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Passengers at Hankou railway station in Wuhan, China, on 22 January 2020, the day before the government locked down the city. 

Xiao Yijiu/Xinhua/Eyevine/Redux

China overhauls its public health bureaucracy

The Chinese government, roundly criticized at home and abroad for its initial response to the COVID-19 pandemic, appears to have taken some lessons from that crisis. On 13 May, it announced an overhaul of its public health bureaucracy, centered on the creation of a new national agency that will report directly to China’s State Council. On paper, at least, the new structure should help bypass the layers of bureaucracy that stymied the timely flow of information from local authorities in Wuhan and Hebei province to top national officials in the early days of the coronavirus outbreak.

The new National Administration of Disease Prevention and Control (NADPC) will be tasked with safeguarding and promoting public health, establishing an epidemic monitoring and early warning system, and guiding disease control research, according to the official Xinhua News Agency. It will absorb the existing Chinese Center for Disease Control and Prevention (China CDC) and will be headed by Wang Heshang, an official at the National Health Commission (NHC) who was dispatched to Hubei last year to direct the governmental response to the outbreak.

“The development is clearly important,” says Keiji Fukuda, an epidemiologist at the University of Hong Kong who previously held several positions at the World Health Organization (WHO). Although Xinhua’s announcement did not link NADPC’s creation to the pandemic failures, “In essence, it is a response to China’s internal assessment of what it needs to do differently to perform better,” Fukuda says. “What is not clear is how this will actually work in practice.”

Through stringent quarantines, contact tracing, and lockdowns, China crushed its COVID-19 epidemic months after it erupted in January 2020. But the country stumbled badly in the early days, as a report issued earlier this month by the international Independent Panel for Pandemic Preparedness and Response has confirmed. Health care workers were warning about a serious, unusual pneumonia spreading among hospital staff in Wuhan as early as 30 December 2019, but local authorities ordered institutions not to disclose information to the public. Whistleblowers were silenced. The first report that scientists had fingered a novel coronavirus came not from authorities, but in a story in The Wall Street Journal. It wasn’t until 20 January 2020 that an NHC delegation led by noted respiratory diseases expert Zhong Nanshan acknowledged that human-to-human transmission was occurring and that health care workers were being infected.

“The structure of the Chinese political system creates incentives for lower level officials to conceal and manipulate information,” aided by censorship and the lack of independent media, says Jennifer Pan, a political scientist at Stanford University.

As a result, China missed a chance to better control the outbreak and failed to warn other countries early. When the national government finally got up to speed, it fired local officials deemed responsible. Chinese health experts also began to discuss a new high-level agency that would combine the administrative functions of the existing NHC with the research functions of China CDC, says Yanzhong Huang, a global health specialist at the Council on Foreign Relations in New York City. In a speech last week, Sun Chunlan, a vice premier and member of the Communist Party Politburo, emphasized that the new agency should strengthen its leadership over lower level disease control agencies, according to Xinhua.

It’s not the first time China has tried to make its public health bureaucracy more effective. In 2002, it converted the Chinese Academy of Preventive Medicine into China CDC, modeled on the U.S. Centers for Disease Control and Prevention. Yet in 2003, the country badly botched the outbreak of severe acute respiratory syndrome, another coronavirus disease, by failing to respond quickly and initially withholding information from the public and WHO.

Additional reforms after that episode did not overcome the structural issues, Pan says. China CDC remained “bedeviled by a lack of funding and autonomy,” Huang adds. Local officials blocked reports of unusual disease cases from reaching the agency, which was not authorized to issue alerts about looming public health emergencies, he says.

The Xinhua report does not mention what will happen to China CDC, but the agency’s head, George Gao, confirmed to Science that it will be under the new agency, without giving further details. NADPC is still technically affiliated with NHC, and its mission and authority “remain not very clear,” Huang says. But if NADPC gets sufficient resources and authority, he says, China might be better prepared for the next disease crisis.