
Wuhan’s location in the heart of China, with its extensive and highly developed transport network, meant that the virus quickly spread out, right before the world’s
busiest travel season: the Spring Festival holidays. For the coronavirus, both location and timing were perfect.
Criticism of the Chinese government has mounted. Pessimists see virtually no improvement in the state’s reaction to a public health crisis; with its poor preparedness, sluggish response and low transparency, the sparks were neglected until a fire broke out. It would seem that Wuhan government officials and their superiors had committed all the “do nots” at every critical juncture.
As a public-policy scholar, I have some sympathy for them. The disaster is rooted in China’s fragmented bureaucracy, which often blurs critical command chains.
When interviewed by China Central Television,
Wuhan mayor Zhou Xianwang offered a well-known explanation for his slow reaction: information disclosure of this kind required authorisation from the central government, under the law on prevention and control of infectious diseases, and many pre-emptive measures could not be introduced until the State Council specifically asked the local government to take charge.
China has a fairly rigid system of disease prevention and control, which was strengthened after Sars. Operational protocol stipulates that any suspicious communicable disease must be reported to the upper-level
Centre for Disease Control and Prevention, which ultimately reports to the National Health Commission.
Yet, this vertical command chain is at best able to offer “professional advice”, while any political decision must be made by the horizontal command chain.
Administrative divisions are natural and exist in almost every government system. However, in China, the vertical chain, especially in health care, is usually weaker than, if not subordinate to, the territorial horizontal authorities, making it often impossible to “speak truth to power”.
Complicating this is the sheer size of China’s multilayered bureaucratic machinery. Concerns over social stability, economic performance, political careers and city image crowd out precious time on the part of local leaders in preempting a public health crisis. The Wuhan disease outbreak is a repeat of what we saw in 2003.
However, it is untrue that the Chinese government has learned nothing from that
crisis. Years of advocacy by public administration scholars to streamline the emergency management authorities bore fruit two years ago. In a major central ministerial restructuring, the Ministry of Emergency Management was founded, with most related powers consolidated. Yet public health was excluded from its portfolio, given the extensive professional expertise involved.
Ironically, the night before the capital city of Wuhan was
locked down, top officials of the province of Hubei were still enjoying their Lunar New Year gala in a closed-door auditorium, many mask-free. One cannot describe this as mere negligence.
For decades, the Chinese bureaucracy has oscillated between decentralisation and recentralisation. When combating a crisis, bureaucratic fragmentation could be temporarily eased with concerted political will from the top. A divided bureaucracy can be quickly turned into a mighty combat squad, as seen in the
2008 Sichuan earthquake and other
major disaster-relief exercises. Another iron-fisted
firefighter-type leader, similar to then-mayor of Beijing and now Vice-President Wang Qishan, may emerge.
Without a doubt, the party-state is able to tackle this formidable crisis with its high mobilisational capacity, but at extraordinary costs. When this emergency mode is eventually turned off a few months from now, the hope is for a determined review to identify the fundamental defects of the bureaucratic machinery that led to this tragedy.
Alex He Jingwei is an associate professor of the Department of Asian and Policy Studies, The Education University of Hong Kong. He specialises in health policy
