Transparent and open access to evidence and methods used by authorities to make decisions regarding a public health emergency are essential requirements to effectively respond to a pandemic, according to the U.S. National Institutes of Health (NIH). Effective prevention of future outbreaks vitally depends on open and transparent public communication, according to the World Health Organization (WHO). Silencing medical workers who faced Covid-19 firsthand and not sharing initial information with the international community, including WHO, questions the intention of the Chinese authorities during the three critical months of November 2019, December 2019, and January 2020. This mischief at the start of the pandemic has created a growing backlash across the Chinese populace, and caused the international community to blame China for the spread of Covid-19. Unjustified suppression and censorship by the Chinese Communist Party’s ruling elite contradicts the aspiration of the Chinese state as an emerging global power, which demands transparent accountability toward its citizens and the international community.
Toward this end, institutionalizing both the recovery from the Covid-19 outbreak and prevention mechanisms for future pandemics require the United States (U.S.) and the European Union (E.U.) to jointly approach China’s role in the global public health crisis. In the post-Trump administration era, this demands a strategic trans-Atlantic task, as Washington and Brussels claim to be the guardians and promoters of global governance, democracy and human rights. Holding the Chinese government accountable for an open and transparent public health information mechanism is essential for post-pandemic recovery. Chinese government secrecy about the origin of the coronavirus, its initial outbreak, and reasons for suppressing medical workers are legitimate questions that demand legitimate answers. At a time when Covid-19 has caused the deaths of more than 3.3 million people, and left another 159 million infected with immeasurable disruptions and traumas, this paper attempts to evaluate relevant factual baselines around China’s assumed role in the Covid-19 outbreak, raise some essential questions, stipulate a U.S. and E.U. joint approach, and discuss pragmatic propositions deemed significant to the global governance. Key to all of this is to invite human rights, legal, foreign policy, and public health scholars and practitioners to respond to questions and analysis in this article to further an evidence-based deliberative dialogue.
The first case of Covid-19 was detected in the city of Wuhan on November 17 and exponentially increased to 381 by the end of December 2019 – as recorded by the Chinese authorities. By January 1, 2020, frontline doctors urgently warned authorities about an outbreak, but they were denied permission to announce it to the public. This initial cover up misled WHO, which ruled out any person-to-person transmission through its January 4, 2020, report on social media and the “Disease Outbreak News,” first published on January 5. Based on the information provided by Chinese authorities, WHO issued its first warning on January 14, classifying the Wuhan public health crisis similarly to that of SARS and MARS and considering human-to-human transmission limited but not surprising.
Simultaneously, Dr. Ai Fen, director of the emergency department at Wuhan Central Hospital, sent a memo that contradicted the WHO’s warning. The memo was based on laboratory results, chest X-rays, symptoms, and the virus’s resistance to conventional treatment methods of patients she cared for between December 27 and 30, 2019. On January 1, 2020, Dr. Ai sent another warning to the hospital’s public health and medical departments about the admission of a growing number of patients to a clinic near the South China Seafood Market, hoping to raise the necessary attention. This time, Dr. Ai was harassed by the hospital’s supervising authorities and accused of spreading rumors.
Dr. Ai’s original Wuhan memo reached Dr. Li Wenliang, an ophthalmologist at the Wuhan Central Hospital, on December 30, 2019. He was alarmed by the report, and posted it on his private account at WeChat, which he shared with his medical school classmates. Once the memo was copied into the public domain, Dr. Li’s action was condemned by hospital authorities and he was interrogated by the Wuhan Public Security Bureau a few days later. The police officially labeled him a “rumor monger” for disseminating false information to the public. He was forced to admit that his post and comments about the outbreak were false; his police punishment was aired on China Central Television. As the outbreak grew exponentially, front-line doctors and nurses fell victim to the virus. On January 8, Dr. Li was infected by one of his patients with a “high viral load” of the coronavirus. On February 4, the Chinese Supreme People’s Court cleared him from any wrong-doing and noted, “It might have been a fortunate thing if the public believed the ‘rumors’ then and started to wear masks and carry out sanitization measures, and avoid the wild animal market.” Meanwhile, his condition worsened during his time under treatment; he died on February 7, 2020. Dr. Li’s death caused a public outcry regarding his treatment by government authorities.
