【Name】Chan Chi Ming Victor【Organization】 (at the time of the grant): Ritsumeikan Asia Pacific University【Title of Research】
State and International Public Health:
the Cases of SARS Control in Peoples’ Republic of China, Singapore and Vietnam【Purpose of Research】
This research aims for examining the role of state in containing infectious disease withspecific to the cases of Severe Acute Respiratory Syndrome (SARS) control in the Peoples’
Republic of China (PRC), Singapore and Vietnam. The outbreak of SARS in late 2002 on
the one hand demonstrated the infectious risk of a highly globalized world and posed a
doubt to the capability of state in managing infectious disease crisis on the other. However,
the experiences of SARS control restored the importance of state in contributinginternational health cooperation against infectious disease. In other words, weak or evenfailed state such as PRC during the early outbreak of SARS is the epicenter of trouble.
Instead of solely focusing on the in-depth and essential participation of non-state actor inpolicy process, strengthening state capacity is the nub for effective and highly-motivatedinternational health cooperation. In this research, I am going to (1) reexamine thecontroversial debate on the role of state within the unchallengeable wave of globalization
since late 20th century; (2) delineate the significance of SARS in international health; (3)conceptualize the concept of state capacity and argue for the importance of “capable state”
in relation to supply international health cooperation; and (4) scrutinize the cases of SARS
control in PRC, Singapore and Vietnam.
This research endeavors to go beyond the debate between “state-centrism” and “globalgovernance” and hence explore the important of ‘capable state’ in international public healthcooperation. The debate seems to examine the actual scope and function one state should
perform. However, both approaches ignore the capacity of state institutions in policy process.
In this research, Capable state, which is able to collaborate upward with internationalorganizations, steer downward with local governments, and coordinate outward withnon-state actors, in fact, can provide a middle-range approach as it not only revitalizes
state’s role but also includes the interactions with non-state actors.
This research enables our society to reshape our understanding on public health. Publichealth is no longer a lesser important issue. We should pay considerable attention to publichealth. Domestically, the trend of privatization and decentralization in health care system isprevalence but the responsibility of state cannot simply be ignored. Effective national healthsystem is a must for the success in economic development. Internationally, state withsufficient capacity is much more willing to cooperate with international community so as tocontain infectious diseases effectively and efficiently.
【Content/Methodology of Research】
There are extensive literatures about the role of state and public health in East Asia. It isessential to review the updated published books and journal articles. I have spent part ofresearch grant to purchase latest books on SARS (both in English and Chinese) andphotocopy journal articles so that I am able to scrutinize them and hence reinforce myliterature review. Large numbers of documents have been obtained from the official websitesof governments and related organizations such as the World Health Organization (WHO). It
is also very imperative to include statistical information complied by various national,regional and international players. In Vietnam’s case, I have recruited a Vietnamese student
to help me translate some Vietnamese materials related to SARS control. Statistical analysis
is also occasionally used throughout the research in order to illustrate the significance of theseverity of SARS on domestic economies and international community.
This research is a qualitative-in-depth analysis of state capacity and international publichealth with specific to health governance and Severe Acute Respiratory Syndrome (SARS)
control in Peoples’ Republic of China (PRC), Singapore and Vietnam. State capacity alwaysrelates to the steering ability over the network including societal actors and international
players. In order to deeply understand what actually happened, it is better for me to conduct
in-depth interviewing. Since October 2005, I totally carried out three fieldtrips – two in China
and one in Singapore. In the following, I am going to delineate the details of each trip.
However, some of interviewees’ names are not provided as following their requests.
The first field trip was conducted in early November, which lasted for a week. The target
territory was Guangzhou, the capital of Guangdong province. Since Guangdong was theorigin of SARS virus, it was a must to visit the areas and interview with all related informants.
I went to Guangzhou Health Bureau and visited its infectious control unit. I spent three days
there and interviewed 6 officials totally. All of them were working in an emergency teamagainst SARS in 2003. My questions were related to three areas: (1) how to respond to first
SARS outbreak; (2) how to work with other levels of officials; and (3) how to stimulate andgain support from the general public. These questions allowed me expanding myunderstanding of local governments’ capacity in SARS control. Another group of informants
is from mass media. It was commonly regarded that there was not sufficient information
during SARS outbreak. The local governments seemed to strict the coverage of potential
unknown disease outbreak. But, various kinds of mass media like newspaper ignored therestrictions and continued to disclose the news. So, I interviewed two reporters formerly
working in these newspapers. My questions were related to (1) why they still insisted toreport; (2) how to deal with the pressures given by governments; (3) whether there were anychanges after April 2003 when the central government decided to be more transparent
related to SARS control. The final group of informants in this trip was some semi-socialorganizations including some resident committees. Civil society in China was still immature.
