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Authoritarianism, outbreaks, and information politics

February 2020
The Lancet Public Health 5(3)

DOI:10.1016/S2468-2667(20)30030-X

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Matthew M Kavanagh

Georgetown University

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e135

Authoritarianism, outbreaks, and information politics

Are autocratic states such as China better equipped

than their more democratic counterparts to respond to

disease outbreaks? On Dec 31, 2019, China alerted WHO

to an outbreak of pneumonia of unknown cause in the

city of Wuhan in Hubei province. The epidemic quickly

spread, with cases of a novel coronavirus (2019-nCoV)

conﬁrmed throughout China and elsewhere in Asia,

Europe, North America, and Australia. The Chinese

Government’s forceful response has drawn praise from

global health oﬃcials. Scholars and health leaders have

long debated whether democracy improves, hinders,

or is immaterial for public health.1–3 Does this signal an

authoritarian advantage in tackling outbreaks?

On the surface, the power of authoritarianism is on

display in China’s response to 2019-nCoV. The Huanan

seafood market suspected as the outbreak source

was closed and decontaminated within a day of the

announcement. Within 3 days of conﬁrmed human-to-

human transmission, with cases rising and the world’s

largest mass travel event underway for the lunar new

year Spring Festival, the Chinese Government imposed

an unprecedented cordon sanitaire. Movement of more

than 50 million people across Hubei province was

rapidly restricted, curtailing transportation inside cities

and outbound transportation by air, train, and bus.4

Authorities halted Spring Festival celebrations in Beijing

and restricted movement into other major cities. Two

1000-bed hospitals were built within days. These moves

reﬂect a level of control only available to authoritarian

governments. WHO oﬃcials have congratulated China

for setting “a new standard for outbreak response”.5

Yet, time is key to controlling outbreaks; getting good

information and acting on it rapidly can halt outbreaks

before they need emergency measures. The early

history of the 2019-nCoV outbreak raises questions

about whether this situation is an example of beneﬁcial

autocracy.

For Amartya Sen, authoritarian states face serious

challenges in information and accountability.6 Govern-

ments in closed political systems, without open media

and opposition parties, struggle to receive accurate

information in a timely manner and to convey urgent

information to the public. Governments can be the

victims of their own propaganda, because the country’s

political institutions provide incentives to local oﬃcials

to avoid sharing bad news with their central bosses and

await instructions before acting.

Information politics in China undermined a rapid

response to the 2019-nCoV outbreak. Health-care

workers suspected an outbreak in early December, 2019,7

but information with which the public might have taken

preventive measures was suppressed, and communication

channels that might have alerted senior oﬃcials to

the growing threat were shut down.8 Police detained

a clinician and seven other people posting reports on

2019-nCoV, threatening punishment for spreading so-

called rumors. Social media was censored; a preliminary

analysis of Weibo and WeChat published on China’s

biggest online platform9 showed outbreak discussions

were nearly non-existent through much of January, 2020,

until the Chinese Government changed its oﬃcial stance

on Jan 20, 2020.

Through much of January, 2020, the Wuhan

Municipal Health Commission reported no evidence of

human-to-human transmission, no infection among

health workers, that severe cases of disease caused

by 2019-nCoV infection were conﬁned to those with

underlying conditions and older people, and that the

Huanan seafood market was the source.11 Reports

in The Lancet7 and New England Journal of Medicine,12

however, show that half of patients admitted to

intensive-care units were aged 25–49 years, and

two-thirds had no underlying illnesses. Human-to-

human transmission and health-worker infection

were evident before the Chinese Government made an

announcement.12 This information either did not make

it to authorities or the public were misinformed. The

Mayor of Wuhan has said publicly that not only was

information not revealed in a timely manner but also

they did not use information eﬀectively.10 By the time

quarantine went into eﬀect on Jan 23, 2020, ﬁve million

people had left the city of Wuhan for holiday travel.10

Outbreaks were subsequently reported throughout

China.

Without open media and an opposition to check

on bureaucratic hierarchy, knowledge from the front

lines of the 2019-nCoV outbreak did not reach Beijing.

Weeks into the outbreak, leaders were forced to publicly

threaten that oﬃcials withholding information “will be

nailed on the pillar of shame for eternity”.4

Published Online

February 13, 2020

https://doi.org/10.1016/

S2468-2667(20)30030-X

Comment

e136

www.thelancet.com/public-health Vol 5 March 2020

Is there an authoritarian advantage in disease response?