Many across China blamed the Chinese authorities for the outbreak of Covid-19. A group of Chinese academics, led by Prof. Tang Yiming, the head of the School of Chinese Classics at Central China Normal University in Wuhan, published an open letter on February 17, 2020, in which they classified “the outbreak as a man-made disaster” and called Dr. Li “a victim of speech suppression.”
The Global Implications
The world first learned that the virus could be transmitted person-to-person only on January 20, when President Xi Jinping admitted the outbreak and put Wuhan under lockdown on January 22. Since up to five million people traveled out of Wuhan to numerous domestic and international destinations between November 2019 and January 2020, Covid-19 was already a global pandemic. The revelation of three months of silenced transmission of the virus among humans caught the entire world by surprise and without preparation. Even by February, during and after the CCP’s Politburo Standing Committee meeting, the government’s “internet police” threatened people for criticizing the Communist Party’s handling of the outbreak.
By May, more data from China revealed the government’s acknowledgment of the outbreak before January 2020. These records indicated increased importing and decreased exporting of medical supplies as well as the closing of the Hunan Seafood Wholesale Market on January 1. The German Federal Intelligence Service (BND) reported that the Chinese president personally asked the WHO’s director general to delay the dissemination of information about human-to-human transmission. Some reports, including a dossier by the Five Eyes intelligence alliance (U.S., U.K., Canada, Australia and New Zealand) went into detail about how Beijing made whistleblowers disappear, and discarded early virus samples and electronic evidence. It also claimed that President Xi Jinping was informed about the human-to-human transmission of the virus at least two weeks before he publically announced it.
China’s role in the global public health crisis comes from numerous angles beyond its emergence as a global power with rapid integration into international governance and economic orders. From a demographic perspective, China, with about 1.5 billion people and the presence of hundreds of wildlife food markets, more than any other place in the world, needs transparent and effective measures for robust public health regulations in place. Indeed, the Covid-19 outbreak has caused labeling China as the origin of a number of pandemics during the last five decades. (Former U.S. President Donald J. Trump called Covid-19 “the China Virus.” In part, this categorization and accusation has been false and unjustified.) It is correct that the 2002 SARS coronavirus was first detected in humans in the Guangdong province in southern China and now Covid-19 was first detected in Wuhan, the capital city of the Hubei province in the central part of the country. However, Chinese citizens were infected and died by a number of pandemic outbreaks that originated in other places like the 1957 H2N2 in Singapore, the 2006 Bird Flu in Hong Kong and the 2009 Swine Flu in Mexico. The critical point here is that China, as the second largest global economy – after the U.S. – and an important epicenter for global trade and tourism, is more vulnerable to pandemics. Vulnerabilities in China’s public health system relevant to infectious diseases, like Covid-19, will have disastrous global consequences.
Since the beginning of the Covid-19 outbreak, China has established and enforced effective (yet some questionable) measures, including large-scale mobilization of the society and collective efforts toward greater social solidarity to recover and also to prevent a major resurgence of new cases of Covid-19. The deployment of the Chinese-made Sinovac and Sinopharm vaccines – as well as two more vaccines – has made significant strides in inoculating the population against Covid-19. As the vaccines also made their way to other parts of the world, this helped the country’s GDP to continue expanding by 2.3 percent year-over-year in 2020. Meanwhile, Chinese leader Xi has used global forums ranging from 73rd World Health Assembly to the 15th G20 leaders’ summit as important opportunities to repair China’s global image. In each forum, he promised to make Chinese Covid-19 vaccines a “global public good,” ensuring that the vaccine was accessible and affordable in developing countries. In part, Xi’s “generosity” was a political and diplomatic statement that fit well within the influence operation directed by the Communist Party, serving to shift global attention from suppression of speech and censorship during the initial outbreak of coronavirus in Wuhan and beyond. Alternatively, the availability and affordability of Chinese Covid-19 vaccines to the world was considered a significant step forward by some experts, including Yuanqiong Hu, senior legal and policy adviser for Medecins Sans Frontieres’s “Access Campaign” for lower drug prices. In the absence of a Western approach, and at a time when the Trump administration cut off funding to WHO and soured relations with America’s traditional allies, particularly the E.U., Xi’s message was effective. The Trump administration’s “America First” approach regarding Coid-19 vaccines combined with the E.U.’s immunization crisis due to AstraZeneca’s production and distribution problems offered Beijing historical political and diplomatic influence at the expense of Western democracies and their global leadership.
