Wuhan: How the COVID-19 Outbreak in China Spiraled Out of Control, by Dali Yang, seeks to provide a comprehensive and critical examination of China's emergency response to the initial COVID-19 outbreak in Wuhan in late 2019. The core argument of book is that the Chinese party-state's political structure, bureaucratic process and cognitive biases hindered the flow and sharing of information, which significantly contributed to the mishandling of the outbreak and led to an escalation of the outbreak's scale and severity, ultimately precipitating a global crisis.
Yang's expertise in Chinese bureaucratic politics and public health governance, along with the profound impact of infectious disease on his family story in China, shines through in this insightful and compelling narrative. His timely book provides a detailed account and accessible analysis of how the COVID-19 crisis unfolded in China. Yang meticulously documents and reconstructs the timeline of the outbreak, highlighting critical moments when interventions could have altered the course of the pandemic. Serving as a vital historical record, it also constitutes a valuable resource for scholars, policymakers and researchers, informing future research and policymaking.
This book greatly contributes not only to the literature on Chinese politics and public health policy but also to mainstream comparative studies of public health politics. One of the major findings points out that
…contrary to popular perceptions of China under the centralized control of the party-state led by Xi Jinping, the underlying fault lines and tensions of fragmented authoritarianism, typically concealed or minimized in more stable times, significantly weakened the health emergency response during the initial weeks of the COVID-19 outbreak. (p. 280)
It is widely believed that since Xi came to office in 2012, Beijing has largely recentralized its power through measures such as sending Central Inspection Teams to local areas (zhongyang ducha xunshi) and implementing anti-corruption and responsibility attribution (guanyuan wenzi) campaigns to hold local officials accountable. The “fragmented authoritarianism” model, characterized by “selective implementation” and huge gaps between policy and implementation – hallmarks of the Hu–Wen era – have given way to campaign-style “over-implementation” (jiama zhixing). Recent studies on environmental politics suggest that under Xi's centralized rule, local officials get more incentive for top-down, one-size-fits-all “blunt force” solutions, thereby avoiding the gaps in earlier implementations. This campaign-style implementation usually involves strong political will and policy priority from political elites, extensive mobilization of administrative and social resources across various sectors and jurisdictions, and radical targets set to be achieved within tight deadlines. While this approach may be highly effective in the short term, it risks undermining the rule of law, bureaucratic rationality and meaningful public participation.
Yang deeply engages with ongoing debates about China's central–local relations and demonstrates that in the early stages of the Wuhan outbreak, bureaucratic and territorial fragmentation significantly undermined the effectiveness of the health emergency response regime. This resulted in deliberate concealment, distortions and blockages in epidemic information flows, defensive avoidance by organizational leaders, shirking of responsibility, and efforts to assign or shift blame to other authorities. It is suggested that, if China had not practised censorship and imposed limits on the free flow of information, “major missteps and deficiencies would likely have been avoided or significantly mitigated, and there would have been a real and non-trivial chance of containing the initial outbreak early on” (p. 281).
Yang's analysis extends beyond China, offering valuable insights into the global response to the pandemic and the lessons that can be learned to better prepare for future public health emergencies. He identifies key takeaways from the Wuhan outbreak, including the importance of transparency, rapid response and international cooperation in mitigating the spread of infectious diseases. Examining the role of public health specialists in Wuhan outbreak, he argues that
Modern bureaucratic hierarchies tend to promote specialists into leadership roles whose qualities may be ill-suited for situations requiring decisive leadership. Regrettably, during the early weeks of the Wuhan outbreak, effective public health leadership was desperately needed to tackle political, organizational, and psychological vulnerabilities but was largely absent. (p. 280)
To empirically test these arguments, Yang conducted extensive research involving original data collection and analysis, including interviews, government documents and media reports. Despite the difficulties of doing fieldwork in Wuhan during and after the pandemic, this thorough approach allows him to present a balanced view of the crisis, acknowledging the extraordinary efforts of healthcare workers and the eventual mobilization of resources by the Chinese government, while also critiquing the initial mishandling and lack of transparency.
This book can further inspire readers to critically ponder on the following three questions. First, how did Xi's security-focused governing philosophy, centred on the concept of “overall national security,” shape China's political and public health system's response to the outbreak? Yang highlights that stability, as “overall national security,” is a key feature of the Xi Era. However, studies on this concept often focus on his foreign policies, particularly their impacts on US–China relations, and few works extend their scope to public health policy or other areas. Examining the “overall national security” concept in different contexts may also significantly improve our understanding of China's economic downturn in the post-pandemic era.
Second, despite the centralization trend under Xi's rule, why is China's public health and emergency response regime still fragmented, with different agencies having their own agenda and bureaucratic interests? Through the lens of the “fragmented authoritarianism” (FA) model, the big paradox in China's public health politics emerges: on one hand, the central state needs to maintain its legitimacy through controlling public health crises in a centralized authoritarian manner; on the other hand, its crisis management system at the local level is highly fragmented and decentralized in nature. Some studies reveal that the FA model can also explain the blame-generating and blame-shifting games between central and local governments. A further study on the blame politics of public health regime may show that China's policymakers have intentionally chosen this fragmented system because it obscures who should get blamed when policies fail and who should receive credit when they succeed.
Last but not least, comparative studies on public health policy have a long tradition of debating the correlation between regime type and the performance of pandemic governance. Mainstream research claims that democratic systems perform better on pandemic governance than authoritarian systems due to their high information flow and meaningful public participation in the decision making and crisis management process. Does the study on Wuhan's outbreak provide another case to support these mainstream arguments? Will a democratic regime transition systematically address the political and institutional constrains lead to mishandling of the COVID-19 outbreak in Wuhan? Scholars, students and general readers interested in critically examining the above questions will find Yang's thought-provoking book on China's response to the Wuhan outbreak a compelling read.
