This episode of the Matrix Podcast features an interview with Yan Long, Assistant Professor of Sociology at UC Berkeley who focuses on the politics of public health in China. She was formerly an Assistant Professor of Sociology at Indiana University and a Postdoctoral Fellow at the Stanford Center for Philanthropy and Civil Society. She obtained her PhD at the University of Michigan and her master’s and bachelor’s degrees at Beijing University.
Matrix Social Science Communications Scholar Jennie Barker spoke with Long about her forthcoming book, Authoritarian Absorption: The Transnational Remaking of Infectious Disease Politics in China. In the book, she examines how foreign interventions aimed at tackling the HIV/AIDS epidemic in China in the 1990s and 2000s affected the Chinese public health system, government, and society both in ways that the interventions did and did not intend.
Jennie Barker: Hello, and welcome to the Matrix Podcast. I’m Jennie Barker, your host, coming to you from the Matrix office on UC Berkeley’s campus. Our topic today is public health in China. Since the onset of the COVID-19 pandemic, what affects when and how a government responds – or does not respond – to public health crises has been a pressing question for policymakers and beyond. For example, does the regime type of the government, such as whether it is a democracy or autocracy, matter in how it responds? Does the ideology of the government matter? Does it matter what resources the government has?
This big question is one that our guest today, Yan Long, is addressing in her forthcoming book, Authoritarian Absorption: The Transnational Remaking of Infectious Disease Politics in China. In the book, she examines how foreign interventions aimed at tackling the HIV/AIDS epidemic in China in the 1990s and 2000s affected the Chinese public health system, government, and society both in ways that the interventions did and did not intend.
Yan Long is an Assistant Professor in the sociology department here at UC Berkeley. She is coming to us from Indiana University, where she was an Assistant Professor, and the Stanford Center on Philanthropy and Civil Society, where she was a postdoctoral fellow. She holds a joint PhD in Sociology and Women’s Studies from the University of Michigan, and a master’s and bachelor’s degree from Beijing University. Welcome, and thank you for coming to our podcast.
Yan Long: Thank you very much for this opportunity to be here and to share my research a little bit.
Barker: Let’s start our conversation today by getting into the developments in global politics that set the stage for your study of public health in China. In your book, there are two parallel developments that you focus on: the first being the rise of foreign aid from Western governments, and the second being HIV/AIDS activism going global. Can you speak a little bit about the origins of these interventions from foreign governments in general, and how HIV/AIDS became a big focus for these interventions?
Long: This is actually a quite complicated question. The foreign interventions in China happened as global health took the stage and entered the political agenda of international relations in the late 1990s. There were three things happening at this time.
One of the things is that, since the 1980s, there has been an increase in transnational governing rules and norms that really forbid, permit, or require particular kinds of government regulations or governing arrangements in different areas. Nations no longer enjoy the ultimate authority in certain areas, such as finance, security, food, urban development, labor, gender, and human rights. That has been a general trend outside health. Even till the 1980s, however, global health was so marginal. People did not think of health as important.
At the time, there was also another very important shift, which is that development banks like the World Bank started to think that global health was important. It’s important that financial institutions started saying that health is actually really important for development. If you want to establish overseas markets, if you want economic development, you need to have health first.
When it comes to HIV/AIDS, it wasn’t until the late 1990s when the United States started to take an interest. This began under the Clinton administration who eventually became convinced that HIV/AIDS was a security threat, although it had been going on in Africa for a long time. The US government was convinced that this required intervention. It began to lead this campaign to put HIV/AIDS into the Millennium Development Goals. HIV/AIDS was the first disease that was put on the political agenda. China and Russia were very much against this politicization of a disease, but the US had made up its mind. This continued with the Bush administration, which started the US President’s Emergency Plan for AIDS Relief (PEPFAR). This was when the US government began to assume the leadership in global health.