A growing controversy over whether the Covid-19 outbreak was a biological phenomenon or a man-made disaster led to the March 2020 calling upon WHO by the World Health Assembly to “identify the zoonotic source of the virus and route of introduction to the human population, including the possible role of intermediate hosts, including through efforts such as scientific and collaborative field missions.” Under this guideline, an international team conducted a field study from January 14 to February 10, 2021, in China and visited Wuhan. Even though this WHO-led international investigation has been a ground-breaking step forward in opening the way for “further studies,” as it was called by WHO’s Director-General Dr. Tedros, still the legal, political, as well as public health questions regarding the origin of the virus and the reasons to justify censorship initially imposed by the Chinese authorities were not answered. The persistent lack of clarity on these particular issues has furthered a growing mistrust and ambiguity over China’s role in the outbreak, resulting in an increasing number of legal claims as lawyers around the world began to sue China within local and international court systems. In April 2020, the U.S. states of Missouri and Mississippi initiated a lawsuit against China’s Communist Party for “enormous death, suffering, and billions in economic losses.” In March, lawyers in Florida launched a class-action lawsuit comprised of thousands of claims from 40 different countries. The lawsuit claimed the virus might have originated at the Wuhan Institute of Virology and spread accidently due to “unsafe laboratory practices.” In response, lawmakers in China drafted a law that allows Chinese citizens to sue foreign governments in domestic courts in retaliation against the U.S., while the Chinese Communist Party launched a massive “influence operation” to change the global narrative on this issue in its favor.
Neither the new Chinese law nor the influence operation of the Communist Party are dissuading a growing number of legal and human rights experts from accusing Chinese authorities of keeping the international community in the dark and questioning the origin of the coronavirus. Scott McNabb, a former Centers for Disease Control (CDC) epidemiologist and current research professor at Emory University, blames “China’s censorship as the main culprit” in the spread of Covid-19. Questioning such censorship in the Covid-19 outbreak against the Chinese government has already led to lawsuits that have reached the International Criminal Court (ICC). One of these lawsuits was filed by Larry Klayman from the Texas-based firm, Freedom Watch and Buzz Photos. Klayman is alleging China for crimes against humanity and asking the Court to open an investigation. The ICC under Article 7 namely considers inhumane acts that “intentionally causing great suffering, or serious injury to body or to mental or physical health” as crimes against humanity. Other legal experts argue that it would be “doubtful” to establish the qualification of crimes against humanity at this moment. Still, more lawsuits might reach to the ICC on this particular matter. Experts also suggest that other sovereign states might file lawsuits before the International Court of Justice (ICJ) or the Permanent Court of Arbitration (PCA) on the basis of endangering the world population or causing damages to the international economy as a result of “poor management” of the Covid-19 pandemic relevant to a breach of China’s international obligations. Indeed, the participating states in such a lawsuit must accept the jurisdiction of the court as compulsory in the event of a dispute. In this direction, states, citizens, or the UN Security Council are viable plaintiffs to file lawsuits against the Chinese authorities, even though Beijing is not a member of the ICC.
