Earlier this month, hundreds of aggrieved parents gathered outside the government office in Jinhu County, in the eastern province of Jiangsu, demanding an explanation for why 145 infants had been administered expired doses of the polio vaccine. It was China’s fifth vaccine scandal in less than seven years, and yet another blow to the country’s drug industry, its national immunization program, its regulatory authorities — and to the very legitimacy of the Chinese Communist Party (C.C.P.).
Last summer, one of China’s largest vaccine makers was found to have issued at least 250,000 substandard doses of vaccine for diphtheria, tetanus and whooping cough. (Many more were discovered later.) Soon after, in a survey of 300,000 parents by Xiaodoumiao, an app used to book vaccination appointments, 79 percent of respondents said that before the scandal, they would have given their children a vaccine made in China, but only 36 percent said they would still do so now. Sixty percent of respondents said they were considering having their children inoculated outside mainland China.
Then and this month as well, there were protests, sometimes violent, against local officials. Last summer, after a senior regulatory official appeared on state-owned television to address public concern, Chinese web users lambasted him for his stiff manner and his Burberry shirt, calling it inappropriate for the occasion. The sanctions that the government undertook — firing officials, imposing a colossal fine on one drug company — didn’t seem to quell people’s anger.
The scandals, especially their repetition, undermines the people’s trust in the state. This would be true to some extent almost anywhere, if only as a failure of regulatory oversight, but they hit harder in China.
As the sociologist Dingxin Zhao has argued, a state can justify its power in essentially three ways: by appealing to shared values, to the sanctity of an electoral process and the rule of law, or to its own performance. In China, the C.C.P.’s hold on power today isn’t based on popular elections or the rule of law, and the party can no longer appeal to the superiority of communism as a holistic political theory. So it must justify its continued rule by consistently delivering public goods, such as economic growth or better standards of living.
Democratic governments also worry about their performance to some extent, because they are concerned about losing the next election. But democracy as a political system draws its legitimacy from respecting basic rights and procedural fairness, rather than from achieving concrete results; a failure of performance does not endanger the system itself. Not so in China, where the party is the state. President Xi Jinping implicitly recognized as much when he warned in late 2013: “If we do not do a good job in food safety, and continue to mishandle the issue, then people will ask whether our party is fit to rule China.”
As Mr. Zhao has argued, some form of performance legitimacy can be traced back to the notion of the “mandate of heaven” (tianming) in imperial China, according to which an emperor’s authority was thought to come from heaven itself, but lasted only as long as his rule remained virtuous. When the imperial rulers became ineffectual or tyrannical, they could rightly be removed in a coup or a revolution.
After the Communists’ rise to power in 1949, the state penetrated deeper into society and increasingly made promises about improving people’s well-being. Health care, which had long been seen as an individual responsibility, became a public good. But communist ideology and the cult of personality surrounding Mao maintained the party’s legitimacy even when it fell short: For instance, the famine during the Great Leap Forward did not fundamentally shake Mao’s authority.
Performance only became the main basis of the C.C.P.’s legitimacy in the post-Mao era, after the state could no longer justify its rule by invoking communism. And the approach seemed to work for a time: “Had it not been for the achievements of the reform and the open policy, we could not have weathered June 4,” Deng Xiaoping said in 1992, referring to the day of the Tiananmen Square crackdown in 1989.
But Deng’s statement was also an admission of the inherent frailty of performance-based legitimacy: In a top-down, state-dominated political system, the link between performance and legitimacy is dangerously tight. When I was conducting research about the health effects of pollution in China last summer, I was amazed to hear so many people, academics and ordinary Chinese, treat a policy failure (like a food safety crisis) or an economic problem (like rising income inequality) as failures of the “system” (tizhi) itself.
The centralization of power since late 2012-early 2013, when Mr. Xi became the C.C.P.’s general secretary and then president of China, has only highlighted the system’s fragility. Thanks partly to the removal of presidential term limits and his vast, terror-inducing anticorruption campaign, Mr. Xi has become China’s paramount leader. But his extraordinary authority has deeply unsettled officials at all levels, with unwanted effects.
Lower-level officials have strong incentives to jump onto Mr. Xi’s bandwagon, especially when he signals a policy priority clearly and consistently. With pollution control, for example, they have sometimes become overzealous and have overshot. But with issues that have gone on and off the government’s agenda, such as vaccine safety, local officials are more likely to adopt a wait-and-see attitude for fear of making a mistake — paying lip service to directives but essentially shirking their responsibilities. As the independent scholar Deng Yuwen has argued, extremely centralized leadership leads to the paradoxical situation in which strict regulation backed by tough penalties can actually translate into no regulation and little accountability.