A third thing was happening in the background. In America, many of you probably know that San Francisco was the center of HIV/AIDS activism in the 1980s, when the US government was not going to intervene in the “gay” disease. American activists, especially gay activists, came to play a very important role in global HIV/AIDS activism. They were also the ones who worked with activists in the Global South, such as those in South Africa, to really put HIV/AIDS on to the political agenda. This is very important. It wasn’t just the US government suddenly saying that HIV/AIDS was important. There was a decade of bottom-up efforts from activists to push it on to the political agenda.
Barker: Thank you so much untangling that complicated question I asked you. As you document in your book, foreign interventions in China focused particularly on HIV/AIDS activism. Why did China become such a focal point for this type of activism, and this type of intervention?
Long: I’m going to tell a very cynical version of this story. First of all, AIDS activism didn’t originate from inside China. In the 1980s and 1990s, there were some sporadic efforts in China to push for HIV/AIDS activism, but they were not successful. Things took a turn in 1999 when the US Embassy in China began to investigate the HIV/AIDS pandemic in China. China’s largest HIV/AIDS outbreak had taken place in the early 1990s. The outbreak was very specific to China because it was caused by blood contamination in the commercial blood donation sector. The outside world certainly knew about that outbreak, but nobody really took an interest until the US Embassy began its investigation and launched a campaign shaming the Chinese government for not taking any measure against HIV/AIDS.
Another development at the time was a fear that China and India could experience an HIV/AIDS outbreak similar to that in Africa. It was viewed as a major security threat to the world. There were also new organizations, such as UNAIDS, that really needed a target. They needed to demonstrate that HIV/AIDS is very important and that China was not doing anything. There was an agenda, so they did exaggerate the sort of scope of the impact of the blood contamination issue in China. China provided the target. The SARS outbreak in 2003 certainly also emphasized the kind of crisis around public health in China. It’s reasonable to think that it would be a disaster if the HIV/AIDS pandemic happened in China because of the huge population. There were a lot of organizational and political interests behind these kinds of interventions.
Barker: What were some of the changes that these foreign actors wanted to see in China in terms of its public health and how it was approaching the HIV/AIDS epidemic?
Long: In terms of particular strategies, various international organizations and Western governments used typical blaming and shaming strategies. Foreign media began to blast China, mostly the central government, for not taking any measure against the HIV/AIDS epidemic – rightfully so. China had a long history of public health policy as part of the socialist legacy before the 1970s. However, during the 1980s, China pretty much gave up on public health. Compared to economic development, it was no longer important. Public health was pushed to the margin of the policy agenda. Throughout the 1980s and 1990s, there was a collapse of public health institutions in China. So HIV/AIDS was just one part of a lack of infectious disease control.
In China, there was denial of the HIV/AIDS epidemic. It was actually very similar to what we observed during the early phases of the outbreak of COVID-19. Not just China but also many other countries denied the existence of the pandemic. Similarly, China did not want to inform the people who were infected by HIV/AIDS. Many, many people in my research didn’t find out about their HIV-positive status until 10 years later. There was no effort put into HIV/AIDS.
In the early stages, the major target of foreign actors was to get the Chinese government to invest in public health, the need for which was amplified by the SARS crisis. These actors called for the government to pay attention to public health, but they also provided technical expertise and funding to help China. So there was definitely socialization but also substantial help to assist China in this area.
Barker: As you note in the book, this new mode of public health through foreign interventions really clashed with how public health was traditionally dealt with. In most states, including in China, the government was the main actor in setting the public health agenda. Can you explain this clash?
Long: When the concept of public health was proposed back in the 18th century, the idea was that public health was the responsibility of the state. In this view, health, disease surveillance, and prevention usually are considered to be things that help the state to exercise and expand its power over people and their bodies. It is really an exercise of control. This is why we saw a lot of debates around mask mandates and quarantine during the COVID-19 pandemic. There is the freedom of the people versus control of the state. Public health is also a domain to establish social contract between the state and its citizens. When the state delivers public health goods, it is supposed to be the foundation of citizens’ rights claims.
