Modern epidemic history informs advances in governance
The Shengjiang Plague Prevention Hospital was set up to receive suspected cases of the 1910 plague in Northeast China. A series of effective measures taken in the plague’s prevention and control indicated the emergence of a modernized epidemic prevention system in China. Photo: FILE
As seen with the ongoing COVID-19 epidemic, epidemics have affected the country, society and people of China throughout modern times. Some scholars believe that epidemics in modern times have displayed the following characteristics: higher frequency and larger scales; positive correlation between the frequency of epidemics and the degree of socio-economic development; increased epidemics imported from abroad; and since the late Qing Dynasty (1644–1911) increasingly stronger national control over epidemics.
Development process
The late Ming Dynasty (1368–1644) witnessed a serious plague in North China. The Ming government’s passive attitude and weak measures during the epidemic accelerated the fall of the dynasty. During the Qing Dynasty as society gradually stabilized, the frequency and scale of plague decreased, but many other kinds of infectious diseases still troubled the people. During the Taiping Rebellion (1851–64) in the late Qing, rampant plagues again ravaged China. In the Republican era (1912–49), plagues broke out in the northern regions frequently, accompanying almost the entire period of the era.
After the founding of the People’s Republic of China in 1949, despite many wartime damages demanding attention, handling epidemics remained a focus for the government. With continuous efforts, smallpox was eliminated, and plagues have almost disappeared from China. In the 21st century, the most impressive fight against an epidemic was that against SARS in 2003. With effective prevention and control measures taken by the government, there were no large-scale transmissions or deaths. After this campaign, China’s health and epidemic prevention mechanisms and governance systems have become more effective and transparent.
Today, the overall goal of deepening reform in every field is to improve and develop the system of socialism with Chinese characteristics and modernize China’s system and capacity for governance. The national governance system comprises a set of closely linked and coordinated national systems and mechanisms as well as laws and regulations in such areas as economy, politics, culture, society, ecological civilization and Party building. The epidemic prevention and control system is naturally an integral part of the national governance system. As such, we need to consider how to learn from the experience of China’s epidemic responses in modern times to further modernize the national governance system.
Governance modernization
When an epidemic occurs, it needs to be managed and controlled by a specialized government agency with professional personnel, and its institutional guarantee is a modernized health and epidemic prevention system. In 1894 a plague attacked China, with Hong Kong and Guangzhou as the epicenters. During the plague, traditional concepts of treatment and Western health concepts clashed violently, promoting the emergence of quarantine systems and modernized health and epidemic prevention systems throughout China.
In October 1910, a plague erupted in the city of Manzhouli on the China-Russia border and spread rapidly along nearby railway lines, placing the three northeast provinces in a severe situation. To deal with the crisis, the epidemic was placed under the direct management of the Ministry of External Affairs founded in 1901. Due to his profound Western medicine expertise, Wu Lien-teh (1879–1960) was assigned to the northeast to tackle the epidemic. With the cooperation of local officials, Wu worked to quarantine and disinfect the epidemic area, dividing the area into several districts to limit the activities of potentially high-risk people, challenging the convention by burning the bodies of the infected deceased. In addition, the local governments also blocked land and water transportation and restricted population mobility to prevent the epidemic from becoming a pandemic. By the spring of 1911, the epidemic situation had basically stabilized. These practices of plague prevention and control were of great significance, indicating that a modernized epidemic prevention system had begun to appear in China.
After its establishment, the Nanjing national government (1927–48) set up the Ministry of Health, responsible for a series of health services including epidemic prevention. Due to the fierce political battles inside and outside the government, it was difficult for the ministry to play an essential role, but it still played an elementary role in epidemic prevention and control. After the outbreak of a cholera pandemic in 1932, the Department of Health, the new name of the Ministry of Health, ordered emergency epidemic prevention measures. It isolated potentially high-risk populations, strengthened the detection and disinfection of drinking water, diagnosed and treated patients, investigated and reported cases in a timely manner, and promoted mandatory vaccinations. These measures helped alleviate the epidemic situation.
In addition to the leading role of the state, social forces, such as civil charitable organizations, can also play a role in the prevention and control of epidemics under the framework of national governance. In his study on Qing era epidemics in the Jiangnan region, Yu Xinzhong, a vice dean and professor of the Faculty of History at Nankai University, pointed out that forces of civil society in many areas responded to epidemics more actively than official forces. In Suzhou, Nanjing, Hangzhou, Shanghai and many other places, almost every major epidemic witnessed the active participation of local citizens or civil charities in providing treatment. This is directly related to the level of regional economic development. The more economically developed a region is, the stronger the social rescue force is, and the better the epidemic response measures are.
When dealing with epidemics, national governance needs to learn from the experiences of the early days of the PRC and initiate large procedures to maximally cut off the spread of viruses. The Patriotic Health Campaign in the 1950s developed into a nationwide health campaign, improving the backward sanitation environment in the countryside and popularizing the concept of sanitation to the public. The campaign eliminated a large number of harmful pests including rats, mosquitoes and flies, promoting the extinction of many forms of contagion such as plagues in China. Another important contribution to epidemic prevention during that period was the prevention and treatment of schistosomiasis, which has existed for a long time in the Jiangnan area and has long plagued the lives of local residents. In 1955, Chairman Mao Zedong called for a mobilization of the whole nation. A combination of mass movement and scientific management effectively controlled schistosomiasis in many places.
In the context of globalization, an epidemic is no longer just a problem of one country or one region, as it is easy for both the virus and panic to spread widely. These situations require close international cooperation between countries and technical and personnel assistance from developed countries.
Looking back, the extinction of smallpox in China was largely due to the introduction of external medical resources. Missionaries who came to China in the Qing Dynasty brought the cowpox vaccine. It was of lower cost than previous vaccination (human pox) and provided free of charge by the government, thus it soon spread throughout the country. After the founding of the PRC, the Chinese government continued to promote cowpox vaccinations for the entire population. By the end of the 1970s, smallpox had completely disappeared in China.
In response to an epidemic emergency, the national government must conduct comprehensive management to prevent local governments from acting in an uncoordinated fashion. In 1918, a plague broke out in Shanxi Province. The then Shanxi governor responded quickly and organized comprehensive epidemic prevention work, conducted inspections and disinfections in various places, blocked traffic, vigorously publicized information about epidemic prevention, mobilized the people, and quickly overcame the epidemic. However, according to Cao Shuji, a professor from the Department of History at Shanghai Jiao Tong University, after the cessation of the plague in Shanxi, the plague reappeared in Xing and Lin counties of Shanxi Province, which were not previously plague-stricken areas, but this did not attract the attention of the Shanxi Provincial Government at the time, eventually causing a larger plague in the neighboring Shaanxi Province. It can be seen that, without comprehensive planning from the central government, it is very likely for local governments to administer measures in their own ways or even benefit at others’ expense when fighting an epidemic.
Gao Hang and Fu Haiyan are from the Institute of Modern Chinese History at Central China Normal University.
edited by MA YUHONG