Wuhan: a tale of immune system failure and social strength

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Image: @SDUIVF许超医生

For most Chinese people watching the unfolding of Wuhan’s coronavirus emergency, the situation escalated dramatically on Jan 20, almost 20 days after it was first made public (and downplayed).

In a stunning appearance at a press briefing organized by the National Health Commission (NHC), Zhong Nanshan, the 84-year old respiratory specialist and leading expert of the NHC’s high level advisory group, admitted to a room full of reporters that the coronavirus transmitted from human to human. He also revealed that medical workers had been infected. In a televised conversation with “News 1+1” anchor Bai Yansong later that day (a kind of Anderson Cooper moment), Zhong went further by suggesting that people should avoid leaving or going to Wuhan altogether. That morning, Zhong was invited by Premier Li Keqiang to give input to a cabinet meeting on the outbreak, following President Xi Jinping’s first official instruction since the emergency. But it was Zhong’s re-appearance on the national scene that changed the tone of the national conversation in a decisive way.

By now, the contour of the novel virus’s journey to the center of a global health crisis is relatively clear. At the beginning of Dec 2019 and probably earlier, the coronavirus likely broke through species barrier at a wet market in the middle of Wuhan, a Yangtze River city of 11 million, and infected its first victims. The infected suffered from an acute form of pneumonia and from there, it began to spread. What’s also clear, is that before Jan 20, the discourse around the epidemic was defined by the local authority’s slow and mumbled response. According to multiple timelines recreated by Chinese social media users, the first case of infection appeared as early as early December 8. But it was not until Dec 30 did the Wuhan health authorities acknowledge the existence of a “pneumonia of unknown reason” through an internally circulated notification that was later leaked. The notification installed a strict gag order on the condition. Furthermore, on Jan 1, 2020, the authorities “sanctioned” 8 citizens for spreading “rumors” about the disease. After media got hold of the notification, local authorities admitted that 27 cases had been diagnosed, most of which associated with business owners in Huanan Seafood Market. But the market, a suspected reservoir of the virus, was allowed to open for business till the new year, closed only after the situation went public.

Zhong Nanshan’s blunt admission waked the country up to a life-threatening situation that was uncannily reminiscent of 17 years before, when the disastrous 2003 outbreak of SARS killed more than 700 globally and traumatized the entire country. At that time, Zhong’s appearance on CCTV’s flagship news show “Face to Face” directly challenged the false assurance provided by Health Minister Zhang Wenkang. Zhang famously laughed at a foreign journalist for wearing a facial mask at his press conference in early April 2003, when the SARS epidemic in Beijing had, in fact, spun out of control. He was dismissed, together with Beijing’s mayor, less than two weeks later, a turning point of the battle against SARS.

The symbolism of Zhong’s re-emergence was reassuring. The doctor, together with Dr. Jiang Yanyong, who risked political persecution to alert international media about Beijing’s SARS outbreak, were the conscience of China’s medical community that gave people hope in 2003. He proved that 17 years later he still garnered formidable respectability among the Chinese public. A photo of the fatigued octogenarian napping on a train to Wuhan circulated wildly on Weibo as people paid tribute to the doctor. And Weibo users lamented the fact that 17 years later it still took the old man to convey the bad news to the nation.

Zhong Nanshan

Later events would prove that the sense of reassurance was both misguided and pre-mature. The China of 2020 is economically and technologically much more advanced than the China of 2003. And yet, the Wuhan outbreak exposed its frail and weakened “social immune system” that, for a new generation of Chinese, was a painful discovery and political education.

Sensed that the political signals were changing, Caixin, the business weekly that’s regarded the bastion of journalistic professionalism, was among the first to send reporters to Wuhan, while people were running from it in flocks, some for the disease, some for Chinese New Year, the country’s most important holiday every year when hundreds of millions went on trips home for family reunions. Caixin’s first dispatches from the Wuhan scene was from the Tongji Hospital and the Wuhan railway station, documenting the measures that were belatedly installed. Apparently, Zhong Nanshan’s advice of not leaving or going to Wuhan was not heeded as a great number of travelers were still roaming the halls of the busy terminal. The epidemic couldn’t have happened at a worse time.

Inside the city, reporters were picking up much more disturbing signs of trouble. A group of Sanlian Weekly reporters revisited the closed Huanan Seafood Market, and bumped into business owner Huang Chang who was collecting stuff from his shut shop. Huang was infected. And so was his wife. But both were allowed to move freely in the city as hospitals were either not sufficiently alerted or unprepared to receive patients from the seafood market. Sanlian’s report brought people’s attention to the battered hospitals of Wuhan, many of which were already showing signs of stress: longer lines at the emergency rooms, shortage of testing kits, wards filling up with patients that must be isolated…

For some, such on-the-ground muckraking represents a flashback to the not so distant past that is destined to be short-living. Li Haipeng, a veteran investigative journalist reminded his Weibo followers to “take a last look at the glorious sunset”, as these were China’s last remaining media outlets still defending public interest. Between 2003 and 2020, the one difference that is obvious to anyone watching, is the decline and degradation of China’s non-state media industry. At the turn of the century, China’s newly (partially) liberalized newspapers and magazines were pursuing news and scandals with a ferventness not unlike their Western counterparts. The SARS episode established media outlets such as Southern Metropolis News, the history making daily broadsheet and Beijing Youth Daily as a force to be reckoned with. Their brave breaching of gag orders sounded the first alarm bells in Guangzhou and Beijing, two epicenters of the SARS epidemic. The following years saw waves after waves of cleansing and disciplining of the sector. Watchdogs became a rare breed and investigative journalists became an endangered species. The decline of media is so obvious that even Hu Xijin, chief editor of Global Times and a shrewd defender of Party policies, conceded that constant curtailment of media’s power by “unrelated government departments” (referring to those not directly in charge of supervising media) had significantly undermined society’s ability to raise alarm about imminent danger.

17 years after SARS, the country had proactively dismantled a key part of its immune system against such danger. And the price was dear. On Jan 23, people in China woke up to the news of Wuhan being sealed off by government order. The great Yangtze River city had closed all the transportation terminals. No one could get out of the city anymore.