Foreign interventions into public health can then be seen as a breach of the social contract between the government and the people. For example, in my research, one security officer wondered that if China allowed international foundations to come, or if foreigners gave money and delivered all the public health goods to the people, then they’re going to listen to them instead of the Chinese government. What is at stake, I would say, is sovereignty. It is a concern of national security. This is fundamental about foreign interventions in public health. I think a lot of political scientists have already discussed how these kinds of public health projects in Africa would damage the authority and capacity of national governments.
Additionally, there is a difference between what the Western world considers a public health intervention versus the Chinese tradition. These types of clashes also exist. China certainly had its own socialist tradition. As I already mentioned, in the 1980s and 1990s, public health was very much marginalized. At the time, China created what I call the “socialist contagious model,” which pretty much relegated infectious diseases to the realm of defending socialist moral boundaries. Infectious disease was viewed as a morality problem rather than a welfare problem. Health departments would just improvise emergency measures, rather than develop systematic expertise and technical knowledge of public health responses. There was a lot of anti-professionalism in public health at the time; departments relied on grassroots mass-mobilization.
Then there is the Western model. First, the model emphasizes decentralization; the central government no longer has the ultimate authority. It also emphasizes equal partnership between the state and non-state actors, mostly nonprofit organizations or civil society groups. It also emphasizes the delivery of technical intervention, and measures of quality or performance became really critical.
A major difference not just in China, but also in a lot of Latin American and African countries, is that public health interventions were delivered as a set of projects. There were many campaigns. It was no longer a coherent system of public health defense; it became a rather very fragmented patchwork of projects aimed at supposedly achieving very specific short-term goals. There was an emphasis on the return on financial investment poured into the project. So there were two sorts of clashes: one about the sovereignty of the state and the other about the actual content of the interventions into public health.
Barker: I think this is the great puzzle in your book. There are other states such as Russia that really resisted this type of intervention from foreign actors into their public health sector, particularly with their response to HIV/AIDS. Like some of these states, China has a strong government. So why didn’t China resist this foreign pressure? Why didn’t China take the path that Russia took? Why were there these profound changes in public health administration in China as a result of these HIV/AIDS interventions?
Long: That’s a great question. One thing I want to emphasize is that this was not a calculated decision made at the very beginning. People tend to think that the Chinese government is so smart and sophisticated, but no, it was not decided at the very beginning.
There are several reasons why China didn’t resist. First of all, again going back to the SARS crisis in 2003, China definitely faced much more international pressure compared to any other authoritarian regimes. That’s one thing. But why not just window dressing? Why not just make some temporary measures and afterwards go back to the prior way of doing things?
There are two factors I highlight in my book. One is that transnational health organizations were very successful in cultivating social movements in China. They put in a lot of funding and training into Chinese HIV/AIDS activism. They also worked a lot to remove the stigma around HIV/AIDS, which was very effective in terms of mobilizing people infected with HIV/AIDS. As I mentioned, there was a time when the Chinese government didn’t want to respond to HIV/AIDS, but, at the same time, people who were infected didn’t want to acknowledge that they were, either. There was silence on both ends. These international interventions really helped to encourage people to rise up because of the problems they were facing and assert their rights and claims. The international dimension provided the impetus to sustain the pressure on the Chinese government. That didn’t happen in many other countries.
Then the second thing is that, although people tend to think that China’s government is wealthy, this is not the case for everybody, especially specific bureaucrats. Public health officials and their pursuit of a professional identity were a driving force in China embracing foreign interventions into HIV/AIDS. When we think about a state’s reaction to foreign pressure, we tend to think of it as coherent, for example that Iran would have a certain reaction or North Korea would have a certain reaction. In reality, when you look beneath the regime, there are different departments and organizational agencies that have very different ways of pursuing their goals and getting resources. The Communist Party in China did have this vigilance against foreign influence in the 2000s, especially because of the Orange Revolution in Ukraine and the other color revolutions in Europe. The party was very unhappy with interventions, but the public health departments in China really welcomed the material resources, the legitimacy, and most importantly, the technical knowledge and professional training from these interventions.