Beijing has been facing both domestic and international questioning regarding the authenticity of the authority in handling the Covid-19 outbreak. To quell the domestic backlash in early 2020, the authority allowed China’s highest anti-corruption body, the National Supervisory Commission, to launch a “comprehensive investigation” into the issues involving Dr. Li Wenliang. This was a positive legal step forward, but in the absence of independent observers left the following questions of both local and international parties without answers:
- How and when exactly did the Wuhan CDC conclude they needed to warn hospitals?
- Why was the December 30, 2019, warning by the Wuhan CDC’s Dr. Ai Fen sent out as an internal memo only to Wuhan hospital, and to what extent was this memo shared with the Chinese CDC?
- Why did the Chinese CDC not share the December 30, 2019, Wuhan internal memo with WHO or their international partners, including the U.S. CDC?
- Why was Dr. Li Wenliang suppressed by the hospital authorities and why was Dr. Li interrogated by Wuhan Public Security Bureau on January 3, 2020? And finally,
- Was the Wuhan suppression of information, intimidation of front-line clinicians, and internet censorship part of a government policy?
Answering the above questions will establish the grounds for an investigatory conclusion by the Chinese and international governing authorities in terms of public health and human security.
The U.S. and E.U. Joint Approach
The sharp differences over a range of issues from human rights in Hong Kong, Xinjiang, and Tibet to assertiveness toward Taiwan and the South China Sea during the March 19 face-to-face summit between the U.S. and China’s top officials in Anchorage, Alaska, reveal that both sides have key principle differences toward global governance. However, the Biden administration’s willingness to work on shared challenges of climate change and the pandemic with China is sobering news for both global pandemic recovery and the prevention of future pandemics. On the E.U. side, three recent high-level diplomatic events have caused a 21st century paradigm shift of global impact between the E.U. and China: 1) the September 14 E.U.-China leaders’ video conference (which was preceded by the June 22 historical summit between President Xi Jinping, Chancellor Angela Merkel, President of the European Council Charles Michel and President of the European Commission Ursula von der Leyen), 2) the high-level tour by the powerful director of Central Foreign Affairs Commission Office Yang Jiechi to Spain and Greece, 3) and the Foreign Minister Wang Yi to France, Germany, Italy, the Netherlands and Norway, which occurred just a few days prior to that. These events put the E.U. in an exceptional strategic relationship with China that can boost the ability to hold China accountable and transparent on key essential issues, particularly the questions regarding the continued crisis recovery pertaining to Covid-19.
President Biden’s participation in a March 2021 summit of E.U. leaders, “the first in 11 years,” was a step forward toward reinvesting in the Transatlantic partnership. Since the E.U. had moved forward with China without Washington during the Trump administration, German Chancellor Angela Merkel stated that “the E.U. had much in common with the U.S. but that it differed on China policy.” However, Brussels, in solidarity with Washington under Biden, followed the U.S. and imposed sanctions against four Chinese officials in response to Beijing’s mass incarceration of the Uyghur population in Xingjian. Beijing struck back with wavering counter-sanctions against a far larger number of European parliamentarians, diplomats, and academics. This extreme reaction outraged members of the European Parliament who threatened not to ratify the E.U.-China investment deal. In addition, Chinese ambassadors were summoned by Germany, France, Belgium, Netherlands, Denmark, and Italy. This extreme retaliation by the hard liners in Beijing reveals the ideological contradiction between the communist hardliners and the accountability of the state, measured with the presence of a viable statecraft.
