From the century of turmoil through years of the Opium war, public health remained a matter of Imperial concerns. It did not only exert pressure domestically but also exposed dreading meritocracies within the imperial courts. Thus, for the old and new rulers of China, public health remained central to their legitimacy. In 2020, the COVID-19 pandemic has turned out to be
another moment of truth for China’s rulers and the ordinary public to know where it falls short of becoming a great nation. While the State exercised unchallenged control over matters of public health and security, the underlying paradoxes within the institutions are continuously overlooked by the disconnected leadership. The Chinese leadership’s binary approach to limit and eliminate these paradoxes is often proved as ad hoc; this includes medical, administrative and political actions.
The control measures taken by the Chinese leadership are rooted in political insecurities rather than dealing with the acute structural, institutional and operational inconsistencies. As a result, these inconsistencies persist and result in ineffectiveness. Responses in containing the epidemic cannot be solely seen as the metric to append the success. There lies an inherent tension between political successes and structural incompetence in stemming the epidemic in the long run. Chinese rulers’ scramble to override these imbalances was noticeable in its macroeconomic policies. These urgencies were categorised in a hierarchical way, and the matters pertaining to political stability and legacy were treated with utmost urgency when it came to disasters such as famines, flood control and epidemics. This was evident in all cycles of crisis the Chinese rulers faced in the 20
th century. The ongoing floods in central and eastern China, after causing havoc over two months, succeeded in getting the central leadership’s attention only when matters reached perilous levels for the political establishment.
The ongoing floods in central and eastern China, after causing havoc over two months, succeeded in getting the central leadership’s attention only when matters reached perilous levels for the political establishment
China’s record in dealing with public health related urgencies is no exception to this pattern. With modernisation at its peak, China developed a
top to bottom approach in escalating near-to-crisis dilemmas. Former President Jiang Zemin’s plans for indigenous science and technology capabilities focused on bolstering the scientific base to create growth opportunities for the Chinese economy. But the
severe acute respiratory syndrome (SARS) and serial outbreaks of other epidemics affected China’s image negatively, and science and technology was perceived to be the magic wand to solve these intricacies. In 2018,
China ranked second globally in research and development investment. Still, in the field of biotechnology, China is far from the top position. As noted by political scientist
Scott Moore, “China’s biotechnology sector is still too nascent to have produced true giants on the scale of Huawei or Alibaba.” Post-SARS,
China endeavoured to widen the base of health-related intelligence, for example, the launch of the
Thousand Talents Program in 2008. Away from property and manufacturing, Chinese cities witnessed a boom in biotech firms and scaled up funding for biotech research. China ensured a substantial increase in
medical research investment, especially in the field of biomedical sciences. Concurrently, on the international scale, China made decisive advances at global forums using its economic clout. China has risen as a significant player in the
global league of scientific research. The Chinese presence was soon noticeable at several scientific committees and institutions. Given the sheer size of its demography, China plays a critical role in the complex dynamics between health, prosperity and security. As evident through the COVID-19 pandemic (and also during SARS), the spill-over of disease outbreaks in China has had severe implications at the regional and global levels.
China plays a critical role in the complex dynamics between health, prosperity and security. As evident through the COVID-19 pandemic (and also during SARS), the spill-over of disease outbreaks in China has had severe implications at the regional and global levels.
The research funding certainly plays the role of a catalyst, but it is not all that is required to institutionalise the robust ecosystem of national health planning. Moreover, it is easier if the funding project falls in line with the municipal, provincial and central national science academy’s agenda, which are motivated towards seizing laurels at international forums. This explains the extremes—on the one hand, the Chinese universities have topped scientific charts in terms of publication and research, but in the process of rapid rise, the research forays have created asymmetries. While the Chinese political system and bureaucracy think unidirectional, it has downsides as well. Additionally, China was hit by epidemics twice in the last two decades, indicating rising intricacies related to public health contingencies. China only looked at the tally of patents, seeking membership in global forums.
In Chinese academia, the haste to publish research often leads to the neglect of measurable growth and advances in applied research. Researchers in China think incrementally rather than radically, since that is how the system incentivises them, which keeps them disconnected from the ground facts (the microbial threats confronting China, whether it is SARS or COVID-19). The country also continues to face challenges from other major infectious diseases, such as the plague, cholera, HIV/AIDS, tuberculosis, viral hepatitis and endemic schistosomiasis. Past experiences related to epidemics underline that the health sector did receive increased attention at high levels. Still, the government placed top priority only on preventing the return of diseases (in this case, SARS). This created inconsistencies between what party cadres and officials wanted and their silence with regards to the other major infectious diseases. The
case of Dr Li Wenliang, an ophthalmologist from Wuhan Central Hospital, and the injudicious response by the Wuhan municipal authorities illustrate these paradoxes.
The effectiveness of China’s foray in medical science-related research can also be gaugued through the metrics of innovation, which is the core component of scientific research and development. Despite the large-scale funding for medical infrastructure, China remains largely
under-competent in deliberating its capability in innovative research and scientific achievements in the field of biomedical innovation. In their scientometric analysis of China’s biomedical innovation,
Xiaoli Tang and Jian Du conclude that “China does not have strength in biological and medical sciences as it does in chemistry and physical sciences”. This paradox in exceptional growth in scientific investment and output can largely be attributed to institutional lapses. Why does the comparatively lower-funded Taiwanese innovation system deliver better than China? The answer is because China’s research institutes have been forced to industrialise and corporatise lines, including the basic research in health.
Pao-Long Chang and Hsin-Yu Shih, using comparative lenses, have produced an outstanding research paper in this regard.
Despite the large-scale funding for medical infrastructure, China remains largely under-competent in deliberating its capability in innovative research and scientific achievements in the field of biomedical innovation
One more striking imbalance that China could not address effectively in its race with global institutions is
negligence of clinical research (which directly involves human subjects or human tissues). Despite rising investments in medical research, clinical research remains poorly pursued. Medical research involves rigorous clinical research and not just the resources. The large number of Chinese students who continue to enrol in Western medical science studies indicates that
Chinese students prefer Western institutions to gain hands-on experience in applied research originating from fundamental understandings.
The epidemic control expertise is something that China has gathered from SARS, enabling it to administer full control and lockdown but without mitigating the risk of various institutional inconsistencies. During the SARS and COVID-19, China’s political and administrative leaders exercised control at the top. The initial misreading of the potential threats, from a public health perspective, caused acute political embarrassment, further triggering the regressive outlook of the State. SARS witnessed ambiguity, uncertainty, social panic and political control. COVID-19 caused further damage as it validated the ineffectiveness of stated-led interventions. Going forward, this may lead to denial of public health problems and deficiencies in the country’s health systems.
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