People probably do not know that the Chinese Center for Disease Control (CDC) was not founded until 2002, and it was modeled after the US CDC. Chinese public health professionals really worshiped the US model for a very long time, at least until 2013. The marginal position of public health within the bureaucratic system in China made those officials particularly interested in the material rewards as well as symbolic capital of being accepted into this global public health professional community. They were really the driving force in terms of welcoming and embracing foreign money and models.
One thing that has shifted since 2013 is that the Chinese government began to realize that China was actually quite good in public health interventions. It became an area associated with international power and prestige. In the beginning, it was the United States who was telling China that HIV/AIDS was important, but after 2013, the Chinese government was saying that HIV/AIDS is important. It has become part of its political identity, which you can see very clearly during the COVID-19 pandemic. The government wanted to show that it was powerful and a responsible superpower that is much better than the US because it can do a better job in countering infectious diseases. Infectious disease control, including of HIV/AIDS, has become part of the political status of China and something that can show its high standing in the world. Infectious disease control has also been a part of the Belt and Road development project; China has begun to export its own HIV/AIDS intervention model into Africa. It has come full circle.
Barker: Coming from a political science background, what you’ve just said makes me think of the research that came out about vaccine diplomacy. During the COVID-19 pandemic, we saw countries such as China and Cuba that were developing their vaccines as a way to demonstrate the strength and capability of their public health system.
Barker: As you just very thoroughly discussed, China did engage with these international actors on HIV/AIDS quite deeply. These foreign actors, including Western governments and organizations, expected that these interventions could bring about a more liberal population. But that didn’t exactly happen in China. You develop a term for this in your book, which is “authoritarian absorption.” What does authoritarian absorption mean, and how did it play out here with the HIV/AIDS interventions?
Long: Usually when we look at international interventions, we scholars tend to think they often fail, and this happens a lot. What happened in China was a surprise to many people, including me. The democratic interventions were very critical from the very beginning. For a very long time, HIV/AIDS was seen by many people as an area where you could cultivate democratic behaviors in China, such as participating in elections or community mobilization. However, these types of democratic intervention techniques can be absorbed by government agencies into the state apparatus for different purposes.
By using the term authoritarian absorption, I’m emphasizing two factors. One is that intervenors can train and cultivate social movements to carry the transnational materials, symbols, and various practices into a domestic context. But then, secondly, the government could have the skills to channel the same social movements in ways that basically repurpose those elements for authoritarian goals.
Because I am a Star Wars fan, I often use this analogy. I think this is pretty similar to how the Jedi trained Anakin Skywalker, and then he became Darth Vader. This is authoritarian absorption.
I do want to emphasize that although international interventions often failed to strengthen public health systems in places in Africa, they were very successful in China. Even though eventually the public health system has come to serve the political purposes of amplifying authoritarian control, I would still consider these international interventions to be successful in many ways.
Barker: Yeah, definitely. To some degree, this absorption of these interventions was brought about by the Chinese government and by the local health agencies. In your book, you also discuss how this absorption was enabled by the practices of these foreign intervenors. You have a great quote about the attitudes of these organizations: they would always say can we get the same results for less money? This was a huge focus of these organizations that were giving resources and funding to local health agencies in China. Can you explain how these foreign actors enabled this process of absorption?
Long: I really love this question. When we think about the expansion of an authoritarian world, we tend to think of terms such as authoritarian resistance. We tend to think that it always comes from the authoritarian side. But the fact is that the game, especially when it comes to international development, was set up by the Westerners.
International organizations often rely on two types of authority, especially in the area of public health. One is what we call principled authority, which is using political morals and values, such as freedom, democracy, and human rights. However, international organizations have decreasingly relied on this type of authority. They have turned to another type of authority, which is expert authority based on specialized knowledge of managerial science and epidemiologic engineering. This is when quantitative measures of quality come into play; you must have a good return on your financial investment.
Thus on the international side, there is this tension between promoting democracy and focusing on how many interventions can be done given this amount of money or how short term goals can be met as quickly as possible. This type of shift is especially beneficial to players such as China. Authoritarian governments are very good at playing the numbers game. If you want a number or quantitative measures, these types of governments are incredibly good at manufacturing good numbers; they have a strong capacity for mobilization. This type of game plan helps authoritarian governments rise to the top because the game is set up for them. It is partially because Chinese governmental agencies are very good at adapting. But it is also because the game is set up in this way, so you cannot blame them for playing it.
