China Power

China’s Early COVID-19 Missteps Have an All-Too-Mundane Explanation

Recent Features

China Power | Politics | East Asia

China’s Early COVID-19 Missteps Have an All-Too-Mundane Explanation

How intergovernmental dynamics influenced the coronavirus outbreak in China.

China’s Early COVID-19 Missteps Have an All-Too-Mundane Explanation

Residents cross the Yangtze River on a ferry in Wuhan in central China’s Hubei province on April 8, 2020.

Credit: AP Photo/Ng Han Guan

The steps and missteps taken by government actors in China and around the world during the early weeks of the COVID-19 pandemic will be scrutinized for years, if not decades, to come. Investigative reporting has already highlighted a number of ways that authorities in China mismanaged the coronavirus outbreak initially, before putting in place extreme but apparently effective control measures in late January and early February 2020.

The concerns are manifold. Although health professionals raised alarms about a new pathogen infecting Wuhan residents in late December 2019, action — and critical inaction – on the part of governmental actors at various levels obstructed information flows and delayed a coordinated public health response for nearly a month. Most egregious, regional authorities in Wuhan municipality and Hubei province intimidated would-be whistle-blowers and stymied the timely release of information about the illness, carrying on with large-scale political meetings and holiday festivities despite mounting contagion risks. Similarly problematic were the delays of China’s central leadership in enacting effective control measures and communicating the gravity of the situation internationally and, later, Beijing’s apparent obfuscation of the true scale of disease spread and mortality.

But beyond wrongdoing or recklessness on the part of specific government actors in the early weeks of the outbreak, China’s flawed initial response also reflected built-in biases of governmental structures and decision-making dynamics. On the one hand, these institutional maladies delayed the escalation to the national and international levels of what was, from its very start, much more than a local crisis. On the other hand, these shortcomings hampered public health responses at key subnational levels of government. It is worth considering the impact of these systemic characteristics not just to better understand the origins of the global pandemic but also to gain fresh perspective on how crucial intergovernmental dynamics are in shaping the fight against the coronavirus.

China’s Leninist-style party-state suffers from shortcomings that are the obverse of the system’s seeming strengths. In China’s unitary, party-dominated state, the center holds ultimate political authority and, hence, final responsibility. But in order to manage a vast, regionally diverse country, China’s governmental system is divided into five formal state levels and thousands of local government jurisdictions. Day-to-day administrative responsibility and a large measure of operational discretion is devolved to provincial and subprovincial governments and their bureaucratic departments. It is political-administrative chains of command that give coherence to this sprawling system: all territorial governments answer to the levels above them, while most functional agencies answer to the territorial units in which they are based as well as to functional counterparts at higher levels. The hierarchical orientation and party-enforced discipline of China’s governmental system allows higher-level actors to direct and sanction lower-level actors and makes lower-level actors responsive to their immediate superiors.

But hierarchical governance has corresponding weakness: it separates ultimate political authority from immediate administrative responsibility, and it depends critically on level-by-level transmission of orders and information. In such a system, Beijing bears ultimate responsibility and authority but has a difficult time overseeing and sanctioning actors more than one level below — those at the subprovincial level. And while these lower-level actors nod to the ultimate authority of the center, they are wary of offending or bypassing their more immediate superiors. Further complicating matters, the relaying of official orders and information up and down the party-state’s chain of command takes time and can introduce both accidental and deliberate distortions. These kinds of shortcomings impaired China’s early response to the coronavirus outbreak and have continued to complicate crisis management.

Why, given its past experience with SARS and its extensive preparation for the recurrence of dangerous viral epidemics, did Beijing not take decisive public health action before January 20, when Xi Jinping gave orders to Hubei and other localities to mount a major emergency response? Central authorities apparently became aware of the emergence of a worrisome new disease in Wuhan by the end of December thanks to information leaked online. Central authorities reported the appearance of an unknown disease to the World Health Organization on December 31, and the same day China’s National Health Commission sent an expert team to Wuhan to investigate. On January 3, the National Health Commission called for patient test samples to be routed to approved testing sites or destroyed and, more troublingly, instructed health organizations not to publicly report on the new illness.

But these early interventions from Beijing were essentially bureaucratic. Lacking the imprimatur of China’s top political leadership, they left the main locus of decision-making at the provincial level in Hubei. Indeed, the bureaucratic rank of the National Health Commission was equivalent to that of the province, meaning that it could not compel provincial leaders to behave one way or another even if it had tried. And while Xi Jinping retrospectively claimed in a February 3 speech that he had discussed and “issued demands” relating to the coronavirus crisis as early as a January 7 meeting of China’s elite Politburo Standing Committee, there is little public evidence to suggest that China’s top leader attached any special emphasis to the crisis at that stage or issued very specific directions. Instead, processes unfolding within Hubei province remained decisive through much of January, and it was the relative inaction of central leaders that was most striking.

