CONTAINING SARS: A CASE STUDY OF CHINA’S BUREAUCRACIES

By Baopu Liu

The deadly SARS virus in China is far more than just an epidemic and a threat to public health. Because of the outbreak, there has been much discussion about China’s notorious control of national media and the flow of information. Of greatest significance, and much to the surprise of even the Chinese leadership itself, the outbreak has revealed the rusty and inflexible nature of the nation’s bureaucratic machinery.

It is difficult to measure the performance of a nation’s government when it responds to natural disasters. Typically, the evaluation is based on the resulting damages, because in rating one government’s performance it is difficult to find as a point of comparison another government faced with an identical disaster. However, one notable aspect of the SARS outbreak is that it happened not only on the Chinese mainland but also in Hong Kong and other regions. This provides a rare opportunity to compare China’s government bureaucracy and public services with those of other systems.

WHAT MERITS A GOVERNMENT’S ATTENTION?

The manner in which Chinese authorities initially responded to SARS is puzzling. They may have truly believed that the outbreak was under control, which would indicate a failure to recognize an actual and highly threatening public health situation. Or the authorities may have emphasized “stability” over the death of many hundreds–or perhaps even thousands–of civilians. What, then, was the Health Ministry’s number one priority? On March 28, the former Chinese negotiator to the World Trade Organization (WTO), Long Yongtu, criticized Hong Kong media for overreacting to the situation. He charged that the press was responding to the 300 cases in Hong Kong (a city of six million) “as though there were three million infections.”

–February 10: A press conference was held by the Guangzhou municipal government in response to “rumors of spreading pneumonia” that had already caused local panic and the price of medical supplies to triple. The message of the press conference was: “Public panic is unwarranted; there is nothing to worry about.”

–February 11: Guangdong Province authorities vowed to crack down on merchants who were taking advantage of the panic to raise the price of foods and medicines.

–February 14: The Guangdong Public Security Bureau rounded up suspects for “spreading rumors” about the disease through the use of cell phone messages.

–March 12: The mainland vice minister of health, Zhu Qingsheng, claimed: “The mainland has received the WHO [World Health Organization] warning of the outbreak in Hong Kong. However, there is no indication that the outbreak in Hong Kong has any link to the outbreak in Guangdong, where the situation is well under control.”

–March 14: Guangdong officials refused to hand over specimens collected in its province. They claimed that there had been no new cases.

–March 19: The Beijing Center for Disease Control refused to confirm that a couple from Shanxi Province had died of SARS, although this province proved later to be the site of a large outbreak. While the Public Health Minister confirmed the outbreak in November of 2002, he insisted that the situation was under control.

In clear contrast to the mainland government, health authorities in Hong Kong responded with a fairly clear emphasis on safeguarding public health. The bad luck of having a “super-spreader” on its hands seems not to have been the cause of any errors on the part of the administration.

–February 10: Responding to the situation in its neighboring mainland province, the Hong Kong Department of Health sent a letter of inquiry to the Guangdong Province Public Health Division.

–February 11: Hong Kong’s secretary for health, welfare and food, Dr. Yeoh Eng-kiong, informed the public that the authorities were monitoring the outbreak and that there had as yet been no indication that the disease had entered Hong Kong.

–February 12: Though their mainland counterparts had taken no visible actions to contain the outbreak, Hong Kong authorities officially notified all doctors in hospitals and clinics to watch out for “pneumonia cases.”

–February 20: With the cause of the spreading pneumonia still unknown, the first major action taken by the Hong Kong government was to implement a bird flu vaccine injection program for chickens on all of its 157 chicken farms.

–March 10: The first cross-infection took place at Hong Kong’s Prince of Wales Hospital, prompting the Department of Health to notify the World Health Organization and to form a monitoring group headed by the secretary for health, welfare and food.

Meanwhile, all visible actions taken by the Chinese government up to the point of cross-infection in Hong Kong–which was the event that triggered the world wide alert issued by the WHO–indicate that preventing social instability was its obvious goal. This was the overriding agenda of the CCP central government.

COLLECTING ACCURATE DATA: MISSION IMPOSSIBLE

What truly surprised top Chinese leaders about the SARS outbreak was how ineffective and misleading their own official reporting systems proved to be. Given the nature of the outbreak, the initial data had to come from the country’s local health systems via government offices at different levels. These data collection efforts were beyond the reach of such traditional data collection agencies as the National Bureau of Statistics. In the case of SARS, this setup proved to be a disaster.

In some instances, local officials reacted with confusion amid the outbreak, and their disarray was all too apparent. On April 15, the Health Ministry failed to list the remote province of Ning Xia as an infected area. And although this claim was consistent with that of provincial news networks, as early as April 12 one of Ning Xia’s local papers had already reported five cases of cross-infection within one extended family. The source of this infection had already been traced back to a trip to Beijing. Five days later, the Health Ministry revised its SARS data to report ten times as many cases in Beijing, while the figure for Ning Xia was “one”. On April 24, twelve days after the first report in local papers, all of the five cases in Ning Xia were finally reflected in the national SARS statistics. This came a week after the Politburo ordered “no under-reporting,” which is about as much time as it might take to send a message to Beijing by horse.