The drastic measure was met with confusion, panic and hysteria. At one point, even the mayor of Wuhan wasn’t clear to whom the travel ban applied. The tone of media reports quickly darkened from Zhong Nanshan’s measured alarm to Guan Yi’s despair. Guan, a top virologist at the University of Hong Kong, described himself as “scared” in a one-on-one interview with Caixin. The SARS and bird flu veteran conceded that in his brief visit to Wuhan before the seal-off, he witnessed a city completely unarmed. “It would be 10 times worse than SARS.”

As mood turned, the horrendous situations in Wuhan’s hospitals began to surface. Sanlian Weekly and Beijing News, another newspaper joining the on-the-ground press corp, both turned their attention to crowded wards and emergency rooms. The picture they depicted was horrifying: medical workers were being overwhelmed by a large number of incoming patients. The capacity of hospitals were reaching its limit, turning themselves into hazardous public spaces. Undiagnosed patients were being turned away, who lingered between home and hospital. In 2003, SARS claimed the lives of a huge number of medical workers as hospitals failed to quarantine patients immediately. But isolation needs space that Wuhan’s over-crowded hospitals did not have. Social media was quickly filled with images of long queues at health care facilities. A heartbreaking video of a frontline doctor making desperate phone all to his superior, crying and cursing, got widely posted, then censored, and posted again repeatedly.

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Like their predecessors in 2003, Wuhan’s medical workers confronted an onslaught of a poorly understood virus like barehanded soldiers. The heroism was all the more poignant when their sacrifice was avoidable. There was no shortage of irony when the life-and-death situation in hospitals were put side by side with the festive mood of Wuhan’s administers. It turned out that on the eve of Jan 21, less than two days before the closure of the city, leaders of Wuhan and Hubei province were enjoying an exuberant Spring Festival show put up specifically for cadres. Social media also noticed that on Jan 19, just one day before Zhong Nanshan’s warnings on national TV, Wuhan government organized a massive celebratory Spring Festival banquet involving 40 thousand families, a blatant disregard of containment principles. More attentive observers began to connect the dots. Wuhan’s belated official release of infection data stopped just 5 days after the virus outbreak was made public on Dec 31. Between Jan 6 to Jan 16, the city’s public health authority reported not a single new case, leaving the impression that the epidemic was under control. The silence coincided perfectly with official conferences and celebration schedules: between Jan 6-11, provincial cadres were all gathering in Wuhan for the annual sessions of the local People’s Congress. Apparently, the political ritual could not be disturbed.

As indignation against the officialdom mounted, another kind of anger was collecting force. Guan Yi’s pessimistic message on Caixin met with rebukes from social media, with netizens calling him scaremongering and “showboating“. His choice of leaving Wuhan immediately was also sneered at as an act of defection. Some went further to suggest that Guan had a track record of exaggerating virus situations, citing his alarmist comments around bird flu outbreak in 2013. Caixin itself was not spared from such criticism, prompting the author of the interview to defend the article publicly, insisting that including such voices was healthy for the battle against the virus.

The backlash against Guan Yi and Caixin was not uncommon in the national outburst of opinions around the outbreak. If things have changed in the 17 years since 2003, one clear difference is the emergence of grassroots online defenders of the state against what they see as “subversive forces”. Experts, media, and individuals may all become targets of intimidation in the name of “rumor busting” (piyao). The unifying value of such online actors (some showing signs of state coordination, others spontaneous) appears to be the upholding of social order and stability in the face of extreme uncertainty and chaos. Any utterance that is considered to incendiary or misleading is treated with harsh, and in many cases personal, criticism. Media questioning of official statistics and amplification of non-officially condoned voices run the double risk of both government censorship and punishment by public opinion. What’s tragic is that right in the middle of the Wuhan emergency, this advanced online “immune system against dissent” were activated to attack individuals with real needs and grievances.

In the confusions of the seal-off, three Wuhan Weibo users posted descriptions of what their aunt had experienced. The suspected coronavirus patient was turned away by overcrowded hospitals. Her conditions worsened rapidly at home, was finally admitted into an Intensive Care Unit, and died two days later. She never had the chance to be formally diagnosed. When her nieces posted about her death, they understandably expressed dismay. One of them described gruesome scenes at hospitals, some of which she heard about from interactions with an ambulance driver. This became her sin. As influential Weibo accounts picked up the story, they were displeased and irritated by the distraught posts. Part of the account sounded implausible. And how come three seemingly unrelated Weibo users all of a sudden started to post about an “aunt”? Quickly, a narrative of “bad elements” trying to sow mistrust about government disease response began to develop around the three cousins. Discrepancies of their accounts were highlighted. Suspicious wordings were scrutinized. The most eye-catching theory was that they were internet agents hired by the Taiwanese regime to stir up discontent on the mainland, based on their occasional language usage. Piqued by such storylines, thousands of Weibo users descended on the cousins’ Weibo space to insult them. “Disgusting bitches!” they cursed. When Weibo belatedly verified the identity of the three women, a few accusers made public apologies. Weibo later suspended some leading accounts in this episode.

The cousins were not alone. All over Weibo, desperate help seekers from the epicenter of the contagious disaster were being chased and attacked by “truth guards” for spreading rumors and misinformation. The bullying was so widespread that a user came up with a satirical guideline advising Wuhaners asking for help on Weibo to self-humiliate and apologize preemptively to the truth guards for their forgiveness.

Observers believed that the attackers were suffering from a paranoia of extreme aversion to others disseminating information that upends their orderly worldview. Wuhan’s distressed internet users were not the only group enduring abusive paranoia. Offline, in the real world, people from Wuhan and Hubei province suddenly found themselves unwelcome in their own motherland. Incidents of travelers from Hubei being rejected by hotels and residences began to emerge. By Jan 26, 3 days after the official seal-off, the spectacle had grown into a national concern, prompting bloggers to openly call for a calm-down of the frenzy: “Wuhan people are not our enemies.” More concretely, a plea went out to stop leaking the personal information of people from Hubei. Apparently, vigilantes in the system who had access to information such as hotel check-in registries were passing it on so that others could avoid, report, or drive away those associated with Hubei province.