This diplomatic mismatch by Beijing tipped the balance in favor of trans-Atlantic collaboration versus an E.U. stand-alone policy on China. This said, there are still considerable complications toward a full-grown policy alliance between Washington and Brussels, which needs time. At the heart of such policy deliberation is institutional synchronization beyond the traditional shallow political expediency of the alliance formed on the basis of viable threats during the Cold War. A full-grown trans-Atlantic policy at the dawn of 21st century is far from the foolish ranting by former U.S. President Donald Trump over military expenditures to NATO. In contrast, it demands maturity in the principles of democracy as the legitimate and progressive response to badly needed global leadership. A 21st century democracy-based trans-Atlantic alliance between the U.S. and E.U. should be able to project shared common interests, particularly in regard to China’s role in the global public health – concerning recovery from Covid-19 and preventing future pandemics. Washington might have a difficult time persuading the powerful pro-business interests in Europe to support their approach toward China in response to Beijing’s suppression of the Uyghurs and the pro-democracy activists in Hong Kong. This is why a mature alliance must be able to look also inwardly toward domestic-oriented objectives. However, a joint pandemic recovery and prevention policy should unite all sides of politics across the Atlantic. Regardless of compartmentalization of transparency in public health from trade or a comprehensive approach, this is an area where a joint U.S./E.U. policy toward China can boost global governance as essential for attaining human security.
The good news in this regard is that E.U. leaders have already agreed with China in a shared responsibility to lead the global efforts needed to develop and deploy the Covid-19 vaccine. With the Biden administration now standing with the E.U., there is tremendous opportunity for global governance to improve transparency and openness of public health information. The Brussels and Beijing memorandums regarding an “independent review of lessons learned from the international health response to Covid-19” should contribute to establish whether or not the outbreak of the Covid-19 was a biological or man-made catastrophe.
The importance of clearing this question stands on number of key studies, including an epidemiological study from Southampton University that concluded if China had shared the information on the Wuhan outbreak one, two, or three weeks earlier, fatalities from the pandemic would have been prevented by as much as 66%, 86%, and 95% correspondingly. Looking at this study from the prism of the ongoing devastation of Covid-19 to establish preventive measures toward future outbreaks offers the Chinese state and the international community long-term advantages. Even though the economic toll of Covid-19 is incalculable now; a recent estimate projects $10trn in 2020 globally that is more than 10% of the $86.55 trillion as of 2019. Thus, the U.S. and E.U. can’t and shouldn’t surrender long-term global public health priorities for short-term economic gains via trade. A healthy economy demands a healthy population and this is why it is absolutely crucial to include the following in future Washington and Beijing negotiations and also in the discussion on the Strategic Agenda for Cooperation 2025 between the E.U. and China:
I: Pandemic Recovery: There are urgent needs for expanding the number of CDC employees in China and boosting cooperation with health officials responsible for pandemic responses. The Trump administration reduced the United States CDC staff in China from 47 to just 14 in 2017. In the following months, the offices of the U.S. National Science Foundation (NSF) and the United States Agency for International Development (USAID) were also closed down. The United States Department of Agriculture (USDA), which had been assisting with an animal disease monitoring program, was transferred out of China in 2018. Indeed, American scientists and medical liaisons within these offices always faced various levels of secrecy and censorship by Chinese authorities, but they were still able to maintain a 30-year-old partnership in helping China monitor and respond to outbreaks.
A key function of the CDC, for instance, was to fund up to 40 capable local staff with a real depth of knowledge of the public health system in China. Shutting down these important offices and downsizing the CDC caused that extensive communication and deep expertise to be lost. “You have to consider the possibility that our drawdown made this catastrophe [Covid-19 outbreak] more likely or more difficult to respond to,” said an involved U.S. official to Reuters.
To regain the lost knowledge and expand expert monitoring and training programs, the U.S. Congress should appropriate designated funding toward reopening the NSF and USAID and expand the CDC and SDA. It would be important to redeploy medical scientists such as Dr. Nancy Sung, a respected scientist who worked with the medical and scientific community in China in the past. On the E.U. side, the E.U. Parliament ought to move beyond the 2007 E.U. Memoranda of Understanding with China toward institutional cooperation and alignment toward more effective and accountable measures in support of transparency in issues relevant to global public health. This requires the USCDC, the ECDC, the USNSF and the European Commission’s Directorate for Health and Food Safety (DG SANTE) to have a seat at the table when Washington and Brussels discuss policy and planning with Beijing.
