(Xinhua/Cheng Min)

Opinion – Coronavirus and Reform of Public Health Institutions in China

Although Wuhan city and Hubei province have seen a decline in the number of daily infections with Coronavirus, the weaknesses of public health institutions have been exposed in China at both central and provincial level. Hopefully, the Chinese health authorities will reform these institutions by learning a lesson from the development of Coronavirus.

Several public health institutions have become prominent since the outbreak of Coronavirus in late 2019. They include the State Council’s National Health Commission (NHC), the Centre for Disease Control and Prevention (CDCP) under the NHC, and the Red Cross (RC) at the levels of the central government in Beijing and the provincial and local governments, especially at Hubei province and Wuhan city.

The outbreak of Coronavirus has shown some problems in the coordination, communication and operation of the NHC, CDCP and RC.

First and foremost, some netizens pointed out that in early December 2019, Wuhan and Hubei had already noted a mysterious lung disease, but it took almost a month for the NHC and CDCP at the provincial level to “report” to their corresponding organizations at the central level. The crux of the problem was whether there was a cover-up attempt at the local level.

Some rumours were circulated that public health authorities at Wuhan and Hubei had covered up the virus. One mainland medical expert went so far as to claim that the virus began as early as September 2019. There was no evidence to verify this rumour, but the sluggish way in which the Health Commission (HC) at the Wuhan city and Hubei province reported the disease up to their organizations at the central level needs to be changed.

According to the Health Department Directive No. 17, which was enacted by the State Council in December 1991, Article 51 states that health departments must report any new infectious disease to the upper-level governments. Article 53 says that local governments at the county level or above must take swift measures within 24 hours to cope with any infectious disease. Article 71 adds that officials who are slow to report the development of infectious disease to the government at the county level or above can be penalized by a fine.

The problem of this Directive is that the outbreak of Coronavirus showed insensitivity and slowness on the part of local health officials to report upward to provincial authorities, who then are expected to report to central authorities.

Because China is a huge country with several layers of government, the provincial health authorities in Hubei failed to coordinate and communicate well with their counterparts in Wuhan, not to mention reporting the outbreak of Coronavirus to the central NHC and CDCP. Some netizens said that the provincial government lost almost a month from mid-December to mid-January to act quickly to stop the spread of Coronavirus. 

Some observers also said that the central government appeared to be informed by the provincial government at Hubei, because President Xi Jinping discussed the issue on January 7, 2020, 13 days before he made an announcement on the need to terminate the spread of Coronavirus, and followed by an immediate lockdown of Wuhan and Hubei. 

Indeed, when the central government decided whether there should be a lockdown of Wuhan and Hubei, careful considerations had to be made. Beijing had already made a relatively swift decision to impose the lockdown on Wuhan and Hubei.

The problem was that local health authorities and officials at Wuhan city and Hubei province appeared to be hesitant, slow and indecisive, lacking experiences in dealing with infectious disease. One unconfirmed media report in Hong Kong claimed that local health officials seemed to destroy the virus samples – an accusation that might not be accurate but pointing to the likelihood that Directive No. 17 was ignored locally.

Second, the CDCP at the provincial and central levels was criticized by some netizens, who pointed to the phenomenon that some researchers knew the virus early. However, these researchers concentrated on conducting their research and published their findings in international journals rather than stopping the spread of the virus right away.

Yet, a few netizens defended the researchers and argued that, by publishing their findings internationally, the result would prompt the high-level authorities to take immediate action. The messy relations between provincial and central health authorities were highlighted in the debate among some netizens, whose views were later censored by authorities.

Third, when the central leadership ordered the lockdown, the challenge was how to implement the central directives. Yet, the Wuhan and Hubei authorities were slow, especially the Red Cross at the local level.

The image of Red Cross was undermined by the Guo Meimei scandal in June 2011 when she showed off her wealth by inappropriately linking her lavish lifestyle with the organization. Although Red Cross was victimized by her incident, its management and some contracting-out companies were under scrutiny. Public donations to Red Cross declined immediately. 

In late 2019, Red Cross implemented reforms in which its finance, board of directors, members and other stakeholders are expected to uphold the principle of transparency and accountability.

Moreover, the honorary chairman of Red Cross is now Vice President Wang Qishan, who helped President Xi to combat corruption. In September 2019, President Xi appealed to the Red Cross to make contributions to the country by championing “the spirit of humanity, compassion and dedication” and by pursuing “reform and innovation with great endeavour.” 

Clearly, the central leadership is keen to reform the Red Cross, which however remained chaotic at the provincial and local level when Coronavirus broke out. Public complaints about the implementation gap of Red Cross in delivering logistical supplies to hospitals in Wuhan led to the removal of local Red Cross authorities. 

Fourth, although the central government sent a leading group led by Vice Premier Sun Chunlan to Wuhan and Hubei to ensure that the implementation of Beijing’s directive of terminating the spread of Coronavirus is smooth, local authorities still play a game of “beautifying” the situation at some localities.

On March 5, a Hong Kong television news reported that Sun went down to visit a locality at Wuhan to inspect the food supply there, but local officials covered up the situation by showing adequate food supply, while some angry citizens were protesting on the streets against local authorities. 

Sun responded by asking local officials to ensure better delivery of services to citizens. This example illustrates that even if central-level officials, like Sun, went down to Wuhan to monitor policy implementation, local cover-up attempts remained commonplace.

Directive No. 17 also stipulates that places affected by infectious diseases must be burnt down. Interestingly, the South China market in Wuhan remains intact, with news reports showing that some wild animals were still alive inside. 

Fifth, the Chinese public health bureaucracy is complex, demanding much better coordination, effective communication, swift decision-making and smooth policy implementation at the central, provincial and local levels. The three bodies, namely the Health Commission, CDCP and Red Cross, will have to perform much better with stronger and effective leadership. Personnel matters in their reform. In fact, some 650 local officials were removed and penalized after the outbreak of Coronavirus.

Sixth, more financial resources will have to be injected to public health institutions, personnel and equipment at central, provincial and local levels in the future. In Hubei, although Wuhan has more hospitals and resources than many other mainland cities, its hospitals have mostly been privatized and lacked specialised ones focusing on infectious diseases. Although two make-shift hospitals were built to deal with Coronavirus, their establishment was perhaps a bit too late.

Ideally, China will have to reorganize and democratize the existing public health institutions. One way is to create a new Public Health Commission under which the CDCP and Red Cross would be held directly accountable to both Beijing and citizens at provincial and local levels. Another alternative is to introduce some elected representatives to the Commission.

In fact, the new constitution of Red Cross empowers its members to elect their Red Cross executives. If so, the democratization of public health institutions in China will perhaps be necessary by not only merging the three bodies systematically but also injecting the elements of accountability, transparency and elections. Finally, the mass media should ideally be liberalized so that editors, reporters and journalists will play the role of a fifth government in scrutinizing public health issues.

In short, China needs a fifth modernization, namely reform of public health institutions. Such reforms will pave the way for China to cope with any public health crisis far more swiftly, effectively and pre-emptively.

MNA political commentator