As ordinary people were being chased, isolated, bullied, silenced and pushed around, the other line of questioning, after those responsible for the fiasco, was struggling to keep its focus. In a bombardment of outbreak-related information, public anger acted like the small ball in a roulette game. At any given moment it may land on top of the Wuhan Municipal Government, Hubei Provincial Government, the Chinese Center for Disease Control and Prevention (CDC), the United States CDC, or the World Health Organization (WHO), depending on which media story or blog post was trending at that time. The outbreak and the Spring Festival holiday together created an unprecedented online time-space where hundreds of millions of Chinese, all off work, had nothing else to do but watching one of the country’s worst public health crises unfolding on their mobile phone screens. Every actor’s every action was scrutinized and commented upon by millions online. At one point, 10 million people were watching the live stream of the construction site of an emergency hospital, assigning nicknames to bulldozers and excavators.

In this environment, China’s ruling elites were all of a sudden thrown into a virtual colosseum where their politician skills were mercilessly tested. And they failed spectacularly. When municipal and provincial officials went on TV, they appeared detached, clumsy and outright stupid. In one of the much watched press conference, none of the three cadres, including the Hubei governor, could get their masks right. In a much condemned and ridiculed segment, the governor, responding to questions about the province’s mask production capacity, had to correct his answer twice after prompted by his secretary. The train wreck made observers wonder if Chinese bureaucrats, shielded off from media inquiry for too long, had completely lost the ability to even maintain the facade of competence. These were wholesale politicians never bothered to do retail.

Wuhan press con

Probably pressured by the public outcry to act more humanly, Zhou Xianwang, Wuhan’s mayor, later went on a one-on-one interview with CCTV’s Dong Qian off-script. To his credit, he answered a few questions with a level of candidness that’s rare in this shit show of government dysfunction. But the performance did not win him many scores. Rather, one of his answers hinted at a much deeper problem in the system. Responding to a key question about whether local authorities covered up the epidemic in the critical days before Jan 20, the mayor complained that as a municipal government, they need higher-level authorization to alert the public.

The admission on national TV started a nasty buck-passing game that would occupy public debate in a disorienting fashion for the next few days. Media seized upon the rare opening to dig into China’s epidemic control regime, revamped after SARS to prevent a repeat of the outbreak, hoping to pinpoint the source of any possible cover-up. But that line of inquiry was doomed not just because of the apparent “ceiling” of such investigation, but also because of the lack of basic ascertainable facts accessible by the public. Zhou’s interview injected a new level of confusion into the public debate. Caixin’s report depicted a picture of intertwined laws and regulations that were not clear whether it was the local governments or the national health authority who had the power to publish epidemic alerts. The Wuhan mayor’s argument seemed to have some legal ground: their obligation was to report infection cases upward, to the provincial, then National Health Commission.

Were health authorities responsible for suppressing life-saving early warning information, making the Wuhan government a victim, rather than perpetuator, of the cover-up? No one knew for sure. High level health officials dodged the question at a Jan 26 press conference. But people were piecing together fragmented information. Where facts were missing, narratives filled the gap. One of the unlikely sources of information were top medical journals. With impressive speed, Chinese researchers began to publish papers detailing the epidemiological and clinical characteristics of the novel coronavirus. Their published work filled some informational holes but left more questions unanswered. A key component of the emerging scientific literature on the virus that was eagerly consumed by the public were timelines. The studies published in journals such as Lancet and New England Journal of Medicine by top Chinese scientists, including senior officials at CDC, contained information of dates when infection cases were detected, onset of symptoms occurred and epidemiological actions were taken. The inclusion of many cases before Dec 31, when Wuhan authorities opened up the lid on the situation, gave the impression that CDC scientists were aware of the contagion before everybody else. Quickly, a narrative began to develop of CDC officials knowingly hide the information of human-to-human transmission. Worse, opinion leaders took aim at some of the scientists, including CDC Director Gao Fu, and asserted that they suppressed the information IN ORDER TO be the first ones publishing those data on top journals. Those accusations piled into a wave of indignation about cold-blooded academic profiteering, pressing CDC, and Director Gao Fu, to defend their work publicly, claiming that the analysis was done retrospectively. They got hold of December cases after they were released by local authorities in January.

Voices protecting CDC scientists argued that within the Chinese epidemic control system, CDC was the one institute, sitting under the NHC, that clearly didn’t have the authority to publish information about the disease. In a way, the scientists were circumventing disclosure restriction by sending out detailed information through Western academic journals. Critics of the Wuhan authorities also reminded people that even if their hands might have been bound by law when it comes to alerting the public, they nevertheless chose to actively silence those who took risk to send out early warnings. It turned out that the 8 Wuhan citizens censured in December for spreading “rumors” about the epidemic were doctors who alerted their colleagues and friends of the suspicious disease through WeChat. Wuhan government actively killed the canaries in its coal mine.

What’s ironic about the chastising of scientists for publishing papers is the fact that the scientific community is one of the brighter spots of the dark saga. If there is progress in the past 17 years, China’s increased research capabilities is definitely one. Chinese researchers completed the genomic sequencing of the virus in a matter of days and shared it with the rest of the world to allow for speedy development of diagnostic kits and techniques. It is worth noting that during the early stage of the SARS outbreak, Chinese scientists struggled and fought each other for months trying to identify the right pathogen.