Including the above two critical global public health issues over Covid-19 in discussing the U.S. and E.U. policies with Chinese would improve transparency in public health with Beijing and accountability of the Chinese state. The development of a joint U.S. and E.U. memorandum of understanding toward a collaborative process and outcome in China would help the deployed public health specialists and scientists to make the best out of scarce resources. Additionally, the Chinese State infrastructure would have effective capacity to offer a global public health strategic capability beyond WHO operations. This means establishing solid measures and deploying health specialist liaisons at both national and regional levels within China, which could tremendously assist the reinforcement of International Health Regulations (IHR) guidelines. A dynamic liaison/training relationship with the Chinese CDC and a scaling up of the scope of information sharing and cooperation would offer the global public health, and particularly WHO, a rapid response capacity both in terms of recovery and prevention of future outbreaks. This approach ought to be an integral point of the current cooperation, particularly the E.U. Strategic Plan 2020-2025 – Health and Food Safety.
II: Prevention Measures: The enforcement of a proposed blanket ban on wildlife markets worldwide, particularly in Wuhan, should be an important component of the U.S. and E.U. approach toward the maximum enforcement of IHR guidelines. The ban has been called for by the UN Convention on Biological Diversity’s acting executive secretary, Elizabeth Maruna Mrema, as well as by Jinfeng Zhou, secretary general of the China Biodiversity Conservation and Green Development Foundation. China allows 54 wild species to be raised for food consumption and has given space for a thriving network of illegal wildlife trades that challenge public health laws and measures. The February 24 decision by the Standing Committee of the 13th National People’s Congress (China’s highest legislative body) lays the groundwork for amending China’s Wildlife Protection Law that governs the use of wildlife and is an important step toward permanently criminalizing wildlife as food. However, wildlife protection and consumption regulations passed in the aftermath of the SARS outbreak were not adequately enforced, mainly because of the presence of illegal profiteering and the resistance of businesses and communities involved in wildlife trade, sales, and consumption. The Chinese government ought to introduce alternative livelihoods for communities using wildlife as an economic means. The USAID and USDA along with the International Development Aid of the European Commission can offer vast expertise that can be profoundly instrumental for assisting China to expand alternative livelihoods for the affected communities. Since criminals use the same routes and techniques for wildlife trafficking, a joint U.S. and E.U. collaborative effort to support the enforcement of the blanket ban on wildlife market and consumptions is an urgent need. In this direction, Washington and Brussels should fund and task their relevant law enforcement agencies to liaison within the United Nations Office on Drugs and Crime (UNODC) toward emboldening its badly underfunded and under-resourced global response for wildlife and forest crimes. This would establish the undeniable linkage between human rights and human security as noted in the UN General Assembly Resolution 66/290. The resolution obligated member states in “addressing widespread and cross-cutting challenges to the survival, livelihood and dignity of their people.” Beijing coming forward transparently offers China a legitimate global role as a country that championed lifting 850 million citizens out of extreme poverty within three decades while pushing the boundaries of global economic ties and advanced technologies to new historical levels. There is no doubt that U.S./E.U. relations with China are defined by entangled complexities of enmity, competition and cooperation. With a coordinated U.S. and E.U. global health policy approach, Beijing can be effectively held accountable. In the long run, this approach should help the Chinese state to achieve global responsibility with subsequent realization of the calling by the UN General Assembly (Resolution 66/290) for “people-centered, comprehensive, context-specific and prevention-oriented responses that strengthen the protection and empowerment of all people,” for which China is a signatory.
Neamat Nojumi is an American social scientist researching diverse issues relevant to global governance and public and foreign policy. He worked as a research professor at George Mason University, as a research fellow at Harvard Law School, and also as a senior advisor within the U.S. government.
 The International Health Regulations (IHR), first adopted by the World Health Assembly in 1969 and last revised in 2005, are a legally binding instrument of international law that aims for international collaboration “to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks and that avoid unnecessary interference with international traffic and trade.” The IHR is the only international legal treaty with the responsibility of empowering the World Health Organization (WHO) to act as the main global surveillance system.