China View: Erosion of Government Confidence Can Undermine Public Health Efforts

Idea Images

Since the People’s Republic of China was founded, the government has prioritized the prevention and control of infectious diseases. This investment in public health efforts has led to the eradication of filariasis, leprosy, polio, and measles in the country. The country has established an epidemic prevention system as well as a medical prevention and health care network covering urban and rural areas.

These efforts have also aided in the expansion of immunization and vaccination programs, which has helped to address illnesses such as cholera, typhoid, and meningitis. The public health system plays a vital role in the development of the health sector in China and protects the wellbeing of its people. In late January of 2025, China’s National Health Commission (NHC) announced that cases of respiratory infectious diseases and influenza have declined over the past few months.

While this should be great news, many citizens distrust the government’s judgement and decision-making regarding public health issues. Even before the implementation of the notorious Zero-Covid Policy, the public’s trust in the healthcare system has been gradually eroding. Public trust and participation play a significant role in reducing risks and protecting community members during public health emergencies. This mistrust has been exacerbated by underfunded public health services, healthcare facilities, and disease prevention control institutions. How can the government improve the public’s confidence in the health sector?

In the early stages of the PRC, the prevention and control of infectious diseases was prioritized, especially in more rural areas. In 1953, the Department of Epidemic Prevention established a nationwide system for disease prevention from the national level down to the local level. Those efforts played a significant role in controlling emerging diseases such as malaria, measles, and typhoid in rural areas from the 1960s to the late 1970s.

The economic reforms of 1979 created both opportunities and challenges for the health system. While it mobilized more resources for health services and improved working conditions, it also led to a dramatic reduction in government spending. As a result, the capacity of public health institutions in epidemic prevention and control declined as facilities began to provide charged services including inpatient and outpatient care.

In 2003 when the SARS epidemic broke out, the government was completely unprepared. This health crisis revealed many inadequacies within the country’s public health system including in disease prevention and control, information collection, epidemic reporting, and emergency response. After SARS, reforms were administered to strengthen the public health system and address these deficiencies. This led to a surge in government spending on health and the country soon established the China Information System for Disease Control and Prevention (CISDCP), which is one of the largest reporting systems of infectious disease epidemics and public health emergencies in the world.

In 2009, the government launched a major healthcare reform which aimed to create a more equitable and accessible public health service system. To improve accessibility and affordability, the plan aimed to provide rural and urban residents with free basic public health services. Additionally, these reforms would help improve coordination mechanisms for social mobilization and participation. These reforms and increased investment in the health sector proved vital in the country’s response to the dengue outbreaks in the 2010s.

In response to the Covid-19 pandemic in 2020, the government implemented the Zero-Covid policy, which involved mass testing and strict quarantine measures to prevent outbreaks of the virus. These strict measures resulted in low infection and mortality rates due to public cooperation and top-down authority involvement. Despite its effectiveness, many citizens expressed discontent with these restrictions, which were drastically impacting their livelihoods. These negative attitudes toward the Zero-Covid policy and the strict lockdowns undermined people’s confidence in the government. The abrupt abandonment of this policy in December 2022 also led to a surge in infections, strained medical resources, and further decreased the public’s trust in the government, health authorities, and health resources.

China’s public health system significant improvements in providing equitable and accessible public health services to its citizens. The government has also helped to develop an effective health service delivery system and increased investment in public health services. Although positive progress has been made in the prevention and control of infectious diseases in the country, problems within the public health sector need to be further improved and strengthened.

There was a significant decline in public confidence in the government and public health services during the Covid-19 pandemic, with local governments experiencing a more pronounced erosion of trust. These shifts in public trust were closely tied to public perceptions of the government’s handling of the situation. “The government’s responses to significant crises such as this pandemic, especially in the current digital era, may exacerbate the trust gap between central and local governments”. This mistrust was exacerbated by the public health workforce who were underfunded and ill prepared to handle this health crisis. Thus, better funding and training are necessary so that they can help with diagnosing, reporting, and managing of infectious diseases.

To improve public trust in the government and health professionals during these health crises, social media platforms should be more frequently utilized to disseminate accurate information, promote health guidelines, and promote pubic engagement. Health authorities and professionals should use these platforms to communicate with the public on health policy and prevention measures for infectious diseases such as the current outbreaks of Human metapneumovirus (HMPV). Social media health campaigns can help improve public support and social trust. Efforts should also be made to enhance social support networks, such as community groups, neighborhood associations, which can provide “emotional support, practical assistance, and information, further boosting public health participation”.