Barker: As I was reading, I was thinking that we can see this push for quantification of results in a lot of different areas as well. The area that I am most familiar with is democracy aid given to civil society organizations. You can also see there the push to have results privileges some organizations over others, and the organizations that may be most effective at actually doing the things that the donors want are the ones that may not have the same capacity to adapt to having these measurable outcomes. There may be a lot of soul-searching that these international organizations need to do.
One of the impacts of this push for quantification in the HIV/AIDS movement in China is that urban gay men’s groups became the primary beneficiaries of these interventions. This is also a puzzle that you put forth in your book. Why would these urban gay men’s groups be the main beneficiaries, even though male-to-male HIV transmission is actually quite low relative to other forms of transmission in China and, as you note, there is also a long history of homophobia in the country? Why were these groups able to become so active?
Long: It was really a very long-term, historical process. When I first started my fieldwork in 2007, victims of blood contamination were certainly at the center of the movement against HIV/AIDS because they were also the ones who attracted foreign interventions from the get-go. Their death and suffering at the time provided evidence of human rights violations in China for these foreign interventions.
However, victims of blood contamination struggled amid the push for quantification. These victims, who came from rural areas as that was where blood contamination occurred, already experienced a lot of suffering and struggling with the disease and were not very good at producing quantitative measures or achieving the kind of performance compared to the HIV-negative gay men activists in urban areas. In the urban areas, not only were gay men’s groups very effective at producing quantitative results, they were also at an advantage to collaborate with the government.
China became really successful at public health interventions with HIV/AIDS, largely because of the assistance provided by gay men’s groups. These groups helped China to consistently put forward better and better results, which helped the Chinese government to secure more international projects and to project this very successful image of public health intervention. China was able to provide this collaborative model of civil society and the government, which they call the harmonious civil society intervention model. This serves as a counter to the Western civil society model, which entails opposition between civil society and government. Working with these gay men’s groups helped the government to say, no, we can work together. And then this model was exported to Africa. This has certainly helped the gay men’s organizations.
This has also given the government real leverage to repress rural activist groups without political backlash. With their support of gay men’s organizations, they seem more liberal and can show that there is an active civil society in China. I have a separate paper, published at American Journal of Sociology, that talks specifically about how this kind of divide-and-conquer strategy really helped authoritarian governments to shield their own actions from international attention and pressure. This process worked out in a way that was not initially intended or anticipated by anyone.
Barker: You open the book with an illustrative case about these different trajectories of the two groups. One of the activists who you met at the beginning was a member of one of these urban gay men’s groups, and another activist was a leader of a rural blood contamination group. They both benefited from the space that was brought by these foreign interventions, but they ended up in quite different places. I think this is helpful to illustrate what you just explained. On the one hand, you had these groups that were working in a harmonious way. And on the other hand, you had these groups that were repressed and pushed to the side. So could you talk a little bit about these two activists and their different endpoints?
Long: I should go back a little bit and talk about the history of these gay men groups versus victims of blood contamination. As I mentioned earlier, the largest HIV/AIDS outbreak in China took place because of blood contamination. Gay men did not attract any attention from public health departments for a very long time because of strong homophobia among public health officials.
When I started doing this research in 2007, I met several groups of activists. One group was the victims of blood contamination. This group has two components. The first are people who sold their blood. For example, I met a farmer who used to sell his blood in the 1990s. He started selling blood in 1994 and stopped in 1995. Around 70% of the male adult population in his village were selling their blood for money. He got infected, but he didn’t find out about his HIV-positive status until the end of the 1990s when people in his village started to die. Eventually, 30% of people who were infected died of AIDS or other infections or committed suicide. There was a wave of deaths in his village while the government pretty much denied the pandemic even existed.
