A high price for progress

Five years since a deadly virus hit, our five-part series looks back and asks what lessons have been learned; Part 4 - The mainland crisis

China's leaders have long boasted of having a knack for turning crisis into opportunity and this was the line Beijing maintained after the battle against Sars, the toughest public health challenge of recent times.

Central government advisers say the fight to eradicate the disease in 2003 gave the mainland the impetus to introduce reforms on several levels, improving transparency, crisis management and public health system by boosting investment.

But those gains came at the cost of more than 340 lives on the mainland, 5,300 people infected and months of anxiety across the country. The crisis undermined the government's credibility and China's image abroad. Five years after the outbreak, there are lingering doubts about the impact and some analysts are concerned that Beijing has not fully learned its lesson.

World Health Organisation chief Margaret Chan Fung Fu-chun probably knows better than most how hard it is to extract information from the central government. As Hong Kong's health director at the time, it was her role to confirm media reports of an outbreak in Guangdong when the virus first appeared in February 2003.

In remarks to a Legislative Council select committee in January 2004, Dr Chan said she had been told a year earlier by a provincial health official that communicable diseases were classified as state secrets. Beijing, with its long history of secrecy, initially spent weeks denying there was any problem, losing a prime opportunity to try to stop the virus from spreading around the globe.

Even at the central government's first Sars press briefing on April 3, Health Minister Zhang Wenkang played down the crisis and claimed the disease was under control.

But the government's credibility was dealt a blow when military doctor Jiang Yanyong later sent out an open letter to mainland and overseas media accusing the government of lying.

The ensuing investigations by foreign news media (Dr Jiang also sent his letter to state-run China Central Television and Hong Kong-based Phoenix TV, neither of which followed up on it) and pressure from the international community prompted the sacking of Mr Zhang and Beijing mayor Meng Xuenong on April 20 in a bid to repair the government's battered credibility.

Vice-Premier Wu Yi was then pushed forward to replace Mr Zhang, and has helped to restore China's image. From the day of Ms Wu's appointment, Beijing began releasing official figures on new infections. The move was applauded by health authorities who were desperate for accurate information on the scale of infection on the mainland.

By early June the daily rate of infection had dropped dramatically and there was widespread optimism that the disease was under control.

Henk Bekedam, the WHO's representative in China during the epidemic, said the frustration of trying to get information from the central government evaporated on April 20, when the leadership also admitted that the Sars caseload had been underreported by as much as tenfold.

'From that time, when the government and ministries became very open about it, China was the best place to work,' said Dr Bekedam, now based in Manila as the WHO's director for health sector development of the western Pacific region.

'The Ministry of Health is a lot better prepared for new diseases and diseases such as avian influenza because they've improved the public health system, and because they've also understood how important it is to share information in a timely matter, not only within the government but also with international partners.'

But a reluctance to share information doesn't vanish overnight. In another major emergency in late 2005, when the Songhua River in Heilongjiang province was contaminated by a 150km-long toxic slick, the Harbin government initially covered up the spill. But since Sars the government has made efforts to promote transparency, analysts say.

Most ministries and cabinet level departments have appointed spokesmen, and many provincial-level governments have established nominal points of contact for a freer flow of information to the public, although it can be difficult to get spokesmen to answer questions or even pick up the phone.

Press briefings by government departments have become more regular and in some of cases are broadcast live on the internet.

Xue Lan, a professor at Tsinghua University's School of Public Policy and Management, said the move towards greater openness would not just institutionalise a media policy but also reform the government's approach to administration.

The introduction of the Regulations on Government Disclosure of Information, which come into effect on May 1, would be a significant landmark, Professor Xue said. The regulations were more than eight years in the making, but he said Sars had hastened their introduction.

Under the regulations, all levels of government are obliged to make information available on matters ranging from fees for public services to sensitive issues such as the results of environmental investigations and land requisitions.

But China Youth University of Political Sciences media expert Zhan Jiang said the drive to make government operations and information more transparent suffered a huge setback in September 2004, when the Central Publicity Department issued a warning against media outlets carrying out investigations.

'The government had made huge progress in opening up information. But it failed to carry on progress,' he said.

Even with better access to information, Professor Zhan said the mainland media rarely carried out frontline investigations into the epidemic during the outbreaks. And if they did, the probes came at a price.

Cheng Yizhong, editor-in-chief of the Southern Metropolis News, was imprisoned for five months in 2004 with colleagues Yu Huafeng and Li Minying after the newspaper broke a story about a Sars case in late 2003, before the authorities announced it. Mr Li was released in later that year, but Mr Yu was freed only earlier this month.

Professor Zhan said the press had been muzzled since the Publicity Department issued its warning and that restrictions have loosened only slightly over the past two years.

The Regulations on Government Disclosure of Information were released by the State Council, but Professor Zhan said that without the status of a law introduced by the National People's Congress, the rules would only apply to government departments, not party organs, and therefore have a limited effect.

A test of the government's ability to handle emergencies openly came early this year as snowstorms wreaked havoc across China and stranded millions of commuters on their way home for Lunar New Year. Its response showed more transparency than its reaction to Sars, with regular updates on the internet and in the press, but some critics have questioned the effectiveness of the 106 emergency plans drafted after the Sars outbreaks, and others have blamed the government for a sluggish response to the emergency.

Professor Xue said the Sars epidemic had led to better crisis management mechanisms. The Emergency Response Law was introduced in November last year, and various levels of government have set up emergency services offices.

'But this mechanism works better in emergency situations that we are familiar with, such as typhoons,' Professor Xue said. 'A limitation is that we still don't know how to recognise an unfamiliar emergency situation. The prolonged snowstorms in the southern part of China, for example, were rather unusual.'

For Dr Bekedam, a significant change brought by the Sars outbreak was progress, albeit slow, in the public health system.

'When I first arrived in China in August 2002, I came to the conclusion that senior leaders had no interest in public health. And it was only after Sars that they became aware that as a government they need to take a greater responsibility,' he said.

Comparing the National People's Congress report by then premier Zhu Rongji in 2002 and his successor, Wen Jiabao, in 2003, Dr Bekedam said the government had changed its attitude towards public health.

'Mr Zhu's speech was about 45 pages and only on page 34 was the word health mentioned for the first time,' he said. But in Mr Wen's speech, 6 per cent of the Chinese characters were linked to health.

Dr Bekedam said the central government had put extra effort into improving the public health care system by, for instance, boosting the capacity of laboratories to detect viruses and putting in place a stronger surveillance system.

'China is very good at turning crisis into opportunity,' he said. 'And it has turned the Sars crisis into an opportunity to strengthen the public health system towards reform.'