No, Autocracies Aren't Better for Public Health
Some have praised China's response to the COVID-19 pandemic, but its suppression of information helped cause the problem in the first place.
April 14, 2020
Apr 14, 2020
15 Min read time
Some have praised China's response to the COVID-19 pandemic, but its suppression of information helped cause the problem in the first place.
For better or worse, a well-known feature of the Chinese government is its expeditiousness. Upon signs of accelerating infections of a deadly pneumonic disease on the eve of the Lunar New Year, when many Chinese travel to their hometowns, the government immediately shut down all transportation routes to the source of the outbreak. Never given to relying on voluntary citizen compliance, authorities dispatched troops to enforce a shelter-in-place order. Schools, bathhouses, temples, and churches were turned into emergency hospitals. Private burial rights were abrogated, and the government promptly cremated bodies of victims in stark defiance of traditional Chinese norms. Across China, at both the provincial and prefectural levels, a new organizational apparatus tasked to enforce the shutdown sprang up overnight to ensure consistent coordination at the national level. There was little appetite and no tolerance for “states’ rights,” and the epidemic was shortly brought under control.
Any celebration of the Chinese response has to be tempered by a cool-headed recognition that it is at best a purely pyrrhic victory.
Besides state power, authorities also had massive amounts of data on their side. The government had access to census data for the entire population taken every three years—not ten, as in the United States—which collects far more information than just basic identity and demographics data. As one description of the census puts it, it includes “socioeconomic, demographic, and other characteristics for individuals, households, and communities” as well as “demographic outcomes such as marriage, fertility, and mortality.”
You might think I am describing what happened in Wuhan, China, beginning on January 23 this year, when the government closed down the entire city of eleven million people in response to the outbreak of SARS-Cov-2. A few days later came the order for the whole of Hubei province, with fifty-nine million people. Authorities began a massive testing program; the Chinese Communist Party (CCP) used big data—a database of travel information and health status integrated with the census—to track and restrict mobility of the population; anyone who tested positive, regardless of the severity of their symptoms, was taken away, sometimes forcibly, to special facilities and completely isolated; healthy people were strictly confined to their apartments; and the bodies of those who succumbed to COVID-19 were cremated in government-designated funeral houses.
The similarities are stark, but in fact the description with which I began was of another era and government altogether—the Manchu court of the Qing dynasty. It was in January 1911 when the Qing court was battling what has become known as the “Great Plague of Northeastern China.” Like SARS-CoV-2, this pneumonic plague originated from the hunting of wild life (marmots, specifically), a zoonotic disease similar to COVID-19 which made an inter-species jump from a bat to a human in a seafood market in Wuhan. Also like coronavirus, the plague had a high transmissibility rate, spreading rapidly in much of the northeastern corner of China. The census belonged to the Qing court, not to the CCP. The database that survived into modern times covered the period from 1749 to 1909, and for just one province it contained comprehensive information on “1.5 million triennial observations of more than 260,000 residents from 698 communities” as well as information on disabilities of adult males, on grain prices, custom records, and natural disasters.
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In The Art of Not Being Governed: An Anarchist History of Upland Southeast Asia (2009), the political scientist James C. Scott argues that certain “backward” features of traditional societies, such as illiteracy, shielded its people from the sharp and prying eyes of the state. Contrast this arrangement with a modern society that empowers the state to educate and to acquire information from its citizens but relies on the ballot, free speech, and separation of powers to check abuses. China has neither of these mechanisms, traditional or modern. The Chinese state is intimately knowledgeable about its citizens, and this condition long predates the CCP, as the case of Qing’s triennial population census shows. Unencumbered by rule of law and democracy, it can exercise this knowledge in whatever ways it chooses to. The state knows almost everything about society, but society knows next to nothing about the state.
The Chinese robocall system has a standard disclaimer that it will not disclose information to outsiders. But of course the whole idea is to disclose information to outsiders—to the government, specifically.
During the COVID-19 crisis the CCP has exploited this asymmetrical transparency to maximum effect. On January 22, the state-owned company China Unicom, one of China’s largest mobile service providers, provided mobile phone data to China’s health commission and provincial authorities on population movement. The very next day the party made the decision to lock down Wuhan. And the government’s operational decisions and enforcement were informed by more than aggregate data on population movement and mobility. It also deployed two-way robocalls using natural language processing (NLP) developed by multiple Chinese AI firms. Unlike AlertsMA or similar messaging systems used by U.S. states, the Chinese system did not just send out alerts; it also collected and analyzed information from people being targeted and used NLP to transcribe verbal information in order to perform text analytics.
The Chinese robocall system has a standard disclaimer that it will not disclose information to outsiders. But of course the whole idea is to disclose information to outsiders—to the government, specifically. The calls, sometimes made as fast as 1,500 per second, collected personal information on recent movements, contacts and symptoms. Other AI tools were quickly invented. On February 11 Alibaba launched a smartphone app, Hangzhou Health Code, to monitor the health conditions of Hangzhou residents, nearly 500 miles from Wuhan. The city of Hangzhou required citizens to download the app and upload information on health and recent travel history. The app was then scaled to the national level, and the veracity of the information was checked by cross-referencing the vast transactional databases maintained by Alibaba and Tencent. After cross-referencing was complete, the app would generate a color-coded QR code: green signals it is okay to move around with minimum restrictions; yellow requires self-quarantine for seven days; red indicates self-quarantine for two weeks.