Wuhan, in part, was saved from a much worse scenario thanks to that scientific competence. The sealed-off megacity was also kept afloat by an advanced network of internet-based service providers and mobile-organized support groups that were both non-existent 17 years ago. It was Alibaba’s online shopping platform, Didi’s mobile taxi hailing, SF’s courier services and Meituan’s food delivery system that kept the basic life-supporting functions of Wuhan operating when all its public services were either stopped or severely stretched. The contrast between those efficient and nimble providers of services and the bureaucratic apparatus couldn’t be clearer when an appalled public found out how their donation was handled

The Wuhan Red Cross Association, a government-affiliated body unrelated to the international Red Cross movement, won itself nationwide notoriety for its handling of millions of facial masks and other protection gears desperately needed by the battered hospitals on the frontline. The semi-government organization first attracted public attention when people noticed its 6% overhead charge on all donations, a not so high rate by international standard but eye-catching enough in an environment where trust of governmental philanthropies was generally low. When interested netizens dug deeper, they were aghast by what they saw: large amounts of much needed facial masks were channeled to dubious medical facilities while frontline hospitals got almost nothing; doctors had to wait in lines at warehouses to pick up supplies for their colleagues while cadres casually carried away whole boxes of high-end masks; association staff using medieval methods to keep inventory of donated supplies, causing a huge problem of backlogging… To rub salt in the wound, the authorities prohibited all other channels of sending donations to hospitals, making Wuhan Red Cross Association the only game in town. Only after a country-wide outcry did the authorities softened the stance by allowing third parties connecting directly with some hospitals. And after the association opened up its warehouses to a private logistics company, the messy inventory was cleared up in a matter of hours.

If anything, Wuhan bankrupted the meritocracy myth for many people who once believed that the country was largely run by no-nonsense, result-oriented technocrats. Wuhan Red Cross Association reminded them how incompatible the country’s bureaucratic apparatus was to a lively society that was intrinsically good at practical problem-solving. Not only did the state and its organs unhelpful in such problem-solving, they were actively thwarting it. For a generation that grew up after the SARS outbreak, that experience was eye-opening, especially when they found that their self-organized fan clubs for idols were more efficient in delivering aid to the frontline than government bodies. It was no surprise that some of them wondered openly (and naively) if more accountable government officials could be generated through televised competitions just like their idols.

As this blog is being written, there is still no sign of the outbreak being under control. Hundreds have lost their lives and diagnosed cases are over ten thousand, while not a single senior official has been held accountable for the epidemic. There is a permeating sense of loss, for the diseased, but also for an era marked by its warmth and possibilities. As Li Haipeng wrote of the spring of 2003: “Officials at that time did not have to hide their personalities and could demonstrate their human side… From the outside, you could see the bureaucracy thinking, planning, maybe infighting, but almost certainly taking actions. You could feel that they at least had one consensus: that the society’s cries deserve a response.”

Crime and Punishment of a Search Engine

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Does a search engine have the ability to kill a person? After being bombarded by the news about the death of a 21-year-old college student called Wei Zexi, many Chinese have come to the conclusion that it does.

Like numerous online debates about scandals of late, the incident devolves into an exercise of guilt rationing on a massive scale. With the absence of an impartial arbitrator, public opinion takes up the role of fact-finding and responsibility allocation, with implications hard to pin down at this very moment. The story puts Baidu, China’s largest search engine company, at the epicenter of the controversy, bearing the brunt of online criticism, which is guided as much by a complex set of moral convictions as by a vision of technology’s role in the society.

According to Wei’s own account posted on zhihu.com two months before his death (as an answer to the question “what is the greatest evil in human nature?”) , he was diagnosed of a rare tumor, synovial sarcoma. Major hospitals he visited all threw up their hands and told him no effective therapy was available. Desperate, he resorted to Baidu, and initial searches quickly rendered amazing results: a bio-research center based in one of Beijing’s well-regarded hospitals (affiliated with the People’s Armed Police) claimed that they had an advanced therapy (DC-CIK) that could help. The doctor there told him it was “Stanford technology” and promised to extend Wei’s life by “another 20 years at least”. The family invested almost its entire fortune into this last ditch effort, only to find that cancer quickly spread to his lung. Later, well-intentioned individuals on the internet helped Wei find out that DC-CIK was a shelved technology in most parts of the developed world due to limited effect in clinical application. Yet precious time and money was wasted. Wei, the only son of a Xi’an family, died on Apr 12th.

The personal tragedy of Wei Zexi puts a key business component of Baidu under a scorching national spotlight. It is called P4P (pay for performance), whereby customers bid for premium advertisement placement alongside “natural” search results of selected keywords. Although other factors such as quality of content also affect positioning of promoted links, bidding price carries significant weight in the formula, giving high-paying customers good chance of occupying prime locations on Baidu’s search page. The search engine does put a “promotion” mark under sponsored search results, but in a way that is probably not as visually distinguishable as critics and regulators want. The subtlety of the mark can get lost on eyes less experienced with Internet surfing, or those who are eager to find something.

With this background, it may be understandable that the first wave of criticism came for Baidu, even though in both Wei’s original account and the initial investigative piece that directed public attention to the case, the blame fell squarely on the Internet company and on the bio-research center, as well as the invisible yet mightily present state that loomed over the two.

In an era when books like Nudge populate bookstore shelves and people believe in step-counting mobile phone apps to keep themselves fit, the idea that search engine results determine the fate of individual users is only the natural offspring of a faith in the efficacy of technological interventions. It is further enhanced by the towering image of the do-no-evil Google, whose upholding of “enlightened” technology becomes a shining exemplar that shapes the Chinese public’s view of Baidu.

So the conversation swings back and forth between Baidu and Google. Some goes so far as to suggest that Baidu is the “fundamental culprit in dragging down the informational infrastructure of the Chinese society”, by abusing its virtual monopoly in the search market to set up roadblocks on the information highway, profiting from a slowed traffic and a misguided crowd. Google’s Adsense, its core advertising instrument, is upheld as being non-intrusive and responsible. Tales of Google’s efforts to ensure the quality of medical-related search results attracts the attention (and imagination) of Chinese netizens. Very specific ideas proposed by prominent opinion leaders, such as listing ads in a separate column on the screen, are clearly influenced by widely held perceptions of Google’s practices. But it is worth stressing that nowadays Google also puts some ads in the same column as natural search results (with clear marking as “Ads”). More sophisticated industry observers have also pointed out that the growth of Google’s business in China, back when it was still allowed to operate inside the country, was also partially driven by traffic generated by the same kind of search result tricks that Baidu deploys.