Societal interests were reflected by resident committees’, which were organized bygovernment and party. I talked with four members of resident committee in various areas ofGuangzhou. My questions were related to (1) whether there were sufficient information
released by the government on SARS prevention; (2) how to respond in the early outbreak;and (3) how to work along with government.
The second fieldtrip was completed by early December, which lasted for a week. The
target territory was Beijing, the national capital of China. As it was the national capital andone of serious SARS affected areas, it was essential to conduct interviews with informants inBeijing. The first group of informants of course was government officials working in centrallevel (Ministry of Health and National CDC) and in municipal level (Beijing Health Bureau
and Beijing CDC). I interviewed totally 6 officials in this trip. The questions basically wererelated to the process and problems of inter-ministerial coordination as well as central-local
collaboration. Of course, questions related to government-society relations in SARS control
were also covered substantially. Another group of informants were some civil society
organizations like China Red Cross. I interviewed 3 informants, who involved in raising fundand delivering necessities to affected persons and families. The questions basically wereconcerned about the relationship between government and them in SARS control. In otherwords, were they merely an arm of government or more autonomy in planning SARS
voluntary work?
The last fieldtrip was conducted in January 2006, which lasted for a week. The target area
was Singapore. This country was severely affected by SARS virus but relatively succeededin SARS eradication. It was commonly regarded it as an example of authoritarian state likeChina. It may be a good example to learn for Chinese leaders. I visited Ministry of Healthand talked with four officials, who were responsible for planning, implementing, andevaluating SARS control processes. My questions were similar to the set, which I used inBeijing and Guangzhou. It may be good for me to conduct comparative analysis later. Apartfrom government officials, I did also interview some informants in society. I talked with anordinary citizen, who designed and maintained a website for SARS updates related toSingapore. The questions related to his motives and government supports were covered.
Three members of local community committees were also interviewed.
In conclusion, the grant received by the Foundation was very useful for me to deeply
understand the state-society relationship of SARS control in selected countries.
【Conclusion/Observation】
Based on the interviews conducted, it is concluded that the key of SARS eradication in
the selected countries is the quality of state capacity – whether state institutions are able tosteer a network, which may consist of non-state actors in a given issue area to achievecertain aims and goals. In the case of China, the SARS eradication level was substantial
depended on the ability of state’s steering capacity. In local level, Guangzhou health officials
admitted that they missed to do some necessary actions during the early outbreak though
SARS was an unknown disease to the world. They unanimously stated that they shouldreport to central government earlier so that it could make early responses. In terms of medialcontrol, the officials argued that it was necessary at the time because this could avoid
spreading public panic. But, the working relationship with the mass media particularly
newspaper could be improved by giving more necessary updates of SARS contagion in theprovince. The reporters however were not very dissatisfied with local officials in terms ofSARS because the officials merely were concerned about their political interests. They had
to bear all political risks in reporting the news. But, when the central government intervened
to SARS control, more and more information were released. In central level, officials from
Ministry of Health also admitted that they were too passive in working out a plan andcooperating with WHO officials. The situation gradually improved when they realized theseriousness of SARS contagion. National CDC informants also expressed that they could
feel the changes in senior management towards SARS control. These changes enhanced
eventually eventual eradication in China.
In the case of Singapore, the situation of handling early outbreak was very different
from its counterpart in China. Singapore’s Ministry of Health though lack of information still
respond quickly by restructuring its crisis management team to face SARS challenge. A
relatively centralized team mentioned by the informants energized the entire SARS
containment processes. With relatively strong steering capacity of state institutions, societalorganizations though relatively powerless were very supportive by recruiting manyvolunteers for educating people and cleaning. The most remarkable volunteer was the one
who designed and maintained the website for SARS in Singapore. He expressed strongly
that he did it not for himself but for the country. Without any government support, he insisted
to run this website so that more information would be released in a timely manner.
Overall speaking, the information received from the research activities funded by theFoundation can help me confirm the hypothesis which state the relationship between state’ssteering capacity and SARS eradication.