China’s
Health Calamity: Causes and Consequences.”
A
Panel Discussion with Bates Gill, Myron Cohen and David M. Lampton
June
4, 2003
The Nixon Center, Washington, DC
At
a recent Nixon Center seminar, three distinguished experts discussed China’s
the current SARS epidemic, broader infectious disease problems and its economic
and political consequences. The speakers included: Dr. Myron Cohen is Professor of
Medicine, Microbiology and Immunology, Chief of the Division of Infectious
Diseases, and Director of UNC Center for Infectious Diseases, Dr. Bates Gill is
the Center for Strategic and International Studies Freeman Chair in China
Studies and has conducted work on China’s health care systems with a focus on
HIV/AIDS and more recently SARS; Dr. David M. Lampton the Nixon Center’s
Director of China Studies and the author of The Politics of Medicine in
China, both spoke and moderated the discussion.
Myron
Cohen
Dr.
Cohen began his remarks by introducing the concepts of emerging pathogens and
the virus-specific “rules”, governing the transmission of the diseases.
Knowing the rules of transmission is essential in designing preventive
strategies. He briefly named a few outbreaks of microbe-induced crises such as
HIV infection and the current SARS problem and then noted there seemed to be an
acceleration in the appearance of such organisms. Cohen believes that it is
essential to understand the reasons behind this acceleration in order to figure
out new strategies to deal with them.
Cohen
explained that the infection potential of any given virus was governed by the
formula: R=B*D*C (Row= the number of
secondary cases; B=transmission efficiency; D=duration of exposure; C=number of
people exposed). In theory, when R is greater than 1, the epidemic will continue
and when R is less than 1 epidemic goes away. According to Cohen, the lack of
understanding of each component of the equation as it relates to SARS means that
we really cannot yet predict the future course of the disease or design the
optimal strategies to deal with it. In response, politicians and organizations
like World Health Organization tend to make up rules to the best of their
capabilities.
After
discussing the mechanism of contagious diseases in general, Cohen turned
specifically to the ongoing SARS crisis. He first identified two reactions to
the outbreak of SARS in various countries: fear and denial. According to Cohen,
both of the two reactions were unavoidable. Thus, he rejected the proposition
that the victims be blamed for the crisis.
Moreover, Cohen also rejected the prevalent proposition that the SARS
epidemic was a catalyst for change within Chinese society. Cohen believes that
history will repeat itself. Instead of changing the government, China will use
the tools it has used in the past to deal with the ongoing epidemic. Despite the
criticism and the uneasiness in the West about the draconian measures that China
has undertaken in halting the spread of the disease, China will largely stick
with strategies that it has successfully used in the past.
In
the end, Cohen expressed optimism concerning the current situation.
He believes that the current SARS crisis may help speed up the
improvement of China’s rural public health care system. Moreover, he was
pleased to see the empowerment of the World Health Organization caused by a
higher sense of the interdependence in this global village during the SARS
crisis.
Bates
Gill
Dr.
Gill noted the irony that SARS has captured greater attention than HIV/AIDS, a
disease that will likely have a much greater impact on China’s future. Given
the current growth rate of the HIV infected population, Gill concluded that
China would become the second most heavily affected area by 2010, with 10
million HIV infections.
Gill
further pointed out some unique Chinese characteristics that might exacerbate
the problem. According to Gill, the remarkable embrace of reform and opening up
in China is one contributor. He argued that economic reform in China has had
enormous effects germane to the spread of infectious diseases. For example,
economic growth has spurred the emergence of a floating population, most of
which is young and socially unanchored. Because of the nature of their jobs, sex
education, HIV prevention and treatment programs are extremely hard to deliver
to this population. Furthermore, Gill believes that China’s rapid move toward
a market-oriented society is another factor that might further worsen China’s
HIV problem as exemplified by China’s blood scandal in 2002.
Gill
also believes that traditional thinking is contributing to the current HIV
problem. He remarked that in China discussion about sex remained taboo and sex
education was not widely offered in schools.
Moreover, the traditional preference for male children is another problem
according to Gill. The male to female gender ratio in China is increasing,
resulting in an estimated 30 to 40 million males in China that will have little
to no prospects of marrying.
Finally,
Gill provided some policy prescriptions for China’s HIV problem. He first
rejected a strict pharmaceutical regimen as a viable option given the lack of
highly educated doctors to properly monitor, regulate and assure proper drugs
treatment in remote and backward parts of China. Instead, Gill offered some more
pragmatic recommendations to both the Chinese and American governments.
Gill suggested China launch a sustained, serious, highly public and well-
financed interagency program from the top down as well as from grassroots
organizations, which will provide HIV/AIDS awareness education.
For
the US Government, Gill recommended a dramatic increase of US financial support
to China in the upcoming fiscal years in order to help the country more
effectively combat HIV/AIDS. Gill believes that this support would likely
contribute to improving national health surveillance and data collection in
China. However, Gill was pleased to see a growing interest among American senior
leaders in the issue noted that President Bush and China’s former President
Jiang had in a previous summit cited HIV as a major area on which the two
countries should cooperate.
David
M. Lampton
Dr.
Lampton started his remarks by re-emphasizing the importance of knowing the
rules governing specific diseases in order to develop rational strategies.
Lampton then suggested that taking into account the current scope of the disease
in China, SARS is not likely to have a major economic impact over the next three
to five years. Based on a few interviews with American retailers and
distributors, he drew the conclusion that American businesses would be more
likely to modify their way of doing business to a limited extent than to change
their outsourcing strategies and their long-term plans in China. Contrary to the
common perception that most foreign investments in China are designed to use
China solely as an export platform, Lampton pointed out that 60% of the output
from foreign-invested enterprises was for sale in China’s market.
This provides powerful incentives for foreigners not to withdraw FDI
suddenly and massively from China. Undeniably, there are losers from SARS,
especially in those areas that involve the movement of people, for example
travel-related industries and services. However, according to Lampton, foreign
travel accounts for only 1.6% of China’s GDP and domestic travel is only 3+%,
which is not so significant as to massively affect the growth trajectory.
According
to Lampton, the political implications of the current SARS crisis might prove to
be more significant than the economic ones.
Lampton argued that the SARS crisis so far had been strengthening
China’s new leadership including President Hu Jintao and Premier Wen Jiabao
and weakening Former President Jiang’s group.
Lampton observed that Hu and Wen were introduced to the Chinese people
very rapidly as dynamic and decisive leaders through the recent intense
television coverage. Moreover, the ongoing SARS crisis in China clearly exposed
the insufficiency of the rural public health system and the urgent need for
reforms there. Lampton argued that this need fit precisely with Hu and Wen’s
political agenda, which emphasized more equality across regions, social safety
nets, social welfare and public goods. Of course, whether the new, younger
leaders can make a difference in rural public health, in actuality, remains to
be seen.
Finally, Hu and Wen seemed to become the political winners out of this crisis, while leaders of Taiwan and Hong Kong -who are seen as having dealt less effectively with SARS- appeared to be the political losers, despite the fact that the disease apparently had its origins in Southern China.
This Program Brief was prepared by Nixon Center Intern Lihua Liang.