It is unlikely that the system relied on an honor code. According to the New York Times, the police had a front-row seat of all the information. Even in normal times privacy is considered a dirty word—if you’ve done nothing wrong, you have nothing to hide. It is now viewed as a hindrance to an effective implementation of physical distancing.
There is an important difference between the precision quarantine enabled by Hangzhou app and the brute force of the total Wuhan lockdown. In the latter case, privacy is irrelevant; you are required to hole up in your apartment regardless of your personal situation. In the former case, your privacy is infringed upon, but in exchange you gain some degree of freedom and personal mobility. Perhaps even a liberal may see the upside of this tradeoff. The World Economic Forum, for example, credited this system with the COVID-19 response successes in Hangzhou and its surrounding province, Zhejiang.
Epidemics provide an urgent example of the dictum that knowledge is power: not just medical knowledge, but also the personal knowledge of your average Zhangs and Wangs.
There is no evidence that the Qing court ever utilized the census data at its disposal in its response to the pneumonic plague. But the census does illustrate a long history of Chinese society being completely visible to the state, and this acclimation has inured Chinese people to this degree of exposure, unparalleled anywhere else in the world. Epidemics provide an especially urgent example of the dictum that knowledge is power: not just medical knowledge—how the virus spreads, what proteins it uses to enter cells, whether those who become ill develop long-term immunity—but also the personal knowledge of your average Zhangs and Wangs. This cultural acceptance and societal readiness to disclose private information proved extremely convenient during the COVID-19 crisis.
• • •
Today, as much of the Western world is struggling with how to contain COVID-19, it may be tempting to ask whether there is some method to the Chinese madness. Some Chinese think that they already have the answer. “Only in China and only under the leadership of President Xi,” China’s foreign minister, Wang Yi, proclaimed in February, “can there be such effective measures to put this sudden and fast-spreading epidemic under control.” To parse this triumphant claim, we need to separate two distinct issues. One is the capability of a system to discover and contain a newly emergent outbreak; the other is the capability of a system to mitigate one already experiencing exponential growth.
The evidence so far—barring a second wave of reinfections—is that the Chinese system has been effective on the second front. About three weeks into the lockdown of Hubei and the shutdown of much of the rest of the country, China began to flatten the curve; the rate of new infections slowed down. The peak was reached on February 13, just three weeks after Wuhan was locked down, when 15,141 new cases were reported. Then the number of newly confirmed cases dropped precipitously: 2,538 on February 15, and below 1,000 after February 19. One does not have to take Chinese official statistics at face value; the authorities have opened much of the country to business and lifted Wuhan’s lockdown on April 8. Contrast that with the chaos and confusions currently unfolding in the United States, where the outbreak is yet to peak but the number of infections and COVID-19 deaths has already surpassed the official count coming out of China.
What the Chinese have done can be only recommended as a desperate action of last resort rather than as the best measure of first resort.
Any celebration of the Chinese response has to be tempered, however, by a cool-headed recognition that it is at best a purely pyrrhic victory. The draconian quarantine put the entire Chinese economy on hold and upended the lives and livelihood of hundreds of millions of ordinary Chinese people. The costs are monumental in scope and scale. Rather than celebrate it, it is reasonable to bemoan the fact that it had to be adopted in the first place. In the curriculum of any respectable management school, what the Chinese have done can be only recommended as a desperate action of last resort rather than as the best measure of first resort.
Moreover, one of the root causes of Chinese success was its backwardness. New York Times science writer Donald G. McNeil, Jr., wrote that the last time the United States attempted a national quarantine was in 1892, when the country was trying to keep a ravaging cholera from Hamburg off its shores. The move was successful. So was Cuba’s in the 1980s, when the country forcibly quarantined those with HIV, leading to a far lower AIDS mortality rate than New York’s. Cuba and Qing China are not known as exemplary cases of advanced institutions, science, technology, and business and public policy best practices. In fact, the Qing court managed to contain the pneumonic plague as the regime itself was teetering on a systemic breakdown; just six months after the plague was ended, the entire Qing dynasty collapsed. One should think twice before putting oneself in the same league as these predecessors.
A far more probing question is what kind of system, autocracy or democracy, is better at preventing the initial outbreak from getting out of the bag in the first place. Here both statistical and narrative evidence point heavily in favor of democracy.
In February the Economist published a graph that shows, controlling for income and size of population, non-democracies are more lethal than democracies during epidemics. The explanation proposed is that while authoritarian regimes are good at imposing response measures, they lack “free flow of information” and “open dialogue between citizens and rulers.” In other words, countries like China may be good at administering top-down measures such as lockdowns, but they have cut off the bottom-up feedback mechanisms that inform such measures in the first place.
