A closer look at China’s response to the H7N9 outbreak raises alarming questions on its ability to effectively manage a public health emergency of international concern.
First, while the government has become more transparent in sharing disease-related information, the cover up mentality dies hard, especially at the local level. As Zeng Guang, chief epidemiologist at the China CDC noted, local governments with a large tourism or poultry industry are still reluctant to report disease outbreaks in their jurisdiction.
Moreover, political factors continue to interfere in China’s disease reporting process. Not only do local governments continue to arbitrarily assign disease control targets for health authorities to fulfill but the political leaders still have the final say in deciding whether to publicize a new disease outbreak or not.
By 1 March 2013, for example, scientists in Shanghai had already identified a novel influenza A virus (which was later confirmed to be H7N9), yet the local media at the request of health authorities were busy refuting the ‘rumor’ of anything unusual by attributing the increase of respiratory infections to ‘seasonal changes.’
Second, despite a decade of capacity building in the public health sector, China’s surge response capacity continues to be hampered by interdepartmental coordination problems and lack of capacity to identify, diagnose and treat patients in a timely and effective manner.
The capacity gap was observed even in Shanghai, China’s largest and most cosmopolitan city that is supposed to have the most robust surge response capacity. In early March 2013, even though a group of Chinese scientists confirmed that a patient admitted by Shanghai No. 5 Hospital died of an unknown virus, doctors in the hospital failed to take any extra measures in treating patients with similar symptoms.
In a manner reminiscent of the risk communication failure during the SARS outbreak, the Shanghai health authorities for nearly two weeks did not share with China CDC in Beijing the news of a confirmed H7N9 virus. Worse, China’s existing flu vaccine manufacturing capacity can only meet the needs of one tenth of its population. This might explain why during a disease outbreak in China indigo woad root (a Chinese herbal medicine) is more popular than vaccines or antiviral drugs.
Last but not least, during an outbreak the government reactive mobilization efforts often run counter to a risk management strategy essential for effective disaster response. A primary objective of risk management is to maximize protection and minimize disruption to the society and the economy.
But even today the government is still heavily reliant on state-centric, vertically imposed prohibition and coercion — such as mass culling and other draconian containment measures — to address disease outbreaks without differentiating the risk posed by different viruses.