December 18, 2020

The Covid-19 pandemic has shifted the rivalry between China and the United States to the health arena which until now was being played out in the business arena. Ever since the arrival of SARS-Cov2 at the end of 2019, the countries' ability to contain its spread has become a new indicator of the success of their social and political systems. With 16 million confirmed cases and 300 000 deaths for the United States versus 90 000 confirmed cases and 5 000 deaths in China, while the Chinese population is four times bigger than the American one, the game is over: China is the big winner in this pandemic. But we need to look at all the data of this confrontation to understand what it means for the future.

The American and Chinese governments have arraigned each other on the origin of this pandemic. The first SARS-Cov2 cluster was found in Wuhan in December 2019, which is why it is called Covid-19, a name given by the WHO, but China claimed it had been imported by the American army during the Military World Games in October 2019, several athletes having complained of symptoms similar to Covid-19. The molecular analysis of SARS-Cov2 however shows that it is similar to the virus circulating among the bats in southern China, and even to a virus that would have caused pneumonia among the miners working in a cave. Ever since the SARS crisis (Severe Acute Respiratory Syndrome) in 2003, caused by a coronavirus which appeared at the animal market in the Canton region and traces of which were found in bats, Wuhan's virologists were indeed studying mutations of coronaviruses among bats in order to understand in what conditions they could be successfully transmitted between humans. That information led some American websites to pass on the rumor that Chinese virologists would have let a contagious virus escape from a high-level security laboratory (BSL-4), after manipulating it, if not entirely manufacturing it. A study published by Rozenbeek in October shows that a quarter of the citizens questionned in the United States and England believe the theory that the Chinese scientists manufactured the virus.

The Chinese government, for its part, maintains the hypothesis that the virus was transmitted from the Huanan animal market to Wuhan where more than one thousand people were working, of which thirty had Covid symptoms in January. The discovery of a virus similar to SARS-Cov2 on Malayan pangolins, whose consumption in traditional Chinese medicine has been heavily controlled, could go along with this hypothesis. Since the late 1990s, the United States has accused China of not securing the biosafety of the laboratories and markets, since the significant circulation of biological matter between these enclosed areas is considered a factor in the emergence of new viruses. While the United States has 6 BSL-4 laboratories, they were against the building of the Wuhan laboratory, also backed by France. The Chinese government announced in May that they would reinforce the laboratories' biosafety and build new BSL-2 and BSL-3 laboratories. Regulating animal markets will be more difficult because, according to some studies, they supply 40% of China's meat consumption.

The Chinese government was also accused of mismanaging the start of the pandemic since they did not take early measures to contain it. It was only on January 20 that the Wuhan authorities reacted to the warnings given by the doctors who had noticed an influx of patients with atypical pneumonia in the hospitals. Over 5 million migrant workers had then just left the city to celebrate the Chinese New Year, but they were checked by the neighborhood committees in the cities and towns where they went back to. The death of the doctor Li Wenliang on February 6, after being accused by the Wuhan police in early January of "making false comments and disturbing the social order", provoked an outporing of compassion and anger on social media. This death was then seized by the national authorities using an ideology of "sacrifice" when they imposed a lockdown of Wuhan city and the Hubei province to protect the rest of China. Social media allowed Chinese citizens to follow from the inside the drama of Wuhan's confined populations, especially through Fang Fang's blog which was seen online by over 60 million internet users between January and March, and whose English version stirred up the anger of national conservatives. The efficiency of this lockdown was recognized by the World Health Organization in its February 25, 2020 report, which wondered whether other countries were able to adopt such an "aggressive" measure. By comparing with Europe, the United States and Brazil, whose governments hesitated on the compatibility between a lockdown and their liberal principles, China's ability to impose such a measure to one of its provinces provoked astonishment, which led to only partial emulation.

The quick measures taken in other Asian countries such as South Korea, Vietnam and Japan, proved that it was possible to control the spread of SARS-Cov2 without having to do a lockdown. The Trump administration strongly supported Taiwan and Hong Kong in their political and public health fight against security measures imposed in China, prolonging a colonial history during which these territories were used as sentinels for the threats coming from China. The Special Administrative Regions of Hong Kong, whose freedom of speech has been limited by the homeland security law adopted by the Chinese Parliament on June 30, 2020 after a year of protests by the Hong Kong population, and whose governor Carrie Lam has been criticized for having kept a border with China open for too long, confirmed only 5 000 cases and 100 deaths in October 2020. The Republic of China in Taiwan, who democratic president Tsai-Ying Wen had just been reelected, was the first to tell the WHO the new virus was dangerous, though it was not a member. Thanks to electronic monitoring devices distributed to all travelers arriving on the island, it was able to keep the number of cases around 500 and the number of deaths to 7 in October 2020. In this way, Hong Kong and Taiwan were able to show that the speedy detection measures of a new epidemic were compatible with individual freedoms.