A preliminary investigation by the Jinhu government found that vaccine-management personnel at the township’s health center had failed to follow protocols for the use and stockpiling of vaccines. And that the local center for disease prevention and control had then failed to report the problem or take follow-up supervisory measures. The report attributed those oversights to “chaotic management, neglect of duties, and regulatory failure.”
Even as policy paralysis at the local level makes major policy failures and scandals more likely, the social discontent spurred by scandals tends to unnerve the government, which then sometimes overreacts. Within a week or so of last summer’s outburst of public outrage, the word “vaccine” became one of the most restricted words on Chinese social media. This month after the scandal in Jinhu, a video circulated on Weibo and WeChat showing a meeting with local officials and residents from a neighboring district, Hongze. A woman can be heard angrily asking about “unknown disturbance” to her phone line and, singling out the local security chief, saying, “Is this way the government treats us?”
So how can the Chinese government get out of its legitimacy bind? To limit the chances of being perceived as under-delivering public goods, it should stop over-promising them, and concentrate on the ones that the people think are of the utmost importance to their well-being, such as food and vaccine safety. To improve its performance in delivering those, the government should allow economic and social forces to play a bigger role. For example, it should open the vaccine market to foreign products, while encouraging citizens to participate in oversight and formalizing ways they can report any violations of safety standards. Setting clearer directives but less draconian and less arbitrary-seeming penalties would also reduce fear among lower-level officials, giving them reason to do their fair share of work and mitigating the policy-paralysis problem.
China’s people have no institutional recourse to replace the country’s top leaders: They are stuck with the government whether they are pleased with its performance or not. Still, the party-state is generally unwilling to pursue widely unpopular policies and risk triggering mass discontent. In this sense, even the C.C.P.’s rule is an extension of the “mandate of heaven” of imperial times — and in that lineage lies some reason for optimism about the future of vaccine safety in China, more rational and more effective policymaking overall and maybe even some measure of decentralization within the party itself.
Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations and a professor at Seton Hall University’s School of Diplomacy and International Relations.
Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.
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Home » Analysis & Comment » Opinion | If a Government Can’t Deliver Safe Vaccines for Children, Is It Fit to Rule?
Opinion | If a Government Can’t Deliver Safe Vaccines for Children, Is It Fit to Rule?
Earlier this month, hundreds of aggrieved parents gathered outside the government office in Jinhu County, in the eastern province of Jiangsu, demanding an explanation for why 145 infants had been administered expired doses of the polio vaccine. It was China’s fifth vaccine scandal in less than seven years, and yet another blow to the country’s drug industry, its national immunization program, its regulatory authorities — and to the very legitimacy of the Chinese Communist Party (C.C.P.).
Last summer, one of China’s largest vaccine makers was found to have issued at least 250,000 substandard doses of vaccine for diphtheria, tetanus and whooping cough. (Many more were discovered later.) Soon after, in a survey of 300,000 parents by Xiaodoumiao, an app used to book vaccination appointments, 79 percent of respondents said that before the scandal, they would have given their children a vaccine made in China, but only 36 percent said they would still do so now. Sixty percent of respondents said they were considering having their children inoculated outside mainland China.
Then and this month as well, there were protests, sometimes violent, against local officials. Last summer, after a senior regulatory official appeared on state-owned television to address public concern, Chinese web users lambasted him for his stiff manner and his Burberry shirt, calling it inappropriate for the occasion. The sanctions that the government undertook — firing officials, imposing a colossal fine on one drug company — didn’t seem to quell people’s anger.
The scandals, especially their repetition, undermines the people’s trust in the state. This would be true to some extent almost anywhere, if only as a failure of regulatory oversight, but they hit harder in China.
As the sociologist Dingxin Zhao has argued, a state can justify its power in essentially three ways: by appealing to shared values, to the sanctity of an electoral process and the rule of law, or to its own performance. In China, the C.C.P.’s hold on power today isn’t based on popular elections or the rule of law, and the party can no longer appeal to the superiority of communism as a holistic political theory. So it must justify its continued rule by consistently delivering public goods, such as economic growth or better standards of living.
Democratic governments also worry about their performance to some extent, because they are concerned about losing the next election. But democracy as a political system draws its legitimacy from respecting basic rights and procedural fairness, rather than from achieving concrete results; a failure of performance does not endanger the system itself. Not so in China, where the party is the state. President Xi Jinping implicitly recognized as much when he warned in late 2013: “If we do not do a good job in food safety, and continue to mishandle the issue, then people will ask whether our party is fit to rule China.”