Pressed for a response, the Internet firm released a statement through one of its Weibo accounts on Apr 28: it had double-checked the paperwork submitted by the hospital and found it completely legit. This may be true, if your scrutiny stays at hospital level. Move one level below, to the department level, disturbing signs start to emerge. When investigative journalists dug deeper into the bio-research center, they came up with a shadowy web of private entities that had basically “taken over” lucrative departments in military-affiliated Chinese hospitals and ran them like joint-ventures. The public would learn of a so-called “Putian clan”, a group of businessmen who shared the same origin in Putian, a town in southern China’s Fujian province. Lurid, unverifiable stories about the ascent of this group of medical entrepreneurs spread widely on the Internet. As the story goes, they got hold of their first bucket of money in the early days of China’s economic reform. In those years, guerilla clinics prospered in street-side budget hotels, ripping off patients of venereal and skin diseases who were too ashamed to go to proper hospitals. With initial capital in hand, those “bare-foot doctors” began to eye more systematic, legitimate ways of money making. Cash-hungry public hospitals became their natural partners and a new model of “contracted departments” spread like wild fire. In order to bring in more patients, the Putian businessmen took up online marketing, taking advantage of the stellar reputation of hospitals that were hosting them. Baidu’s emergence as a dominant search engine and its offering of P4P handed them a perfect platform to reach out to an anxious, sometimes desperate, clientele. In the process, many patients like Wei Zexi fell victim to sub-par treatments.

The entering of the Putian businessmen into the scene makes the ethical water of the Wei Zexi case much muddier. How much blame should a search engine share if much larger malign interests are motivated to take advantage of its playbook and win access to premium ad slots? As Baidu has always claimed, it only collects and sorts information, not generating it. It acts like a mirror: the reflection is only as good as the Chinese society can be.

An event in 2015 seems to indicate that relationship between Baidu and the Putian clan is less than amiable. At that time, an industry group representing Putian medical interests called for a boycott of Baidu P4P services, claiming that the latter had used its dominance in the market to rip off Putian-controlled hospitals by unilaterally raising prices for promotion. Baidu search results have become a major channel through which such hospitals bring in patients. According to the industry association, P4P expenditures occupy an increasing chunk of those hospitals’ profits, in some cases as high as 60-80%. One the other side of the equation, medical advertisement makes up to 25% of the search engine’s ad revenue, making the relationship of the two parties a love-hate symbiosis. Baidu’s account for the unpleasant stand-off was completely different. It claimed that the industry group was threatening boycott because its crackdown on deceptive medical advertisement was hurting Putian interests. “The threat will not soften our resolute to keep false medical information out of our search results.”

With more information surfacing about the Putian clan, a push back against Baidu-bashing quickly collects momentum. People begin to question the society’s proclivity to blame the safer, easier and more exposed. For them, the focused attack on a publicly listed Internet company is a sign of the collective laziness of Chinese Internet. “The Putian businessmen are happily off the hook now,” as some would proclaim. The despicable deal between public hospitals and the nouveau riche, and negligence of their supervisors, can easily escape public scrutiny under the cover of an outcry directed entirely at Baidu. As a veteran Caijing journalist puts it, what the public should really chase is the regulators who turned a blind eye to the rampant, irresponsible monetization of public hospital reputations. Not only is Baidu a minor consideration in this whole scheme that condemns Chinese patients, so is the Putian clan, whose fortune is determined by the whims of powerful regulators. He predicts that a campaign-style crackdown on private interests in the medical sector would ensue to placate the public, without touching the fundamentals that have allowed the situation to spread in the first place. “It is a way for power to routinely discipline private interest groups, preventing them from growing too big, while reminding them to be more active in paying their rent.”

More methodical minds try to lead people out of this ethical swamp by actually ranking the relative moral responsibility of the parties involved: the biggest share of blame goes to the military-affiliated hospital that knowingly sold its reputation and standing for profit, while being in the best position to judge the medical merit of the technology that its “contracted” bio-research center is promoting. Second comes the center and regulators. Baidu ranks at the bottom of this ethical ladder, for “it is also in relative disadvantage when it comes to medical expertise”. Its only problem is choosing to pursue profits in this category in spite of its own blind spot.

But there are people who resist this way of assigning responsibility. They see it as a distraction or even an intentional tactic to deflect pressure from Baidu, at a point when intensive public questioning is just about to make a dent on one of China’s largest internet firms. The sentiment roots in a deep frustration over a string of Baidu-related controversies (including the one in January this year where it attempted to sell off management authority of an online patient support group to commercial interests), which the Internet giant have all weathered with impunity. “We don’t have the ability to change the root cause of the problem, but at least we can change Baidu with a concentrated effort.” This line of argument contains, at once, a deep sense of powerlessness and a great faith in public opinion: criticizing the power behind the whole corrupt situation won’t bring you much change. It’s a dissipation of precious energy. But the search engine will ultimately bow to such public pressure.

The powerlessness manifests itself in a different reading of Wei’s death. What killed him seems to be a carefully weaved web of sub-lethal elements: acting individually, no element, whether it’s the search engine or the hospital, is potent enough to bring death to a person. Yet collectively, their grip turns out inescapable for an ordinary Chinese like Wei. In the end, each individual element can deny accountability for the collective consequence.

On May 10, China’s Internet authority handed down its verdict on Baidu: it has to change its algorithm for search result presentation, give more weight to credibility, less to bidding prices. Plus, no more than 30% of a page should be given to promotional results. It is a rare occasion where the country’s web regulator publicly dictates change, albeit a noble one this time, to an Internet company’s core business, its algorithm. Earlier, commentators already made a careful-what-you-wish type warning about a more empowered Internet police coming out of this case. But for most part of the cyberspace, vindication is the predominant mood.

The complexity of Baidu’s response to the whole saga is best captured by an article published on the company’s intranet days before the final result. While pledging to collaborate with regulators, it also questioned why the bio-research center could obtain all the certificates and official documents. “As a great enterprise, we sometimes have to shoulder responsibilities that once belong to the state and the medical industry, because with more power comes more responsibility.”

Immune: in the name of rationality

vaccine

In the middle of a massive eruption of public anger over compromised vaccines, a small group of influential individuals considered themselves immune to what they saw as cheap sentimentalities, and set out to restore “rationality” in the Chinese cyberspace. Their intervention created a deep cleavage in the public debate over the scandal, a consequence that considerably complicates the unfolding of events.