Occurrences of this sort prompted the highest Chinese leaders to issue directives three times and to vow to punish anyone who did not comply. The problem of incorrect reporting in Ning Xia and elsewhere took place despite direct orders from authorities at the national level. Shanghai, for example, continues to report itself largely SARS-free. Authorities there are reportedly using a different standard in diagnosing SARS, which is keeping the city’s infection figures artificially low. The WHO has complained that, in Beijing, the data is still seriously flawed according to epidemiological standards, since in more than 50 percent of cases the patient’s source of infection is unknown. By comparison, that figure in Hong Kong is less than 9 percent.

RESPONDING TO THE CRISIS: CHAOS OF LOCAL POLICIES

Since the Politburo’s April 18 decision to make controlling SARS a top priority on the national agenda–that is, to use all the might that the Chinese Communist Party (CCP) possesses–a massive social mobilization has taken place.

But how did the CCP decision translate in real terms into actions and policies, especially at local and other functional levels of government? It is interesting to note in this context that the central government did not come up with a coherent national anti-SARS strategy. Instead, it left the specifics to local authorities. In Hebei, a province adjacent to Beijing where the outbreak was quite serious, local authorities responded by digging trenches across national highways to block all traffic in and out of Beijing. In Tianjin, the authorities took over a school that was partly owned by local residents to use as a quarantine center, causing a violent demonstration. In Guangzhou and Shanghai, the governments responded by ordering fines for spitting in public. In Chongqing, the government set a price cap on surgical masks, causing a massive outflow of mask shipments to other provinces. The official Chinese media cited an idiom to describe the situation: “Piling snow in front of your own door.”

It is even more interesting to note that this “localization” of policies was encouraged by the central government for a specific reason: localization of policy means the localization of resources. The mayor of Beijing, Wan Qishan, spoke openly for the government–at least within his capacity–when he said that “measures of self-protection” should be supported, since the government at high levels simply did not have the resources to support a uniform policy nationwide.

In the absence of a coherent policy, how can the central government be sure that its objectives will be achieved? The answer is simple: By holding local officials responsible if they fail to fulfill those objectives. This is the single most effective weapon that the government has available. Since April 18, hundreds of officials around the country at different levels of government have been sacked for negligence and coverups. In some instances, unreasonable requirements were set for officials. In the city of Baoji, for example, the local CCP Secretary ordered that district officials would be sacked if there were any SARS cases in their district, no matter how the disease got there. It is difficult to imagine what the official would do if a SARS case was discovered in his district.

CONCLUSION

The Chinese government bureaucracies have been undergoing reform since the late 1970’s. The focus of this reform has been: First, a reduction in the size of this bloated officialdom; second, raising the overall educational level of officials; and third, the promotion of younger generations into leadership positions. The reform has made some gains in these areas. Most prominently, Chinese officialdom is now dominated by technocrats from the Politburo on down. But the SARS outbreak has revealed a failure of the reform effort: that is, it thus far has not transformed the bureaucracy into a modern rule-governed system and has therefore failed to achieve efficiency.

The Hong Kong bureaucracy, and particularly the Department of Health, has demonstrated its resemblance to Weber’s rational-legal model of bureaucracy. It is a rule-governed, expertise-based bureaucracy with defined competencies. The early proactive measures that it enacted, made strictly for the sake of protecting public health, came in sharp contrast to the mainland health authorities’ initial response of maintaining an image of “stability.” This comparison highlights the apparent fact that the mainland organization is based on different principles. It seeks first to maintain existing agendas as set forth by top leaders–agendas which cross functional areas and competencies–and then waits for its leaders to intervene at any time and at any point. Without such interventions, the system is generally too inflexible to respond to crises. In short, the nation’s bureaucratic system is still totalitarian in nature.

This may not be surprising. But what is truly intriguing is that, unlike a model totalitarian organization, which should serve as a perfect instrument for a leader to use according to his personal will, China’s current bureaucracy defied efforts by the top Chinese leaders to control it. On April 17, China’s highest authority, the Politburo, issued a direct order of “no coverup, under-reporting or delay in reporting.” Shortly after this, Premier Wen Jiabao vowed to punish cadres responsible for under-reporting. On May 11, he had to intervene again by ordering “no cosmetic procedures in fighting SARS.”

Many Chinese intellectuals and experts have come forward during the SARS crisis to proclaim the urgent need for yet another round of organizational and legal reform. However, it seems that there is an urgent need first to change fundamental principles of administration, beginning at the highest level.

Baopu Liu– a specialist in Chinese politics and foreign affairs, and a Beijing native– writes political commentary for major publications in Hong Kong and the United States.