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Mainstream, VOL 61 No 14, April 1, 2023

The Curious Case of China through the Lens of Two Doctors and Two Pandemics | Jos Chathukulam and Manasi Joseph

Saturday 1 April 2023, by Jos Chathukulam, Manasi Joseph



The 2003 SARS and the latest Covid 19 pandemic underlined the need to adopt a participatory democratic framework in authoritarian regimes like China. This article looks into how the authoritarian political system in a way failed authoritarian states like China when it comes to epidemic and pandemic management through the perspective of two doctors and two pandemics. 


On March 11, 2023, Jiang Yanyong, the Chinese military doctor who exposed the truth regarding the extent of the 2003 outbreak of severe acute respiratory syndrome (SARS) passed away at the age of 91. In April 2003, when the ruling Communist Party was supressing all reports about the outbreak of the highly contagious SARS, Dr. Yanyong wrote an 800-word letter stating that there were many mores SARS cases than were being officially reported by the Chinese Health Ministry. Dr. Yanyong emailed the letter to state broadcaster CCTV and Hong Kong’s Beijing friendly broadcaster — Phoenix but both the media outlets ignored it. However, the letter got leaked to Western media and they published the facts in its entirety and thus the world got to know the severity of SARS. The letter by Dr. Yanyong, along with death of a Finnish United Nations Employee, allegedly after getting infected with SARS virus and the admissions and serious warnings by public health experts not only forced the Chinese government to become transparent in dealing with SARS but also led to the resignation of Meng Xuenong, who was the then Mayor of Beijing, and Zhang Wenkang, the then Health Minister (Verna, 2023).

The Chinese government quickly enforced strict containment measures as the virulent virus began to spread overseas. More than 8,000 people from 29 countries and territories were infected with SARS, resulting in at least 744 deaths (NPR 2023). In China, which was the epicentre of the outbreak, the SARS infected more than 5, 300 people and claimed the lives of 349 people (Huang, 2004).

Though Dr. Yanyong, who was instrumental in exposing Beijing’s cover — up of the 2003 epidemic was not penalized for drawing attention to the 2003 SARS outbreak, he was later punished for denouncing the 1989 Tiananmen Square crackdown. At the time of the 1989 Tiananmen Square crackdown, Dr. Yanyong had been the Chief Surgeon at the People’s Liberation Army’s main 301 hospital in Beijing when the army fought its way through the city to end the student led pro-democracy protests in Tiananmen Square, causing death of hundreds and thousands of civilians (NPR, 2023). Since 2004, Dr. Yanyong and his wife were periodically placed under interment house arrest for appealing to the Communist leaders for a re-evaluation of the 1989 Tiananmen pro-democracy movement. In 2019, on the 30th anniversary of the bloody crackdown in Tiananmen square, Dr. Yanyong wrote to the Communist leaders asking for its vindication and following this in April 2019 was hospitalized with pneumonia and was heavily guarded and banned from being visited by his family. The authorities cut off Dr. Yanyong’s contact with outside world and restricted his movements (NPR, 2023). Dr. Yanyong remained a politically sensitive figure throughout his life and even in his death, it remains the same, as news reports relating to Dr. Yanyong’s death appeared to have been censored on state-controlled media and even social media.

In late 2019, echoes of Dr. Yanyong’s experience were heard in China’s approach to the initial outbreak of Covid 19 pandemic which was first detected in the Chinese city of Wuhan. A 34-year-old ophthalmologist named Li Wenliang was detained and threatened by the police for trying to raise the alarm about a SARS like virus. Dr. Wenliang had warned his colleagues on social medial in December 2019 about a mysterious virus that eventually came to be known as coronavirus. On January 3, 2020, Dr. Wenliang was detained for “spreading false rumours”. Dr. Wenliang shared the information to his friends and colleagues on the Chinese social media app WeChat. Dr. Wenliang was censured by hospital authorities and was summoned to the Public Security Bureau in Wuhan, where he was forced to sign a statement in which he was accused of spreading false rumours and disturbing the public order.

On February 6, 2020, Dr. Wenliang died from Covid 19. Dr. Wenliang was humiliated even in death. Officials initially declared him dead at 9:30 p.m. on February 6. But when the reports of his death surfaced on social media, “the result was a tide of anger so dramatic that government officials intervened,” (Nie and Elliot, 2020 and Greene, 2020). After that Wuhan Central Hospital issued a statement that Dr. Wenliang remains in critical condition. “Then Dr. Wenliang was declared dead a second time at 2:58 a.m. on February 7,showing that even the date and time of a person’s death can be manipulated in the service of state propaganda” (Nie and Elliot, 2020 and Zhou, 2020). The death of Dr. Wenliang created an uproar among the Chinese citizens. Dr. Wenliang’s death triggered an unprecedented public outpouring of grief and outrage within and outside China and the authorities had to eventually accept the truth and honoured Dr. Wenliang and 13 other health workers by giving the title of a “martyr” (Alice, 2020). The medical fraternity across the globe found an inspiration and a heroic warrior in Dr. Wenliang and countless of books and memoirs dedicated to him stands as a testimony for this [1]. Dr. Wenliang continues to be an inspiration for healthcare professionals in authoritarian as well as democratic regimes with great reverence and respect.