The origin of the story is the Mar 18 revelation by the Paper that 2 million pieces of compromised vaccines (due to improper storage under high temperatures) had entered the market through shady traders all over the country. Two suspects, Pang and her daughter, were caught illegally obtaining and selling Class II vaccines (those that are for voluntary use, as opposed to Class I vaccines that are mandatory for children, whose distribution is controlled by the state). While regulations mandate that vaccines should be kept in a controlled temperature between 2-8 Celsius degrees, the Pangs stored them in a make-shift warehouse with no air conditioning at all. As more details were dug out by the media, the uneasiness among the public, especially young parents, quickly approached boiling point.

As soon as signs of a major public outcry started to appear, a counter-move also began to collect momentum. The Paper’s report immediately met with criticism of “scaremongering”. Ironically, the source of the criticism was a WeChat account targeting young mothers. Declaring that there is little to fear, its main argument is that the vaccine scandal is “old news” (the suspects were actually arrested one year earlier but the police department chose to disclose it to the media now), and there is no reason to believe that the compromised products are still available on the market.

The argument is shaky, as a rebuttal from a veteran Paper journalist points out. Rather than using a piece of old news as click-bait, the fact that the Paper makes a new story out of an arrest a year earlier is a troubling indication of the police’s inability to make progress on the case for over a year and need to overcome interagency barriers by soliciting external support from the press (it was the police that fed the lead to the Paper).

What’s interesting is the man behind that WeChat account. Mai Tian, an Internet executive who made his name in 2012 by venturing the sensational allegation that Han Han, the famous Chinese writer and a sweetheart of the liberal middle class, had hired shadow writers to pen his best known stories, now runs a mobile site focusing on childcare. He is among a vocal group of individuals who have become increasingly vigilant against what they consider misguided populist sentiments. Within this highly heterogeneous group, you find Internet personalities such as him, “science disseminators”, journalists and leftist patriots. Despite their diverse political leaning and professional background, they seem to share one common denominator: a general distrust of popular judgment, bordering on condescension and a contrarian stubbornness.

While this kind of intellectual orientation is not entirely unusual in any society, in China it bumps into a big dilemma: what if that “populist sentiment” is the main driver of progressive change in a country besieged by all kinds of social ills?

An inconvenient truth in recent years is that more often than not, “irrational” concerns from the public outperform “scientific” assurance in terms of their prediction power. A few years after the Xiamen residents were scolded by “science disseminators” for their persistent and “irrational” protest against a planned PX chemical plant in 2007 (as PX is not particularly toxic), a massive explosion at the very facility that was supposed to be built in Xiamen and was relocated to a nearby town due to the protest vindicates the Xiamen protesters in a big way.

The vaccine scandal pitches the two forces against each other once more, this time in the shadow of a media report that is already three years old. On Mar 21, a post named “the tragedy of vaccines” got viral on people’s WeChat walls. In 2013, then Southern Metropolis News journalist Guo Xianzhong completed a three-year investigation into the horrendous side effects of vaccines and the suffering of families all over China. He managed to put a face (or to be accurate, 38 faces) to a problem that was obscured by the country’s general improvement in public health and prevention of contagious diseases. With his camera, he documented 38 kids who suffered severe, debilitating side effects after vaccination and posed serious questions about how the country had been mishandling the recognition and compensation of vaccination victims.

The heartbreaking photos of children are apt ingredients for a new scandal unfolding in front the public’s eyes. The victim of the new scandal is temporarily invisible, as the authority’s investigation has not been thorough enough to uncover those affected by the poorly stored vaccines. When the public is in need of a vehicle to carry their frustration and anger, they pick the most emotionally potent at hand, despite the substantive discrepancy between Guo’s report and the current situation. Side effects happen to proper vaccines too. It is a matter of chance, and when it occurs what’s crucial is expedited recognition and care for those families affected. Compromised vaccines generally pose a different kind of risk, the risk of failure (zero effect), which could be life threatening for those who have to count on their effectiveness, such as potential rabies victims. Angry parents ignored the nuanced differences and aired their discontent using images of crippled or paralyzed kids from three years ago.

The mismatch deeply troubled Hecaitou, a veteran Internet commentator, who penned a sarcastic blogpost insinuating that those retweeting the side-effect story were illiterate and stupid. He maintained that the current scandal concerned only Class II vaccines, and there’s no evidence that these compromised vaccines would be highly toxic. He was particularly harsh on the great number of online media outlets that kept feeding the public with that 2013 story. “Manipulating an ignorant public is like channeling a mindless flash flood. Whoever use it to earn clicks or build up influence is shameless.”

His unnecessarily arrogant tone may have complicated the response to his criticism. Emotional netizens, especially young mothers, were infuriated by his comments. They believe if public pressure can induce positive changes in the management of vaccines in general, then there should be no reason to try to quench that fire. Detailed difference in the numerous facets of the vaccination problem does not matter. Picking bones with public grasping of the issue “is equivalent to defending the evil,” as one popular comment under Hecaitou’s post quipped.

Hecaitou did not back off. Replying to one of the more supportive comments, he revealed his true concern: Chinese parents might be misled into distrusting vaccines totally, a consequence that would be detrimental to the country’s hard won public health gains. A Weibo account fully dedicated to the dissemination of vaccine related scientific information was visibly desperate: “I used to persuade parents that as long as the vaccines are from properly registered producers, they should feel assured of their safety. Now I feel like I am an accomplice in a crime.”

Chinese elites have a natural tendency in worrying about “panic attacks” in the society. One might say that this reflects a deep-seated condescension, seeing the public as incapable of critical thinking and independent judgment in the face of crises. But their wariness is not completely groundless. In 2011, days after the Fukushima nuclear meltdown, many Chinese shoppers raided supermarkets to hoard regular sea salt, as they feared that future salts would be polluted by radioactive water. The episode created a temporary shortage of salt in a few towns. The collective fury of young Chinese parents can also be pretty “lethargic.” Last year, a sudden surge of angry calls for the indiscriminating execution of all those who are involved in child trafficking even pressed the nation’s supreme court to formally response, claiming that doing so would be tremendously counter-productive. It turned out that the “call for execution” was the machination of an online outlet to attract clicks. With such recent memories in mind, the concern that a public clenched by fear may turn away from necessary, legitimate vaccines is understandable, even though no evidence is available to show that this is actually happening.