As Mr. Zhao has argued, some form of performance legitimacy can be traced back to the notion of the “mandate of heaven” (tianming) in imperial China, according to which an emperor’s authority was thought to come from heaven itself, but lasted only as long as his rule remained virtuous. When the imperial rulers became ineffectual or tyrannical, they could rightly be removed in a coup or a revolution.
After the Communists’ rise to power in 1949, the state penetrated deeper into society and increasingly made promises about improving people’s well-being. Health care, which had long been seen as an individual responsibility, became a public good. But communist ideology and the cult of personality surrounding Mao maintained the party’s legitimacy even when it fell short: For instance, the famine during the Great Leap Forward did not fundamentally shake Mao’s authority.
Performance only became the main basis of the C.C.P.’s legitimacy in the post-Mao era, after the state could no longer justify its rule by invoking communism. And the approach seemed to work for a time: “Had it not been for the achievements of the reform and the open policy, we could not have weathered June 4,” Deng Xiaoping said in 1992, referring to the day of the Tiananmen Square crackdown in 1989.
But Deng’s statement was also an admission of the inherent frailty of performance-based legitimacy: In a top-down, state-dominated political system, the link between performance and legitimacy is dangerously tight. When I was conducting research about the health effects of pollution in China last summer, I was amazed to hear so many people, academics and ordinary Chinese, treat a policy failure (like a food safety crisis) or an economic problem (like rising income inequality) as failures of the “system” (tizhi) itself.
The centralization of power since late 2012-early 2013, when Mr. Xi became the C.C.P.’s general secretary and then president of China, has only highlighted the system’s fragility. Thanks partly to the removal of presidential term limits and his vast, terror-inducing anticorruption campaign, Mr. Xi has become China’s paramount leader. But his extraordinary authority has deeply unsettled officials at all levels, with unwanted effects.
Lower-level officials have strong incentives to jump onto Mr. Xi’s bandwagon, especially when he signals a policy priority clearly and consistently. With pollution control, for example, they have sometimes become overzealous and have overshot. But with issues that have gone on and off the government’s agenda, such as vaccine safety, local officials are more likely to adopt a wait-and-see attitude for fear of making a mistake — paying lip service to directives but essentially shirking their responsibilities. As the independent scholar Deng Yuwen has argued, extremely centralized leadership leads to the paradoxical situation in which strict regulation backed by tough penalties can actually translate into no regulation and little accountability.
A preliminary investigation by the Jinhu government found that vaccine-management personnel at the township’s health center had failed to follow protocols for the use and stockpiling of vaccines. And that the local center for disease prevention and control had then failed to report the problem or take follow-up supervisory measures. The report attributed those oversights to “chaotic management, neglect of duties, and regulatory failure.”
Even as policy paralysis at the local level makes major policy failures and scandals more likely, the social discontent spurred by scandals tends to unnerve the government, which then sometimes overreacts. Within a week or so of last summer’s outburst of public outrage, the word “vaccine” became one of the most restricted words on Chinese social media. This month after the scandal in Jinhu, a video circulated on Weibo and WeChat showing a meeting with local officials and residents from a neighboring district, Hongze. A woman can be heard angrily asking about “unknown disturbance” to her phone line and, singling out the local security chief, saying, “Is this way the government treats us?”
So how can the Chinese government get out of its legitimacy bind? To limit the chances of being perceived as under-delivering public goods, it should stop over-promising them, and concentrate on the ones that the people think are of the utmost importance to their well-being, such as food and vaccine safety. To improve its performance in delivering those, the government should allow economic and social forces to play a bigger role. For example, it should open the vaccine market to foreign products, while encouraging citizens to participate in oversight and formalizing ways they can report any violations of safety standards. Setting clearer directives but less draconian and less arbitrary-seeming penalties would also reduce fear among lower-level officials, giving them reason to do their fair share of work and mitigating the policy-paralysis problem.
China’s people have no institutional recourse to replace the country’s top leaders: They are stuck with the government whether they are pleased with its performance or not. Still, the party-state is generally unwilling to pursue widely unpopular policies and risk triggering mass discontent. In this sense, even the C.C.P.’s rule is an extension of the “mandate of heaven” of imperial times — and in that lineage lies some reason for optimism about the future of vaccine safety in China, more rational and more effective policymaking overall and maybe even some measure of decentralization within the party itself.
Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations and a professor at Seton Hall University’s School of Diplomacy and International Relations.
Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.
Source: Read Full Article