It is Hubei province, not Beijing, that directly supervises Wuhan, the city in which the epidemic broke out. Wuhan is Hubei’s provincial capital, and municipal leaders and provincial leaders thus occupy the same city and maintain regular contact and communication (which certainly does not mean they always get along smoothly). Available evidence suggests that provincial leaders were aware of the disease outbreak by late December and not only failed to take adequate action to highlight and respond to the rapidly intensifying public health crisis but also helped conceal it.

Although Hubei’s leaders were ultimately accountable to the center, they, like provincial leaders more generally, proved to be less than fully reliable agents of the center. Hubei’s leaders had different considerations than national leaders in Beijing, particularly during a key political and ceremonial season. The timing of the outbreak in Wuhan not only threatened Lunar New Year festivities in mid and late January, but, more crucially, directly threatened the success of Hubei’s and Wuhan’s mid-January annual People’s Congress and People’s Political Consultative Conference plenary sessions — a crucial time for leadership turnover and for showcasing leaders’ achievements and agendas.

This produced a Catch-22. Given their incentives not to upend the political calendar, Hubei’s leaders and lower-level leaders in Wuhan and its urban districts were unlikely to adopt significant public health measures in the absence of clear national guidance. But neither were key leaders in the central government likely to grasp the severity of the situation without more proactive efforts at the subnational level to investigate and respond to a growing epidemic. In publicly explaining his city’s failure to share information about the novel coronavirus during a media interview, Wuhan Mayor Zhou Xianwang blamed a national law requiring central government approval for the declaration of epidemics, and said Wuhan was only free to adopt significant measures after Beijing gave clear orders on January 20. While that contains a grain of truth, Zhou’s account conveniently downplays the failure by officials in Wuhan and Hubei to convey the seriousness of the crisis early on and press for central action.

In the very local dynamics of crisis response, as well, we see how the hierarchical logics of government hampered China’s initial coronavirus response. A leaked communication from Wuhan Central Hospital (as reported in the New York Times) provides a fascinating but deeply worrying window onto subnational governance of the crisis in its early stages. In the report, a hospital employee recounts the tortuous back-and-forth in late December and early January 2020 with different local health bureaucracies about how and when information on pneumonia cases of unclear origin should be entered into China’s Contagious Disease National Direct Reporting System.

On January 3, the hospital employee was told by a public health official from Wuhan’s Jianghan district government to wait for higher-level authorities’ approval before entering case information into the national system. On January 4, the Wuhan Central Hospital received a guidance document from Wuhan’s Municipal Health Commission instructing hospitals to investigate suspicious pneumonia cases for 12 hours and to enter cases into the national database if unable to rule out a novel pathogen. But procedures for case reporting quickly became more convoluted and bureaucratized as the political-administrative hierarchy asserted itself. On January 5, district-level authorities convened a meeting to review the new municipal-level guidelines. They instructed hospitals with suspicious cases of pneumonia to alert the district-level health commission and have district-level health officials review the cases before any reporting into the national database. When, after this meeting, the hospital employee in question sought clarification from the district health commission about whom to liaise with in the district government, the employee was told that because Wuhan Central Hospital was under municipal jurisdiction it should liaise directly with municipal-level officials.

Still confused, the hospital employee contacted the municipal heath commission, which clarified that hospitals should in fact interface with the district authorities in the district where the hospital was located. Between January 8 and 10, the hospital employee reported several cases of pneumonia of unclear origin into the national database. However, on January 12, provincial health commission officials came to one of Wuhan Central Hospital’s facilities on January 12 to supervise local infectious disease work and warned the hospital to be very cautious in using the national reporting system. Municipal and provincial authorities should sign off before any cases were entered. On January 13, a municipal health commission official reiterated this message, explaining that after a hospital verified cases of pneumonia of unclear origin internally, it should notify district authorities and seek district-level confirmation. Only after proceeding through reviews by district, municipal, and provincial health officials, should cases of pneumonia of unclear origin be entered into the national database by the provincial health commission.

In this microcosm of the broader coronavirus response, it is clear how the level-by-level authority structures and working logics of China’s party-state impeded a coordinated public health effort. The existence of a lengthy bureaucratic process between discovery of new cases in Wuhan’s hospitals and formal reporting of cases in the national database hindered the central government’s and other health institutions’ ability to gain a more comprehensive picture of the evolving crisis. Indeed, such an arrangement was fundamentally contrary to the original intentions of the national reporting system.

While such convoluted arrangements for reporting of suspected early coronavirus cases may have resulted partly from deliberate efforts by provincial or municipal authorities to keep the lid on an embarrassing public health emergency, they also reflected more mundane aspects of decision-making and intergovernmental relations in China. Like the central-provincial dynamics discussed above that delayed the escalation of the coronavirus outbreak into a national and international emergency, these localized problems of communication and coordination show how intrinsic characteristics of China’s party-state can impede effective policy responses in the early stages of a crisis.

Kyle Jaros is Associate Professor in the Political Economy of China at the University of Oxford and a Visiting Fellow (2019-2020) at the Liu Institute for Asia and Asian Studies at the University of Notre Dame.