China is again facing a health scare that has the potential to turn into a major global pandemic — could this become SARS 2.0? This time though, the Chinese government is being more transparent and moving into action much faster.

This is a stark contrast to a long history of covering up infectious disease outbreaks. China waited several months to alert the international community about SARS when it broke out in 2002-2003. The SARS virus eventually infected over 8,000 people and killed approximately 800 throughout the world.

Some public health experts are worried the current outbreak could turn into an epidemiologic nightmare, given the millions of travelers and large crowds during the Lunar New Year holiday. So is China prepared to respond to the novel coronavirus? Here’s what you need to know.

SARS changed public health in China

SARS posed a huge blow to China’s international reputation. After months of political coverups, a whistleblower finally brought SARS to the world’s attention. The Chinese government finally let World Health Organization officials in, following months of mounting international pressure. This pressure helped spur the political commitment necessary to quickly stem the epidemic.

The SARS epidemic uncovered serious deficiencies in China’s public health system. Beijing’s unwillingness to cooperate with international partners to prevent the emergence of a global pandemic turned China into the weak link in global health preparedness for the influenza-type epidemics that often originate there.

After the SARS crisis, China professionalized its public health system, especially in Shenzhen, one of the SARS epicenters. Chinese health authorities built a local emergency and preparedness infrastructure, armed to detect and respond to an epidemic outbreak.

China also doubled its health staff and replaced the former “experts” who had worked for the local public health system with public health professionals trained in epidemiology and related scientific fields, with degrees from prestigious universities at home and abroad.

SARS also changed global health

The WHO revised the International Health Regulations in response to the SARS pandemic, setting new global guidelines for reportable diseases and the global response. China also stepped up its commitment to global health by improving its own public health surveillance system, and by reaching out to other countries.

China spent hundreds of millions of dollars and sent more than 1,000 health-care workers to West Africa during the 2014-2016 Ebola outbreak, for instance. These efforts, however, have done little to prepare China to respond to disease outbreaks at home.

How prepared is China now?

The current outbreak in Wuhan has elements of the SARS debacle. Initial reporting of the new coronavirus seems to have been delayed, prompting accusations on Chinese social media of a government coverup. Citizens who remember SARS were also running scared, buying up face masks and trying to escape the city of Wuhan before authorities totally shut it off from the outside.

Here’s what’s different: The central government in recent days was far quicker to demonstrate the political commitment needed to stem the current outbreak. During the past decade, China has become much more of a world leader — including taking a stronger position on the global health stage — and has much more at stake in 2020 than in 2003.

Yet China wasn’t fully prepared for the current outbreak in Wuhan, not because of Beijing’s commitment, but because of the intrinsic difficulty of public health preparedness. Any government preparing for a health crisis faces several challenges, including what type of threat to prepare for, an ongoing state of vigilance, and the chain of command for responding to an epidemic outbreak.

China seems more prepared for an epidemic attack from the outside that it can control at its borders, however. In 2009, Shenzhen was able to test its new preparedness measures to delay the crossing of the H1N1 virus from Hong Kong.

China is now armed with an advanced surveillance system that the WHO director-general credited for eventually picking up this latest outbreak. But preventing an outbreak also requires a level of preparedness like the one demonstrated in Shenzhen in 2009. Public health officials there were at the ready to detect disease and trace all the people that had been in contact with anyone who was infected. This allowed health officials to get ahead of the infection. But maintaining such a high level of preparedness over the long run is difficult.

The result is pockets of vulnerability in places like Wuhan, home to one of the most advanced epidemic research laboratories in the world. As my previous research has shown, though, the health infrastructure China builds is often window dressing. It is also difficult to sustain a level of preparedness for the unknown in place of deferring resources toward day-to-day public health needs.

Is China protecting its global image — or its citizens?

Chinese officials have been working hard since SARS to build up the country’s reputation as a global health leader. Indeed, China’s investments in global health help make up for funding shortfalls, including recent reductions in global health commitment from countries such as the United States.

But the stigma of the SARS coverups at home in 2003 may overpower the impact of these global assistance efforts. China is receiving big hits to its domestic and international reputation because of its lack of preparedness to fight yet another outbreak of a strange pneumonia-like virus within its borders.

This kind of pressure speaks to Chinese leaders, who don’t want to be “forever nailed to history’s pillar of shame,” as one Communist Party statement explained last week. Ultimately, it is this type of pressure that might help China figure out how to balance its commitment to global health with that of domestic preparedness.

Elanah Uretsky is a medical anthropologist and assistant professor of International and Global Studies and Anthropology at Brandeis University in Waltham, Mass. She is author of “Occupational Hazards: Sex, Business, and HIV/AIDS in Post-Mao China” (Stanford University Press, 2016).

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