The second group of blood contamination victims were mostly women, who had been encouraged by doctors to use blood products, mostly during reproductive surgeries. One woman I met named May got infected at a hospital in 1995. She then infected her baby daughter during breastfeeding, but they never realized what was wrong with the baby. She went to the hospital again and again until 2004, when the virus infected her daughter’s brain. This was the girl’s ninth birthday, and two months after that, she passed away. May found out she was HIV-positive and that her daughter was HIV-positive, and then her daughter died. By the time she found out, she had already infected her second daughter.
Then you have gay men activists. Most gay men’s activists at the time were HIV-negative. They were using HIV/AIDS mostly as a way to come out and to do activism because it was super dangerous, and they did not have the space to really just push for their claims and for their rights around homosexuality. They were super marginalized.
I tracked those two groups in the following 11 years and began to see a divergence. They used to work together between 2007 and 2009, but then there was more and more conflict between both groups, especially as gay men’s groups became endorsed not only by the Chinese government but also by Western foundations and media. By 2012 and 2013, gay men had already become the face of HIV/AIDS activism. They were publicly endorsed by the Chinese government. They became part of this model of harmonious civil society collaboration. Blood contamination groups didn’t have enough support from other parties, and so their movement began to die out and pretty much ceased to exist in 2015. But gay men’s groups are still very active up to this day. These are the different paths of these two groups.
Barker: One of the points that you make in your book that I want to draw out here is that supporting social movements and civil society is not a wholesale good. There are ways that inequalities can be reproduced. In this case, there were these urban groups where people are maybe more middle-class and educated. Even if there’s a lot of homophobia in the country, they may be able to take advantage of these opportunities in a different way than people who are more rural, maybe less educated, and facing gender-based inequalities. You refer to this as the dark side of collective action, which I think is really fascinating.
Long: Thank you.
Barker: To conclude our discussion on this particular topic, as you were following these gay men’s groups, were you able to see what they thought about the fact that they had become the face of the movement, while these other people who were also suffering from HIV/AIDS had fallen away? Did they worry about it at all, or were their attitudes more about the need to make do with what they had?
Long: Coalitions are always difficult for social movements around the world. It doesn’t matter what you do. It takes effort to build.
There was a time in the early to even the mid-2000s where there was a lot of Western funding to help cultivate a coalition and solidarity. I do not think this divergence was intended or planned out with one activist group pushing another one to the side. It was really a process. From the very beginning, there was a division in terms of their relationship with the Chinese government and how they approached their activism because they were using different sources of Western funding. For example, Western NGOs tended to collaborate much more with the victims of contaminated blood. The US government was much more involved with that group compared to the gay activists. Gay activists were mostly working through the public health route in terms of participating in projects, particularly with UNAIDS.
The trend towards quantification made many activists in gay men’s groups accept the idea that if they can push out more quantitative results, they were just better; they could perform very well. They accepted this type of language and discourse. It made them think that, since they could produce more results, that must mean they are better than those peasant groups and that there must be something wrong with them when they cannot just show the return on the financial investment. It created this kind of a hierarchy, which masked a lot of other factors you mentioned, such as class and who had the advantage when interacting with Western organizations. Urban organizations do; it takes rural organizations forever to even go to the city where these Western organizations are. However, when you think your success is only viewed by your own performance, you think other people’s failure is due to their poor performance; you don’t think of it as something else.
The beauty of longitudinal ethnography, which I conducted, is that at a time, you really do not realize a lot of the consequences often show up and appear several years later. I was very much consumed with the different fights among activists and didn’t realize that there was corruption going on and there was state intervention going on. I did not realize that until several years later, but by that time, the coalition was already damaged. But I do not think it was intentional.
Barker: I want to shift gears a bit to the takeaways from your book. What we just discussed was that this coalition breakdown was not intentional, but impacted by all of these different actors over time. One important contribution of your book is offering a much more nuanced view of these transnational interventions. It’s not just a static, one-off thing that happens. There are these downstream effects that you might not have even seen happening, or intended to happen, or even could have foreseen at all. Where do you see the field of research on transnational interventions going? Where would you like it to go? What issues do you think are important to keep in mind for scholars who are interested in this type of work?