It seems that authoritarian information politics inhibited

a rapid response to the 2019-nCoV outbreak in China,

which could have limited the crisis. It is not yet clear if the

extraordinary cordons and inﬂux of resources enabled

by autocratic rule will prove a successful public health

strategy. Yet, in building capacity to prevent, detect,

and respond to outbreaks, democratic openness and

competitive politics seem more asset than inadequacy.

I declare no competing interests.

Access article under the CC BY 4.0 license.

Matthew M Kavanagh

matthew.kavanagh@georgetown.edu

Georgetown University, Washington, DC 20057, USA

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2 Gerring J, Thacker SC, Alfaro R. Democracy and human development.

J Polit 2012; 74: 1–17.

3 Bollyky TJ, Templin T, Cohen M, Schoder D, Dieleman JL, Wigley S.

The relationships between democratic experience, adult health, and

cause-speciﬁc mortality in 170 countries between 1980 and 2016:

an observational analysis. Lancet 2019; 393: 1628–40.

4 Qin A, Wang V. Wuhan, center of coronavirus outbreak, is being cut oﬀ by

Chinese authorities. New York Times. Jan 24, 2020. https://www.nytimes.

com/2020/01/22/world/asia/china-coronavirus-travel.html (accessed

Feb 10, 2020).

5 WHO. WHO Emergencies Coronavirus Emergency Committee Second

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coronaviruse/transcripts/ihr-emergency-committee-for-pneumonia-due-

to-the-novel-coronavirus-2019-ncov-press-brieﬁng-transcript-30012020.

pdf?sfvrsn=c9463ac1_2 (accessed Feb 10, 2020).

6 Sen A. Development as freedom. Oxford: Oxford University Press, 1999.

7 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019

novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24.

https://doi.org/10.1016/S0140-6736(20)30183-5.

8 Yuan L. China silences critics over deadly virus outbreak. New York Times.

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html (accessed Feb 11, 2020).

9 SINA. The mystery of the Wuhan epidemic: evidence from reptiles and text

analysis. Jan 27, 2020. https://cj.sina.com.cn/articles/view/1961718870/74

ed745601900pcsq?autocallup=no (accessed Feb 11, 2020).

10 Zhenhua L. Wuhan Mayor oﬀers to resign over coronavirus response.

Caixin 2020; published online Jan 28. https://www.caixinglobal.com/2020-

01-28/wuhan-mayor-oﬀers-resignation-over-coronavirus-

response-101508899.html (accessed Feb 10, 2020).

11 Wuhan Municipal Health Commission. Questions and answers on

pneumonia epidemic and new coronavirus infection. [In Chinese.]

Jan 14, 2020. http://wjw.wuhan.gov.cn/front/web/

showDetail/2020011509040 (accessed Feb 11, 2020).

12 Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of

novel coronavirus-infected pneumonia. N Engl J Med 2020; published

online Jan 29. DOI:10.1056/NEJMoa2001316.

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Amartya Kumar Sen

Incl. bibl. notes, index.

center of coronavirus outbreak, is being cut off by Chinese authorities

Jan 2020

A Qin
Wang V Wuhan

Qin A, Wang V. Wuhan, center of coronavirus outbreak, is being cut off by Chinese authorities. New York Times. Jan 24, 2020. https://www.nytimes. com/2020/01/22/world/asia/china-coronavirus-travel.html (accessed Feb 10, 2020).

China silences critics over deadly virus outbreak

Jan 2020

L Yuan

Yuan L. China silences critics over deadly virus outbreak. New York Times. Jan 25, 2020. https://www.nytimes.com/2020/01/22/health/virus-corona. html (accessed Feb 11, 2020).

Wuhan Mayor offers to resign over coronavirus response

Jan 2020

L Zhenhua

Zhenhua L. Wuhan Mayor offers to resign over coronavirus response. Caixin 2020; published online Jan 28. https://www.caixinglobal.com/2020-01-28/wuhan-mayor-offers-resignation-over-coronavirusresponse-101508899.html (accessed Feb 10, 2020).

Wuhan Municipal Health Commission. Questions and answers on pneumonia epidemic and new coronavirus infection

Jan 2020

Wuhan Municipal Health Commission. Questions and answers on pneumonia epidemic and new coronavirus infection. [In Chinese.] Jan 14, 2020. http://wjw.wuhan.gov.cn/front/web/ showDetail/2020011509040 (accessed Feb 11, 2020).