Autocracy impedes uncovering emerging problems, and China’s outbreaks of pneumonic plagues only reinforce this proposition. The Qing court sat on the virus outbreak for months before it took action. In the SARS episode of 2002–2003, local officials hid the information and punished those doctors who sounded alarm. According to Dr. Jiang Yanyong, a doctor at a military hospital in Beijing, his hospital was informed about SARS in Beijing early March 2003 but was instructed not to disclose the information for fear of disrupting the annual gathering of the National People’s Congress. For its part, COVID-19 will go down in history as one of the costliest mistakes associated with suppression of the free flow of information. On December 30, 2019, a Wuhan doctor, Li Wenliang, posted to his social media group about “a SARS-like pneumonia.” Instead of following his lead and rigorously investigating the sources of this pneumonia, the Wuhan police called Li in for questioning and forced him to recant his message. Li later died from COVID-19.
One cannot excuse the initial delays on the grounds of shortage of data and information and then turn around and praise a system that routinely exacerbates the shortage by suppressing data and information.
Just how costly was this delay? It took Chinese authorities three weeks to impose a lockdown on Wuhan after Li sounded the alarm. By January 23, five million people had already left Wuhan, and COVID-19 was already silently lurking in the general population of the city. Researchers at the University of South Kempton estimated that if Chinese authorities had taken control actions three weeks earlier, 95 percent of the infections in China might have been avoided. In other words, the lockdown of Wuhan and Hubei and the shutdown of much of the country would have been unnecessary, and COVID-19 might have ended up as a localized limited outbreak and a case study in a medical journal.
To be sure, not all of the Chinese delay was political in origin. A counterfactual analysis, such as the one offered by the South Kempton researchers, is highly sensitive to the assumptions used and subject to high rates of errors and omissions. There is no question that the Chinese government was confronting an objectively difficult situation on the ground, and it might not have had all the information it needed to be decisive on December 30, 2019. An important factor is the novelty of SARS-CoV-2. (Its original name was “novel coronavirus.”) The Chinese authorities operated under deep uncertainty about the transmissibility and the lethality of the virus, and they had to make decisions under enormous time constraints, a pretext that cannot be invoked by the dithering and confused Trump administration.
Still, one cannot excuse the initial delays on the grounds of shortage of data and information and then turn around and praise a system that routinely exacerbates the shortage by suppressing data and information. These are two logically incompatible arguments. An explanation attributing the initial delay solely to technicality would be far more convincing if Li and other doctors had not been silenced and had authorities actively investigated and solicited information during those crucial early days.
• • •
Both the Great Plague of Northeastern China and COVID-19 betray a great autocratic tradeoff between discovery and treatment. Autocracies are terrible at discovery. Their first instinct is to suppress information and truth, but by dint of their power they are also capable of putting out fire when it is already burning fiercely. It is understandable, if misguided, that some U.S. governors battling COVID-19 may wish for the Chinese state capacity to enforce “shelter-in-place” edicts and for the organizational prowess of the Chinese state to build a thousand-bed treatment center (including thirty intensive care units) in ten days. The two epidemics also evoke a remarkable continuity between China of its past and China today. The CCP exercises such a remarkable level of control over the Chinese people and can get things done quickly not because of the Marxist ideology to which it pretends an allegiance, but because of its history—the capabilities it has built over time.
A more accurate assessment of the Chinese response would go something like this: the Chinese system is successful in creating a problem that it is also successful at solving.
In the end, the Chinese state’s failings and accomplishments are cut from the same cloth. A perennial cheerleader for the Chinese system the British political commentator Martin Jacques, author of the opinion-rich but fact-poor book When China Rules the World (2009). To a hammer, everything is a nail, and COVID-19 provided another opportunity for Jacques to expound his exultant perspective on China. Speaking with the Global Times, Jacques said, “I think the capacity of the state in China to deal with emergencies of this kind is far more developed and far more capable than could be achieved by any Western government. The Chinese system, the Chinese government, is superior to other governments in handling big challenges like this.”
An inconvenient hole in this argument is South Korea, a vibrant democracy that proactively tested, contact-traced, quarantined its index patients. It did all of that without resorting to a total lockdown and a complete shutdown of economy and society. And then, on the other end of the political spectrum, the autocratic Iran is still struggling mightily to get things under control. There is really no evidence that autocracy alone, either as a necessary or as a sufficient condition, explains any of the COVID-19 response outcomes we are observing.
If people insist on attributing China’s curve flattening to the superiority of the Chinese system, they should at least be more precise in their flattery. A more accurate statement would go something like this: the Chinese system is successful in creating a problem that it is also successful at solving. This judgment may lack some of the moral bite of Jacques’s original formulation, but it at least has the advantage of have some empirical support. Regarding the superiority of the Chinese system—as Zhou Enlai, according to a legend, once famously commented on French Revolution—it’s too early to say.
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April 14, 2020
15 Min read time