Technical staff in China's Guangxi province inject chickens with a bird flu vaccine. China Daily/Reuters
A new strain of avian flu called H7N9 has infected at least seven humans and killed three in provinces near the Chinese metropolis of Shanghai, with the first death occurring on March 4 . Meanwhile, in the last month, about 16,000 pigs, 1,000 ducks, and a few swans have been pulled dead from Chinese rivers. An April 2nd World Health Organization (WHO) statement that scientists could find "no evidence of any connection" between the dead pigs and the human victims can no longer be found on its website.
Predicting whether infection will spread to the extremes required of the term "pandemic" is a fool's errand. But there's no question the H7N9 outbreak will test whether the administration of new president Xi Jinping is serious about its calls for greater transparency. The early evidence is encouraging; censors have allowed social media discussion of the disease to proceed, and state media is providing frequent updates. In fact, state-run CCTV's report of nine infections is ahead of the WHO's own recent estimates. On social network Sina Weibo -- which YaleGlobal rightly calls China's "virtual public square"-- the top trending post is a list of common-sense tips for preventing the disease.
President Xi is surely using the outbreak of Severe Acute Respiratory Syndrome, or SARS, as a case study. Precisely ten years ago today, teams of scientists from the WHO were traveling through mainland China to investigate early infections from SARS. Days later, I and the dozens of other Peace Corps Volunteers serving in China were told to vacate within 24 hours, taking the last available commercial flight from Chengdu to Washington, DC. Before I left my teaching post in Fuling, school leaders called the resident Volunteers to a quick meeting. They politely told us they disagreed with the Peace Corps' decision to pull out; SARS, the dean said, had "been cured." Ultimately, under then-President Hu Jintao, the government's tight-lipped approach to the disease only fed panic and sowed long-term mistrust.
With the unprecedented openness that social media provides for China civil society, Xi can --and perhaps must -- take a different path. But as Rachel Lu of Tea Leaf Nation recently wrote, the Chinese Web may yet prove "a double-edged sword." Thus far, it has provided government with an interactive platform to both assuage and gauge citizen fears. But it also allows fear to spread along with information. And if watchful Web users perceive anything less than full transparency, they will pounce, and the blow back could undermine public safety and Xi's early credibility at the same time.
David, I am also encouraged by the government's relative transparency when it comes to recent reports of H7N9 infections. By contrast, as you point out, the Chinese government response to the initial SARS outbreak was characterized by cover-up and inaction. As a result of the news blackout about the disease in the government-controlled press, SARS carriers traveled across the country without realizing that they were shedding a dangerous virus. According to Dr. Margaret Chan, then Director of Health in Hong Kong, China repeatedly declined her requests for information on the grounds of official secrecy. Consequently, SARS also developed into a full-blown epidemic in Hong Kong, from where it spread further to other parts of the world.
In the post-SARS era, the government has taken steps to promote the image of a more open and transparent government in its dealing with public health emergencies. As part of the government's transparency campaign, information on the current veterinary epidemics, including avian influenza, was no longer classified as state secrets. According to the Regulation on Infectious Disease Information Reporting Management (2006), cases of SARS and Highly Pathogenic Avian Influenza (HPAI) should be reported within two hours of a confirmed incident. The Emergency Response Law further requires governments at or above county level to "issue public-related forecast information and analytical assessment results about emergency events." This is reaffirmed by the Regulation on Government's Information Disclosure (2008), which asks the disclosure of "contingency plan, surveillance information and responses to public emergencies." Thanks to the revved-up state commitment, China now boasts the largest (if not the most efficient) infectious disease surveillance and reporting system in the world.
But if the government wants to avoid this kind of thing, it needs to be much more transparent itself and to stop preventing investigation by others.
The government response to the ongoing H7N9 outbreak suggests that it is generally following the aforementioned regulations and becoming more transparent than 10 years ago. While questions were raised on why it took more than three weeks for the health authorities to publicize the first cases, it appears that this had more to do with the lack of laboratory and epidemiological capacities than deliberate cover-up. Nevertheless, as I have argued in my new book Governing Health in Contemporary China, the post-Mao policy process has witnessed a shift from "band-wagon" to "buck-passing," which encourages strategic disobedience and policy shirking. For this reason, China's response to public health emergencies may continue to be bedeviled by lingering problems of under-reporting, misinformation, and inaction.
All steps towards openness and transparency are to be applauded, perhaps we should hold off the standing ovation for a little while yet. The first avian flu death occurred on February 27th, the second on March 4th. The authorities waited 20 days to release this information.
There is a huge deficit of trust between the public and the government that can best be addressed by speedier and fuller disclosure. The failure to meet this challenge is one of the many things that feeds rumors which are generally, though not always, even darker than the truth.
The coincidence of the pig scandal and the bird flu deaths has led to a neat fusion of public worries. But if the government wants to avoid this kind of thing, it needs to be much more transparent itself and to stop preventing investigation by others.
Can you imagine 15,000 dead pigs floating down the Mississippi River without hundreds of reporters beating every inch of the river until they found the source and named the guilty party? Have you wondered why we only have vague indications of the source of the Huangpu pigs?
China Digital Times gives us a clue: below is the relevant directive, dated March 19, from China's censors to China's media, as the government tried to damp down this grotesque story:
The Shanghai Huangpu River dead pig incident is already being dealt with effectively. Related follow-up coverage should follow Xinhua wire copy and information issued by authoritative local departments. The media are not to send journalists to Jiaxing or similar locations to investigate, nor to sensationalize or comment on the issue.
So no reporting allowed from Jiaxing. Transparency is not just a matter of officials releasing data to the public at their convenience. It is also about facilitating effective scrutiny and oversight by press and public.. Incidentally, it might even make the official jobs of inspection and regulation easier to do, if the government seriously wants them done better.
To follow up on Isabel's point, the problem is not just whether the government is sincerely interested in transparency. It's whether it has the credibility that's needed to make certain policies effective. For example, the State Commission on Health and Family Planning yesterdayissued a notice stating that it was forbidden to delay treatment or turns patients away because of inability to pay fees. Nobody could quarrel with the wisdom of this policy; there's a significant public benefit in treating victims of a highly infectious disease. But how are hospitals to get reimbursed? "The matter of fees for treatment should be resolved through stipulated channels." I suspect that hospitals, probably on the basis of past experience, will be less than reassured by this vague language, and will with some justification fear that they will simply have to eat the cost despite whatever promises were made. Unfortunately, many necessary measures simply cannot be paid for immediately in cash; the only available coin is the state's promise. If that coin is devalued, any measures that must be funded by it won't be effective.
A version of this post appears at ChinaFile, an Atlantic partner site.
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