In China's COVID-19 Response, Echoes Of Its Handling Of The HIV/AIDS Crisis
Since the COVID-19 outbreak began, the Chinese government received the widespread criticism that it initially mishandled the virus. President Donald Trump has continually called for Beijing authorities to be punished for their lack of immediate response and the Australian government has condemned the government for spreading “disinformation” during the pandemic. Although China currently reports very few cases, its initial lack of action to stop the virus may have accelerated the crisis there. The flaws in this initial response to COVID-19 show similarities to the government’s response to an earlier crisis: HIV/AIDS.
HIV and COVID-19 have their own deadly identities, but the shortcomings of both responses show how China’s present system of fragmented authoritarianism creates an environment where the appearance of stability is maintained at the expense of public health.
China’s system of fragmented authoritarianism is also known as the tiao-kuai (条条块块) system. The tiao-kuai system refers to the channels of authority that link the vertical, or tiao, central government bodies with the horizontal, or kuai, provincial organs of government.
During the 1980s, market reforms led to government decentralization and enhancement of kuai-kuai over tiao-tiao authority, meaning provincial cities were given greater independence. At the same time, the central government gave provinces economic production quotas and targets rather than overseeing production as it had previously.
While at first glance this seemed a viable path toward regional autonomy, the decentralisation efforts also ushered in dangerous tradeoffs between economic profit and health standards. In many cases, standards were sacrificed for profits and the aspiration of economic stability. When farmers in 2008 were unable to meet milk production quotas, some watered down milk with melanin, an industrial chemical that poisoned thousands of children. And when Beijing ordered a reduction of water pollution from factories in 2001, local leaders cheated these mandates by moving their factories to the borders of their province, bringing water pollution to neighbouring regions.
Additionally, local leaders often did not report crimes for fear of losing economic support or respect from the central government in Beijing, pushing local newspapers to publish good news and omit anything negative. As local officials strived to avoid national criticism and scrutiny, the local press was consequently often more repressive than its national counterpart, not reporting and self-censoring on provincial issues for fear of loss of status and support from the centre.
China’s Response to HIV
Fragmented authoritarianism contributed to the flaws in China’s handling of the HIV epidemic in the 1980s and 1990s. A key element of China’s HIV response was amassing blood for transfusions. As HIV spread in the United States, China deemed blood importation from the United States unsafe. Compounding this, Chinese health officials maintained that the virus was spread through sexual promiscuity and homosexual sex—both “illegal and contrary to Chinese morality.” As a result, China embarked on harvesting its own blood supply.
Blood harvesting in China became extremely profitable. In 1993, Liu Quanxi, director of the Henan province’s health department, launched new economic targets for blood collection, doubling the financial target to be met by the Red Cross Blood Center to 20 million yuan. This allowed blood targets to be prioritised over public health, leading authorities to cut corners on safety regulations in certain collection centers.
Intimidation and denial toward outspoken scientists have been strikingly similar during both HIV and COVID. As China expanded its blood supply for HIV it became suspicious of whistleblowers. Dr. Gao Yaojie and Dr. Wang Shuping called attention to the lack of regulations in Henan, including the reuse of syringes and the mixing of blood during centrifugation when extracting plasma. But, even as evidence mounted, their recommendations were not met for fear that they would be “too costly.” Authorities ‘maintained their silence, denying the presence of AIDS in their province, and trying by all possible means to prevent Dr. Gao and her team of helpers from continuing with their preventive work in Henan.’
In 2004, 24 percent of HIV/AIDS cases in China can be traced to these blood donation activities, with an estimated 35-40 percent of blood donors from Henan being infected due to poor safety regulations. In 2002, an official document was released by whistleblower and AIDS activist Wan Yanhai that confirmed that a rise in HIV cases came from negligence in Henan. HIV is still at large in China. Last year the World Health Organization reported that the number of new HIV cases was expanding in China, particularly amongst young people.
Similar Flaws In The Response To COVID-19
Almost thirty years later, these HIV-era tactics can be seen in China’s COVID-19 response. As the warning signs of COVID-19 emerged in December 2019, Wuhan authorities lacked the expertise to understand the virus and the will to follow health advice.
As China’s economy slowed leading up to the outbreak it was reported that the willingness to respond to the crisis would “be limited by the government’s concerns about mounting public debt.” Wuhan is a hub of industry and the government feared shutting down the city would have detrimental financial implications for the national economy.
Beyond economic interests, a Wuhan government advisor stated that “the focus at the time was to maintain the facade of stability.” In February, although the authorities were notified that the virus could spread from human to human, city officials still allowed thousands to gather for a Lunar New Year banquet. The Financial Times reported that “for at least three weeks before the banquet, authorities had been informed about the virus spreading in their midst but issued orders to suppress the news.” This helped the virus spread throughout China as an ‘“exodus of five million people’” left Wuhan to visit family for New Years celebrations.
Like Gao and Wang, Wuhan doctors endured criticism and intimidation from government authorities as they attempted to raise concerns about public health. At the end of December 2019, Dr. Li Wenliang sent a message to fellow doctors warning them to wear protective gear to protect them from the unknown virus in Wuhan. He said, “If the officials had disclosed information about the epidemic earlier, [things] would have been a lot better.” Four days after sharing information about a possible health crisis he was called to the Public Security Bureau and told to sign a letter where he was accused of "making false comments" that had "severely disturbed the social order" as he advocated for a greater government response. Li died of COVID-19 in February.
China’s currently reported death toll from COVID-19 is 4,634 with a total 86,758 cases, and fourteen new cases reported on December 14. However, these figures seem very low, leading to allegations of underreporting the cases. One recent document leak reported that internal reported numbers were sometimes double that of what was reported to the public. Amid the reporting of low cases, people have returned to work with officials boasting about a 98 percent resumption rate among all listed companies.
The coronavirus highlighted the lingering problems of a system that prioritizes economic targets over public health, and the lack of accountability of the government to its citizens. Although life in China is returning to normal, the traumatic experience of COVID-19, as with HIV, was exacerbated by the early cover-up which hampered efforts to contain the epidemic.
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