Is the Authoritarian Political System in China Failing its Responses in Handling Public Health Crises? 

The tragic tale of these two doctors and many others who are silenced and imprisoned in China shows that the it’s time for the authoritarian regime to adopt a participatory democratic framework. Had the China been a democratic state, the Covid 19 pandemic and many other public health exigencies could have been handled in a better fashion. In fact, China could have developed and popularized its model of containing the pandemic by infusing the spirit of democracy and human rights. Had China adopted a democratic framework to successfully handle the pandemic, it would have proved to be a great asset and a valuable contribution to the rest of humanity. One of the biggest lessons the pandemic have taught the world was that scientific knowledge and best healthcare facilities alone are not sufficient to fight a pandemic and instead a participatory democratic setting is equally important in managing and mitigating public health exigencies (Chathukulam and Tharamangalam, 2021 and Chathukulam and Joseph, 2022).

Much before the COVID 19, that is, the 2003 SARS outbreak itself exposed that “government inaction paralleled by the absence of an effective response to the initial outbreak resulted in a crisis”. But the authorities refused to learn the lesson and the same mistake was repeated by not disclosing and divulging information on data and facts associated with Covid 19 pandemic that too even after it started to wreck a havoc not only in China but also across the globe. It is high time the authoritarian regime in China should accept the fact that in the era of internet, smartphones, laptops, a complete information black out is next to impossible, a major lesson that the 2003 SARS outbreak taught but nobody seems to pay a heed to it.

Be it the pattern of the Chinese government’s response to the SARS or the more deadly Covid 19, all of it were shaped by the institutional dynamics of the country’s political system. The “authoritarian tendency to maintain secrecy” along with a “performance-based legitimacy” and an “obsession with economic development and stability” (Huang, 2004), contributed to China’s failure in previously handling the SARS in the beginning and the same applies to Covid 19. Studies point out evidences to suggest that in 2003 when the SARS infections started rising, the provincial governments in China were reluctant to disclose the details not only because of the public health implications involved in it but also because of the negative impact it might have on the local economic development (Garret, 2003). The China’s national agenda itself is that the economic growth is key to solving the problem of the nation and makes social stability as a necessary prerequisite to development.

On the one hand, an upwardly directed system of accountability, a fragmented bureaucracy and an oligarch political structure hampered the government response to the public health crises and outbreaks in China. On the other hand, the interaction between state and society unleashed central Party -state to intervene on society’s behalf (Huang, 2004). The direct involvement of the Central Party strengthens the maximized the potential for interdepartmental and intergovernmental cooperation and in such a manner that the Party -state remains capable of implementing its will throughout the system without serious institutional constraints. Be it a natural disaster, man-made disaster or even a “public health crisis reduces the state capacity just when ever-increasing capacity is needed to tackle the challenges, purely endogenous solutions to build state-capacity are unlikely to be successful and capacity will have to imported from exogenous sources such as massive foreign aid”, (Price-Smith, 2002). Here comes the importance of a participatory democratic framework, that is to build more effective partnerships and institutions as part of the society by collaborating with international actors. These international actors and agencies can play a greater role in creating a “more responsible and responsive government in China,” (Huang, 2003) and this in a way can help shaping China into a democratic society in the years to come.


In the latest Democracy Index (2022), China ranks 156 out of the 167 countries with an overall score value of 1.94 out of 10, keeping it in the category of authoritarian regimes. The change in rank from the previous year was less than 8 points. In 2021, the overall score for China was 2.21 out of 10, in 2020 it was 2.27 (Rank 151) and in 2019 it was 2.26 out of 10 (Rank 153). According to Freedom Index 2022, China’s authoritarian regime has increasingly become repressive in recent years. In the absence of fundamental changes in the political system and a comprehensive epidemic control plan, the instances of cover — up and a lack of transparency and accountability during public health exigencies will keep on repeating no matter whatever criticism comes. A government that is increasingly more open and interested in democratic and international engagement is the need of the hour and the pandemic offered an opportunity to adopt a democratic framework but looks like China and similar authoritarian regimes have failed to capture the message.

(Authors: Jos Chathukulam is former Professor, Ramakrishna Hegde Chair on Decentralisation and Development, Institute for Social and Economic Change, Bengaluru and currently the Director of Centre for Rural Management (CRM), Kottayam, Kerala. Email address: joschathukulam[at]; Manasi Joseph is a Researcher at Centre for Rural Management (CRM), Kottayam, Kerala, email: manasijoseph[at]



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[1Dr B Ekbal, a public health activist and neurosurgeon wrote a book in Malayalam titled Mahamarikal: Plague Muthal Covid Vare, Charithram, Shastram Athijeevanam in April 2022. This book is dedicated to Dr. Wenliang.

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