How the Sars outbreak changed mainland China

In the first of a series marking 10 years since the outbreak, experts say the crisis forced major policy changes to respond better to emergencies

PUBLISHED : Wednesday, 20 February, 2013, 12:00am
UPDATED : Wednesday, 20 February, 2013, 7:35am

Beijing businessman Wu Yong can still smell the disinfectant in the air as he casts his mind back to spring 10 years ago, when an unknown and deadly new disease held the capital and the country in its grip.

The driver, conductor and a handful of passengers on a bus for his daily commute all wore masks. The streets were empty bar a few cars and even the city's busiest shopping street, Wangfujing, was deserted.

"In panic, we bought masks, vinegar and banlangen [a traditional Chinese cold medicine]. Everyone would flinch when someone coughed or sneezed," said Wu, now 35. "It was a very scary and strange time of my life."

The disease, later identified as severe acute respiratory syndrome (Sars) didn't just leave its mark on ordinary citizens like Wu. From the first diagnosis in November 2002 until the World Health Organisation declared China Sars-free on May 19, 2004, the disease infected 5,237 people on the mainland, of whom 329 died. It was a major public health crisis that had an impact well beyond the health sector.

"Sars bears landmark significance not only for economic development but for government reform. It has triggered a series of major policy changes," Premier Wen Jiabao wrote in the February 1 issue of the Communist Party journal Seeking the Truth.

"The crisis exposed all the defects in the political system," said Professor Hu Angang of Tsinghua University's school of public policy and management. "It turned out to be the best teacher for the government on how not to repeat those mistakes."

The first Sars case involved a farmer from Foshan , Guangdong, who was identified days after President Hu Jintao and Wen were promoted to head the party at a national party congress. But they were not due to take over their formal government roles until March the next year and heads of government at all levels were also awaiting a reshuffle.

Such uncertainty meant it was the worst possible time for a major public health crisis to emerge. The subsequent slow response from the central government, which was widely criticised as a cover-up, enabled the virus to cross the border into Hong Kong and spread to the world at large.

"The focus on the power reshuffle led to a vacuum in government administration during the initial stage of the crisis," Hu Angang said. "The government's lack of ability to handle a crisis was exposed."

In February 2003, Guangdong for the first time announced the deaths of five people and 305 cases of the flu-like disease. At the end of March, Beijing was listed as an "affected area" by WHO.

Hu and his team at Tsinghua University wrote a report in early April to the State Council describing the crisis as benign, arguing that it would not rock the political foundations of the county or stop the momentum of economic growth.

The State Council did not set up a national-level contingency task force to deal with Sars until late April.

Hu and other academics were critical of the fact that there were no government agencies to deal specifically with health contingencies and no law to provide a legal basis for handling emergencies.

In July 2003 the State Council's general office put together a task force to start drafting the government's overall contingency plans for public crises. The first state-level plan was published in January 2006 and covered general principles for handling natural disasters, industrial and traffic accidents, public health problems and terrorist attacks. By the following year, tens of thousands of contingency plans had been issued by government departments at all levels.

The State Council also established a permanent emergency response office reporting directly to the cabinet in 2006, and the Emergency Response Law was passed the following year.

"One major impact of Sars is that responding to emergencies has become a regular function of government, which is now much better at dealing with crises," Hu said.

He cited the central government's response to the freak snow and ice storms that brought southern provinces to a standstill during the Lunar New Year peak travel period in 2008, and the aftermath of the Sichuan earthquake that struck on May 12 the same year and killed 87,449 people.

Five hours after the quake struck, Wen stood among shattered buildings, consoling victims and encouraging rescuers.

"You see how the government learned to skilfully handle crises and senior officials tried to build a caring image," said Chen Gang , an associate professor at Wuhan University's School of Political Science and Public Administration.

The flow of information became smoother and transparency was recognised as a powerful tool that allowed the government to seize the initiative and to get disasters under control.

"What we learned from Sars is that transparency has a vital impact on whether a crisis is properly handled," said Mao Qunan , the Ministry of Health spokesman who gave daily updates on the Sars epidemic from April 2003. "Any delay in the release of information has a negative influence."

Hu said: "Sars started a revolution in transparency."

In 2007, Beijing passed the Release of Government Information Ordinance, a breakthrough for access to information.

Beijing's initial failure to admit the true extent of the Sars outbreak was roundly criticised by overseas governments and WHO. It took two months - after devastating Sars outbreaks in Hong Kong, Singapore, Hanoi and Toronto - for Beijing to allow WHO epidemiologists to enter Guangdong on April 3 to assess the situation there.

"There were doubts about 'interference in China's internal affairs' back then," said Chen. "Since then, the Chinese government has established good working ties with international organisations, as demonstrated during the Sichuan earthquake when international rescue teams and charities were allowed quick access to the disaster sites for rescue operations.

Chen said the Sars crisis also triggered moves to hold officials accountable for their mistakes - although the accountability system remains full of flaws.

In April 2003, health minister Zhang Wenkang and Beijing mayor Meng Xuenong were both sacked over their handling of the outbreak, the first ministerial-level officials on the mainland to be fired for incompetence. Since that time, heads have rolled more frequently at all levels of government, including a party secretary in Shijiazhuang , Hebei province over the melamine-tainted-baby-formula scandal.

"You see more and more officials being made to take responsibility not only for the usual criminal offences of living a decadent lifestyle, but for political reasons," Chen said. "Some do not appear to have committed any obvious wrongdoing, and their sackings appear more to be gestures of bowing to public pressure."

Another flaw in the accountability system is that officials sacked from one post have often been able to make a quiet comeback in another.

Following his departure from Beijing, Meng was quietly made deputy director of the South-North Water Transfer Project before becoming governor of Shanxi province. He served for less than a year before being forced to resign in September 2008 after mishandling a deadly mudslide in Xiangfen .

Zhang was made a vice-chairman of a government-linked foundation, where he served until his retirement.

The most noticeable legacy of Sars, though, has been the upgrading of the county's public health system.

"The Sars crisis provided an enormous boost to the development of China's public health system," said Feng Zijian, director of the emergency office of the China Centre for Disease Control and Prevention.

From the end of 2003 until 2006, the central government injected 25.7 billion yuan (HK$32 billion) to upgrade facilities for public health emergencies and hospitals for infectious disease.

By 2006 the Ministry of Health had announced that a disease prevention and control system was basically established and that an infectious disease reporting system covered more than 95 per cent of counties.