Only this time the pushback against elitist condescension comes strong. Panic, as one commentator puts it, is a society’s natural reflex mechanism to danger. It acts like one’s immune system. Trying to mute such reactions will desensitize the body and make it vulnerable to future threats. “In this country, we need more panic attacks, not less.”

Amid the heated debate, a new term is chauffeured into the Chinese vocabulary: “the right to panic.” (konghuangquan) Supporters uphold the “right” as essentially a freedom of expression, the expression of fear. But others caution that even if the public has the freedom to air whatever they feel, it’s a different thing if media and those with influence choose to intentionally fan the fire of irrational fear. At the bottom of that debate is “opposite assumptions about whether public sentiment is being artificially subdued and whether intervention from the media is warranted.”

This is where the rationalists’ seemingly noble cause meets with intense suspicion. Their call for calmness and reason seems always fall in line with the government’s maneuvers to silence alarm and discontent. This time, while “the tragedy of vaccines” was being attacked for being misleading, reference to the report were quickly deleted all across the Internet.

The government also seemed to have seized the opportunity of this “rationalist backlash” to shift public attention from its responsibility in oversight to the safety of those compromised vaccines. The highly anticipated press conference held by central governmental agencies after the scandal broke dedicated substantial amount of effort to explaining to the public that compromised vaccines were unlikely to lead to toxic side effects. Even the WHO intervened along these same lines, issuing three statements in a roll assuring the Chinese public that the risk of adverse health risk is low. The intervention was so unusual that some on the internet suspected the authenticity of the statements, believing it’s the government’s plot.

The drift of public debate into the territory of risk and science is considered by some as “loosing focus” from the urgent priority of tracking those 2 million pieces of problematic vaccines that are still at large in the market. “Scientific rationalists” were believed to have played a key role in blurring that focus. Whether intentionally or not, they helped reduce the pressure on the shoulder of the authority.

In this clash between righteous public indignation and detached rationalism, a kind of cynicism is discernible on both sides. Agitated parents believe whatever maintains public fury works, even if it could be misinformation. Self-professed defenders of science, on the other hand, have no faith in an increasingly well-informed and well-educated general public, and seem to be more interested in establishing their own intellectual superiority than advancing actual improvement in social conditions. Accept it or not, the Chinese society has to zigzag toward better governance of public goods harnessing those flawed yet powerful forces. To slightly adapt a famous line from the Dark Knight: it is a progressivism that China needs now, but not the one it deserves.

It deserves something much better.

A Cure for Humanity, A Bitter-sweet Pill for China

Tuyouyou

“Now I firmly believe that the Nobel Prize is a hostile foreign force. Not to mention the previous (Chinese) winners, now they finally granted us one in the sciences, and they had to pick this particular field of study! In doing so it fulfilled its hidden agenda of tearing apart the Chinese society,” says Wuyuesanren, an influential personality on Weibo.

He meant it to be a half joke, yet it perfectly captures the bitter-sweet Chinese reaction to the Nobel Committee’s decision to award its 2015 Nobel Prize in Physiology or Medicine to 85-year-old Chinese scientist Tu Youyou, for her contribution to the discovery of Artemisinin, a compound that helps the humanity to combat the deadly malaria that has ravaged many communities in the least developed parts of the world.

In many ways, it should have been the moment that the Chinese society has long awaited. In the quintessentially Chinese point of view, only the Nobel Prize in the sciences truly “counts”, as the peace prize proves to be too political and the one for literature too subjective. In the past, even when ethnically Chinese nominees such as Chinese American Steven Chu won the award, a joyful mood would sweep over China, and there has always been a discussion about when an “authentic” Chinese citizen, born, raised and educated in China, could win a Nobel Prize in the sciences. So you would expect Tu Youyou’s recognition by the Committee to be a cue for unconditional national   celebration. Yet the prize somehow acts like a gigantic boulder rolling over an open field full of land mines, touching off all kinds of explosions and leaving behind a smoldering landscape that might utterly perplex an innocent observer.

How could a seemingly apolitical, objective and straightforward Nobel Prize lead to such complications? The answer lies in the country’s own state of mind and its fundamental inability to fully internalize the troubling legacy that Tu and her generation of scientists have left. And when the full weight of the world’s most prestigious recognition is suddenly thrown upon the edifice that used to support and justify China’s own way of pursuing scientific advancement, the structure starts to wobble due to its internal contradictions. Alfred Nobel’s gaze turns out to be too glaring for a country whose scientific endeavors have been discounted for so long.

The discovery of Artemisinin, an active compound extracted from a traditional Chinese herb, is the product of the Vietnam War and the Cultural Revolution, two of the most tragic events of 20th century history. In 1967, Tu Youyou, then a young researcher at a Beijing-based Chinese medicine research institute, was dispatched by her superiors to participate in the secretive “523 Project“. It is widely believed that China initiated the project upon the desperate plead from Vietnam’s Ho Chi Minh, whose soldiers were plagued by malaria while waging guerrilla warfare against the United States military in the unforgiving heat of Indochina’s tropical forests. No archival evidence seems to be available for this supposed origin of the Nobel-winning discovery, but it is clear that the scientists involved were operating under a pressing mandate detached from a general improvement of the human condition. Understandably, most of those involved were “volunteered” by an order from the top, just like Tu Youyou. Worse still, at a time when the country’s intellectual elites were being marginalized and “re-educated” en masse as “reactionary capitalist academic authorities”, the 523 Project, said to be directly overseen by Premier Zhou Enlai, might have become a shelter for those battered academicians.

