CHINA’S HEALTH CRISIS: SYSTEMIC INCOMPETENCE OR MIDDLE KINGDOM ARROGANCE?

HONG KONG

An ugly new strain of atypical pneumonia has medical scientists worldwide working overtime. They are trying to discover why a small but growing number of patients in many countries are now suffering and dying. To date, according to the World Health Organizataion (WHO), seventeen persons have died in Vietnam, Hong Kong and Canada, while over 400 cases have been reported in fifteen nations in Asia, Europe and North America. China disclosed 305 cases and five deaths on February 11. At present there is a natural global media obsession with the American war against Iraq. But too few people, even here in Hong Kong, have paid sufficient attention to what could easily have become a form of indirect Chinese aggression against humanity–one effected through systemic incompetence.

The current situation is reminiscent of the debate that raged within Hong Kong, then still British, during the mid-1980s. At that time, China announced plans for construction of a nuclear power station at Daya Bay, fifty-two kilometers northwest of Hong Kong. With the Chernobyl nuclear meltdown still a recent memory, debate in Hong Kong centered on Chinese crisis management capabilities. If a nuclear meltdown were to occur at Daya Bay, would Chinese officials react quickly to warn Hong Kong? Or would they respond in the time-honored manner–that is, by refusing to admit bad news, so that the bad news ultimately became much worse.

Since 1994 the two reactors have been quietly supplying electricity, and the earlier debate has tended to fade from memory. But that has not relieved fears over China’s ability to address a crisis. Beijing’s shortcomings in this area have been vividly illustrated over the past four months in the saga that has surrounded the spread of the atypical pneumonia strain. China has failed during that time to function as a great and powerful nation should.

THE CONTRAST BETWEEN HONG KONG AND CHINA

Despite fears to the contrary, the Hong Kong Special Administrative Region (SAR) of China continues to function properly. News of the recently-arrived “mystery illness” was reported relatively quickly there. And those with responsibility for the community’s health were allowed to comment freely upon the perceived threat once it–the ironically-named SARS (Severe Acute Respiratory Syndrome)–was identified. Local and international warnings were promptly issued, guidance to citizens was provided, and the necessary international contacts, most notably with the WHO, were quickly made.

The mystery illness did produce some sensationalism, which aroused exaggerated fears. One university conducted an opinion poll showing that 70 percent of residents felt they knew too little about the ailment. Overall, however, the free exchange of information helped to reduce the anxiety accompanying this potentially grave health risk.

In China, by contrast, when the first known cases of the illness appeared in the Guangdong city of Foshan in mid-November of 2002, the news was quickly suppressed. Officials would not comment publicly on the possible threat, and non-officials naturally followed suit, despite the occurrence of additional outbreaks. Newspapers as far away as Shanghai and Shenzhen were prohibited from reporting on the illness. The disgraceful silence lasted for three months before Guangdong authorities finally admitted that 305 persons had been affected by the unknown disease, and that five had died.

Worst of all, authorities dragged their feet in making the necessary international contacts. A scandalous four months passed before China began to communicate effectively with the WHO. A WHO delegation had visited Beijing earlier, but was not able to visit Guangdong. The most recent visit by a WHO delegation, which began in late March, will finally bring officials to the area where the health scare is believed to have originated some eighteen weeks earlier.

Though the state-controlled Chinese media did not deliberately sensationalize the issue, that was the net effect of their decision to suppress information about the illness. As is so often the case in nations lacking freedom of information, ordinary Chinese were forced to rely on rumor, including text messages on mobile phones that spread panic by claiming that a new flu pandemic had arrived.

COMPOUNDING A POTENTIAL THREAT

China’s lack of candor and competence served to compound a potential threat reminiscent of the terrible pandemics of 1918 and 1919, when the death toll exceeded that of World War I. It is a hard fact, but any unknown bacteria or virus that causes unexpected deaths needs to be quickly caught, analyzed and diagnosed so as to avoid epidemics or pandemics in today’s globalized international environment. China’s failure to do this could result in hundreds of thousands of casualties worldwide. The failure comes, moreover, despite the fact that Guangdong is known to the outside world as a “notorious crucible of infection,” as the Economist phrased it.

It was apparently a doctor from Guangdong province who started the current chain of death by infecting others in Hong Kong. Had officials from Guangdong dealt with the emerging crisis expeditiously, they would not have permitted the doctor to leave home. Health officials in Guangdong, moreover, would also have known better how to treat patients suffering from the disease. But that would have required responsible officials to stick their necks out. Instead, at the time of the initial press conference in February, one official blandly insisted that everything was under control. He used the power of his office, in other words, to convey a false image of optimism to the controlled press.

The failure of Chinese officials to deal forthrightly with the emerging disease is perhaps related to political developments that were taking place simultaneously. Official silence was encouraged by the fact that the first outbreak of the disease, in Foshan, occurred as the Chinese Communist Party was winding up its Sixteenth Party Congress. Attention remained focused on internal power politics, moreover, as the National People’s Congress approached in March.

MIDDLE KINGDOM ARROGANCE?

The SARS incident is illustrative of more than a failure of Chinese crisis management, however. Rather, it highlights China’s Middle Kingdom complex–or a self-centered arrogance–that is reflected in the current regime by its unwillingness to deal responsibly with the rest of humanity. Epidemics require close cooperation with the world community. Remarkably, however, even four months after the initial outbreak of SARS, Chinese authorities had still failed to provide biological samples taken from stricken patients, to share test results, or even to share details of patient treatment. As of March 23, China had still not joined the ten-nation network of clinicians who have been teleconferencing daily under the auspices of the WHO to discuss SARS-related findings and research.

China’s four-month stonewalling of information about the SARS outbreak was a shameful and puzzling act, particularly in light of Beijing’s obvious ambition to assume a world leadership role. Equally puzzling has been the world’s ambivalent and deferential reaction to Beijing’s evasiveness on so vital a matter. But unless the world deals more firmly with China, it seems likely that incidents of this sort will be repeated again and again.

Harvey Stockwin has been reporting and analyzing Asian developments since 1955. Currently he broadcasts a weekly fifteen-minute talk “Reflections From Asia” for Radio Television Hong Kong, contributes to the Japan Times, and is the East Asia correspondent of The Times of India.