Having been able to control the first wave of the pandemic, China put a number of screening measures in place which allowed them to avoid other waves. The clusters that were reported in larges cities - Wuhan in May, Beijing in June, Qingdao, Urumqi and Kashgar in October - led to massive testing campaigns. When a case is found in the city, such as at Chengdu a week ago, all the residents must fill out a sheet to declare where they have gone in the last two weeks. In June, the Chinese government said they could test 3 million people per day. The Ministry of Health set up a color-code categorization based on people's risk of transmitting the virus (green, orange, red) and QR codes (scanned at the entrance of public buildings and train stations). The official doctrine of the "four precocious" was adopted for detection, reporting, isolation and treatment. The tests are especially important for the people who handle imported food products. In a situation of strong nationalism, reinforced with Xi Jinping's campaign on the "Chinese dream", these measures seem to be mostly approved by the population. The reopening of Wuhan heralded by Xi Jinping's trip on April 8 has made it a showcase for a society reestablishing economic trust: the IMF's growth predictions for China in 2020 are 2%, so less than previous years' growth, but more than that of European countries and those in North and South America, estimated at -7% for the first ones and -4% for the second. The testing in most Western countries, and in particular in the United States, the lines of cars waiting in the parking lots, the delays in results and the diversity of measures depending on the territory, do not seem successful compared to the measures taken in China.

The Chinese government has also participated in the international race for a vaccine from virus sequences published by its researchers in January - and shared with the rest of the international community. Though they do not use the messenger RNA vaccine which allowed the pharmaceutical companies Pfizer and Moderna to develop and test a vaccine in record time in North America, the Chinese government helped with 12 projets, specifically through the public company Sinopharm and through a collaboration between the private company CanSino and the Military Academy of Sciences. Five of these projects are in phase three of clinical trials and are testing on large populations. Judging by the precedent generated by the H1N1 pandemic, acceptance of a vaccine for a new disease is rather high in Chinese society, especially among the upper class who want to be able to travel again.

China also wants to make its vaccines diplomatic tools. Mid-year, Xi Jinping announced that the Covid-19 vaccine should be a global commodity, which contrasted with Donald Trump's statements demanding that Americans get priority access to vaccines manufactured in the country. Indonesia just received 1.2 million doses of the vaccine manufactured by Sinovac after being one of its main clinical trials sites. Of note, this same country had negociated with the WHO in 2006 to exchange vaccines for the shipment of samples of patients who had had the H5N1 avian flu, while the archipelago had been its main cluster of transmission. The Butantan Institute in São Paulo has also participated in Sinovac's trial clinics and will be manufacturing millions of doses in a factory that has just been inaugurated for that. The issue is however a topic of dispute between the State of São Paulo's governor and the federal government, or rather between São Paulo's governor João Doria and president Bolsonaro, concerning the safety and transparency of the "Chinese vaccine" as the president names it, in reference to the "Chinese virus" denounced by Donald Trump.

The Chinese vaccine politics is part of China's growing influence within international institutions. The WHO's hesitations to declare the virus a pandemic in February has probably a lot to do with the close ties between China and Ethiopia where the WHO director, Tedros Ghebreyesus, was the foreign affaires minister - he replaced Margaret Chan in 2018 who was the Director of Health in Hong Kong between 1997 and 2003. China has invested in international institutions, profiting from the American withdrawal under Donald Trump's presidency, and Xi Jinping's government has opened a health component to its "silk roads" initiative. The coast is all the clearer since the United States pulled out of the WHO while the Covid-19 pandemic was in full swing in protest of the Chinese influence. But this generous diplomacy is offset by the "wolf warrior" diplomacy which consists in responding to accusations from Western countries via the highest level of embassy, sometimes in a very aggressive manner as was seen in Brazil and the US.

Though it seems evident that Asian societies, and especially China, were better prepared for the coronavirus pandemic than societies from the Americas, does that mean they will take the lead in measures meant to prepare for the next public health or environmental crises, bringing a change in global leadership? That is clearly China's objective on the economic side: taking up a project launched by Barack Obama and abandoned by Donald Trump, it has thus recently announced a business agreement with a large number of Asian-Pacific countries, of which Australia despite having tense relations.

But changing from a strategic and economic leadership to a moral and environmental leadership is not simple. The challenges ahead will require that societies reorganize in order to better grasp the resources and reduce their imprint on a world that is increasingly exposed to climate change. It is not evident whether China, which has seen a huge rise in consumption in the past twenty years, can more easily change its model than Brazil and the United States. The public health crisis is therefore only a trial run to see how different countries can take measures to limit the effects of environmental disruptions. It is a long-term endeavor, in which a concealed China began with several strides ahead, and which now it continues by dropping the mask and exposing its global ambitions.

Frédéric Keck, CNRS Senior Researcher, member of the Laboratoire d’anthropologie sociale. He recently published a book Les sentinelles des pandémies. Chasseurs de virus et observateurs d’oiseaux aux frontières de la Chine (Zones sensibles, 2020). His last article, Asian tigers and the Chinese dragon: Competition, and collaboration between sentinels of pandemics from SARS to COVID‐19, is focused on the reaction of Asian countries to COVID-19.

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