It was under such conditions that Tu and her colleagues embarked on an improbable journey of groundbreaking discovery. Inspired by a thousand-year-old ancient record of herbal medicines, Tu came up with a way to extract a highly unstable compound from Artemisia carvifolia, later proved to be very effective against malaria. The pursuit met with unimaginable difficulties (the extreme shortage of proper instruments is but one of them) and involved tremendous personal sacrifices (including testing the new drug on the researchers themselves).

In recent years, the Project has become a subject of serious historical study, partly due to increasing international attention on the significance of the discovery (in 2011 Tu was awarded the prestigious Lasker Award in the United States). It has also become a source of bitter irony because of its special historical circumstances, as one Weibo post remarks after the Nobel announcement: “Just as China initiated a Cultural Revolution to completely destroy its traditional culture, it embarked on a parallel journey to seek a secret cure for malaria from its ancient medicines. How ironic! The fact that the 523 Project ‘incidentally’ protected hundreds of researchers from political persecution is a chilling reminder for every Chinese to remember.”

The Cultural Revolution mark on Tu Youyou’s discovery not just affected how people view its legitimacy, but also caused practical problems that later led to controversies dogging Tu for decades. A key problem is around how the work was organized and how the breakthroughs at every key stage of the drug’s development should be properly attributed. At a time when “private property” was seen as an evil concept, scientists involved in the 523 Project hardly had the luxury to consider things such as intellectual property or patent. The few key pieces of published work were collectively authored in the name of “The Artemisinin Working Group” and other pseudonyms, a common practice during the revolution. This causes headaches for back attributing the discovery. And in this area, Western academic norms and a unique Chinese historical reality inevitably clashes. In 2011, Cell, an authoritative journal in life sciences, published a paper that elaborated the rationale for the Lasker Committee to grant its 2011 award to Tu Youyou. The authors of the article upheld three key principles whereby they determined Tu’s “primary contribution” to the discovery: Who first brought the idea of Artemisinin to the 523 Project; who first extracted the compound with a 100% inhibition; and who conducted the first clinical trial. But Chinese researchers Li Ruihong, Rao Yi and Zhang Daqing contested this way of attributing credit, arguing that this approach imposes a modern appraisal method to a piece of research conducted outside the Western academic norm, i.e. Tu (or any of her colleagues) did not act strictly as a primary investigator (PI) as defined by contemporary scientific project management. They further argued that discovery of an active compound is not equivalent to the invention of a successful therapy. The latter requires a string of steps including not just the extraction and separation of the chemical substance but also the assessment of its therapeutic mechanisms, effects and its chemical structure. And their comprehensive review of the 523 Project reveals that other Chinese scientists played equally important roles in those multiple steps of the medicine’s development, even though Tu’s contribution is still considered “pivotal”.

The attribution controversy, not surprisingly, sucks up much of the oxygen in the aftermath of Tu’s winning of the most craved science award in China. Rumors about her fight with other colleagues to get the Lasker Award spread widely in the cyberspace. Some of the gossip-type posts almost border on personal attack, suggesting that she has “a bad personality” and is “very arrogant and unreasonable”, therefore “deserves to be criticized”. The phenomenon led some to deride the Chinese society for its “foul cultural roots,” full of jealousy and ill-will toward its heroes.

Luckily, credit for the discovery is not the only focus. The Cultural Revolution background of Tu’s research also inspires a completely different discussion: a critical scrutiny of China’s current scientific efforts. If China could achieve such an important scientific development under extremely modest Mao-era conditions, how come modern day state-sponsored science projects with much more abundant cash supplies do not deliver results with the same significance? This line of questioning touches upon a long-time sore point: rampant corruption in China’s academic field and the misaligned incentives for Chinese academicians. A series of 2011 People’s Daily commentaries on Tu’s recognition by the Lasker Award were reposted on social network sites, still creating strong resonance today. The commentaries take their aims at China’s wasteful academic systems that incentivize quantity over quality, which encourages Chinese researchers to produce loads of low-quality publications just to meet their quotas. The result is a “frivolous” academic culture. China’s mechanism to elect its fellows of the Academy of Science is also under fire after the revelation that Tu never made it to that empyrean of Chinese science despite multiple attempts in the past. Web posts remind the public that many sitting fellows of the Academy have been involved in plagiarism scandals or are mere opportunists good at pulling strings in the system.

The discontent was so intensive that it almost brought about a full-blown revolt against China’s scientific establishment: even the congratulatory letters to Tu from the “big bosses” of Chinese science, including the Minister of Science and Technology and the President of the Academy of Science, were openly ridiculed for their grammatical errors and inappropriate wording.

Compared to the above, the bickering over whether Tu’s award “vindicates” Chinese medicine is almost a side show. The fight over the value of Chinese traditional medicine is a perpetual fault line cutting deep into the Chinese cyberspace, with one side (the “science disseminators”) declaring it as nothing more than primitive voodooism and the other (the “traditionalist”) seeing it as a correction to the extremes of Western medicine. Both sides found condolence (and ammunition) in the Nobel Prize Committee’s decision. And when a Chinese journalist brought the issue before the Nobel Committee at the press conference, the spokesperson again handed both sides the sweets they wanted: Tu’s research had been “inspired” by traditional Chinese medicine, but the award was for her scientific discovery using modern methods.

It looks like the Chinese society still needs some time to absorb the aftershocks of Tu’s Nobel Prize. The breakthrough happened in such unique circumstances that some already claims that the journey to find Artemisinin is both unrepeatable and unrepeatworthy, for its toll on those Chinese scientists and its moral compromises. If that’s the case, then the question is: what’s still left with the Tu Youyou legacy? Maybe prominent Chinese scientist Rao Yi is right. He believes Tu’s achievement shows that “science is not the work of geniuses, but the result of a relentless pursuit of ordinary people with very limited resources.” An inspiration for generations of Chinese scientists to come.

A more sophisticated observer looks at the whole Nobel affair with a naughty grin on his face: “The Nobel Prize committees seem to have reached a kind of tacit understanding among themselves: experiment with multiple awards to trigger political discussions in China. In a society at once de-politicized and highly politicized, politics is everywhere. Even an award in the sciences can tap into abundant resources for (political) criticism. Because China is under such a magic spell, the Nobel Prize likes China.”