A key theme of this discussion is whether countries can gradually return to normal life if vaccines are not available on a large scale in the short term, and how to balance the interests of vulnerable groups, especially older people, with younger generations in the process.
It is also of particular interest to China to discuss this issue. Till now, “life first” is still the foremost principal for China’s response. President Xi Jinping has said on many occasions:
"We save lives at all costs. No matter how old the patients are or how sever their health conditions are, we will never give up. The oldest patient we have successfully treated is 108 years old." "More than 3,000 coVID-19 patients aged over 80 have been treated and recovered in Hubei." "We will do anything to protect people's lives!"
So, if, as the theme of this conference says, the global pandemic has become a long-term reality and vaccines remain elusive, will China relax the standard procedural practice of testing and trace tracking, like some other countries did. As long as patients do not overwhelm the medical system, will China allow a certain rate of infection? If there is a second wave, as many public health experts predicted, will China pursue a fast recovery at the expense of vulnerable groups such as the elderly?
My answer is "No". A simple explanation has to do with China’s traditional respect for the elderly, which is an important composite of the Confucian thoughts. Moreover, in today's China, nuclear families composed of young parents often need the grandparents to take care of children in the daytime so that both parents can work. Therefore, the elderly are still very crucial human resources for the family and even for the society. However, more importantly, the form of economic development of China today also determines that China has to fight an all-out war against the virus.
The premise of my answer is that China has become a hyper-mobile society. Interconnection is the engine and driving force of economic development, creating jobs and providing the source of livelihood for many families. China's public transportation infrastructure has made great strides in the past decade. This is a map of China's high-speed rail network and highway network. China also has 248 civil airports. You can see that most of China is linked by these networks. In 2019，passengers of China’s railway numbered 3.66 billion and civil aviation transported 660 million passengers. In addition to public transport, the number of private cars in China is currently 200 million and the number is still rising.
Related to this is the rapid growth of domestic migrant population, which means people living outside of their hometown for more than six months. Today, the number of this population is as high as 240 million. Cities are the destinations of most population movements. Job opportunities attract many people from rural areas to the cities. China's economic growth has benefited from migration a lot. Some studies show its contribution rate to China's economic growth is as high as 20-30%. At the same time, tourism and business related to population movement are also booming. For example, highway service area in China no longer means fast food restaurant and gas station. Some have turned into shopping malls or even art museums since passenger traffic means business opportunities.
Inner city traffic links reinforce people’s movement. Subways, taxis, private cars, shared bikes and deliveries are the basic elements of city dwellers’ life. In Beijing’s recent outbreak, one patient tested positive provided a list of his 38 close contacts, and then public health workers identified 356,000 people who were at risk through big data tracing. This is a case in point showing city dwellers’ life are closely intertwined.
What does this mean for China’s response to COVID-19?
Firstly, big cities are increasingly likely to become the first places of outbreaks. Even if SARS-COV-2 didn’t originate in Wuhan, it is highly likely that it would spread to this large city later on and breakout there. China's recent cluster cases have occurred just in populous cities, such as Beijing, Urumqi and, Qingdao.
Secondly, any virus with strong transmissibility, like Covid-19 virus, would spread out quickly through the traffic network. The scale of the SARS outbreak in 2003 is simply not comparable to theCovid-19 pandemic. Beyond the transmissibility of the virus, the significant increase in global social mobility today is another very important factor. This also explains why the Chinese government cut off public transport between Wuhan and the outside world when the epidemic broke out at its first place. Public health experts estimate that this measure alone has avoided 500,000 to 3 million infections and18,000 to 70,000 deaths in China. At the same time, since people are interconnected with each other so closely, it is very difficult to manage different groups of people in different ways. The idea that government can protect the vulnerable groups while letting the virus transmit in healthy people, is almost impossible to carry out in today’s China.
Thirdly, in integrated societies, without sufficient effective testing, if the epidemic has already spread out -- as it did in China in late January -- the only option is to press the "pause" button and introduce a lockdown. Otherwise, small fires in individual areas will soon burst into flames. Given the size of China's population, even a low infection rate can overwhelm the health care system, and the severity of the outcome has been clearly demonstrated by early outbreak in Wuhan.
Fourth, the fact that everyone could be infected due to massive population movement has created a certain social sentiment, which have important implications for China’s epidemic prevention policies. It worth noting that in the early stages of the pandemic, China's underdeveloped rural areas, usually under the leadership of the village’s committee, spontaneously implemented more stringent measures than that required by the government. Some of them even violated rules by cutting off roads. In Shanghai and Beijing, security guards in some neighborhoods have barred outsiders. In westerners’ perspective, Chinese government has dominated epidemic prevention and control, but it is not the whole story. In fact, some measures deemed as drastic and even violations of human rights and people’s freedom, actually fit the needs of situation at that time and are welcomed by the public. In most cases, people welcome tough penalties for rule-breakers because their behaviors have social impacts. Chinese Internet users have even coined a term, "hardcore prevention and control", to show their appreciation for the measures. People’s self-protection means that, if the epidemic continues, the social economy could not go back to normal even if the government lifts restrictions. The self-enforced measures may even stricter than government’s policy with greater loss of social economy. This is the reason public confidence about government’s effort is crucial. In Qingdao, for example, the government recently decided to test nucleic acid on more than nine million people after three asymptomatic cases were reported. When explaining such a decision, one public health expert said that the chain of transmission was yet clear and government needed "to reassure the public".
By this point, we can a clear answer to the question raised. For China, it is hard to imagine a "normal" situation in which the epidemic continues while the social economy recovers. The choice for policy makers is whether to have a high level of recovery after elimination of the virus or facing a long-term public health crisis with no economic recovery. It is not a hard decision to make.
China has accumulated a rich experience during the pandemic. In a mobile society, there is no trade-off between economic benefits and the health of citizens, but a win-win result. Within 5 months, Beijing rolled out local regulations on responding to major public health emergencies. In order to prepare for the possible second wave of outbreaks, the central government sent inspection teams to inspect the disease prevention and control system in provinces. Wearing masks, using health codes and big data to trace track are highly accepted. And China is confident about vaccine development. Therefore, as long as China maintains vigilant and timely response it may not be necessary to have another "lockdown". Instead, it can pursue public health security with low-cost methods.
Unless the death rate of COVID-19 can reduce to the level of common influenza, it will be dangerous for people to go back to normal economic activities. China's economic growth is gradually rebounding, but the risks ahead should not be underestimated. We have to reflect and meet new challenges: How can governments remain vigilant on public health issues in the international GDP tournaments? How should future vaccines be properly distributed nationally and internationally? How to reopen the borders step by step scientifically? China needs to engage with countries in dialogue to better answer these questions and build a society that is more resilient to risks. Again, I would like to thank our host for inviting me and thank the audience for your time.