Long: I think this is probably a very dark time for us because we’re not talking about global engagement; we’re talking about disengagement.
I think many of my colleagues might not agree with me, but I do think foreign interventions need to keep happening. Despite my focus on these side effects of interventions into HIV/AIDS, one of the major takeaways from my book is that these interventions were pretty successful. Just imagine what could have happened in China during COVID-19 without all of the public health infrastructure and capacity that these HIV/AIDS interventions had put in place. COVID-19 could have gone through a population of 1.4 billion people, a huge disaster for the world. However, now China is becoming very much excluded from the public health discussion in the United States. I think this disengagement is very disheartening. From that angle, I will just say that transnational advocacy is great, even though it has problems.
The second takeaway is that I do think we need to pay more attention to the organizational dynamics on the ground as research moves forward. In the past, we paid a lot of attention to political ideology, other political aspects, and economic aspects, but we haven’t paid enough attention to the fact that all the actors on the ground are organizations: they have their limitations, they have their resources, and they have their goals. We need to think about those types of factors and then think about whether it makes sense. For example, if you look at UNAIDS, they were the biggest critic of China twenty years ago, but nowadays, they’re just praising China left and right. What you need to understand is this is not just politically motivated. There are many reasons behind that.
The third takeaway is that this is also an exciting time for transnational advocacy study. In the past, we were very used to the story of how the Western world was providing assistance to the poor activists in the Global South. Nowadays, Brazil, India, and China are very invested in the new term of “development diplomacy.” There are new actors on the horizon: how are they going to affect the landscape and the future of transnational advocacy? I think this is really exciting. But of course, I’m also worried because in the past, it was much easier to just criticize this advocacy as Western imperialism or liberal hypocrisy. Now there are different actors who are authoritarian. What’s going to happen next? I think it will be much more complicated down the road.
Barker: I’d like to conclude with a question that you just briefly touched on in your response there, which is what would have happened during COVID-19 had this infrastructure not been put in place to help with the HIV/AIDS epidemic? Let’s talk about the COVID-19 of it all. How can your book help us understand how China fared during the COVID-19 pandemic, which is a question still at the top of everyone’s mind?
Long: COVID-19 has posed a lot of challenges for me. I had to really think very deeply about whether the argument I put forward in the book still stands. I would say that when you look at COVID-19, you can see a lot of the techniques that China had learned through HIV/AIDS programs worked really well. One of the major factors was Dr. Wu Zunyou. He was the Director of the National Center for AIDS, STD Control and Prevention from 2005 to around 2017, and then he became the chief epidemiologist of China’s CDC and thus the Chinese version of Anthony Fauci during COVID. That gives you some sense of how important the HIV/AIDS interventions were to China’s response.
I totally understand why people complain about China’s response at the very beginning of the pandemic when China was performing really terribly and made so many mistakes. But again, China’s CDC did not even exist until 2002. In my research, I saw that a lot of public health officials did not even have a basic sense of project management or accounting – really basic managerial practices. We’re talking about a bureaucracy that has been learning actually rather quickly over a period of less than two decades. From that aspect, I would say China has really come a long way.
We also saw community mobilization during COVID-19, which was imported into China as a big component of the HIV/AIDS interventions. During COVID-19, the traditional socialist mass mobilization model was replaced with community mobilization; volunteers and community organizations played critical roles in COVID-19 surveillance. This is another legacy of the HIV/AIDS era.
Overall, I would say COVID-19 showed that China has really come a long way in terms of building up bureaucratic infrastructure and a professional force capable of dealing with infectious diseases. In that aspect, I would say that foreign interventions into HIV/AIDS have done an incredible job. And of course, China has also performed really well because a similar process occurred in many other countries, but didn’t have the same result.
Barker: Thank you so much for joining us today. This was a tremendous discussion about a really important topic. Speaking for myself, I’m very glad we have people like you working on these important questions. So thanks again. That’s it for today.
Long: Thank you.