China has largely controlled COVID-19. A country of 1·4 billion people and a size similar to Europe or the USA now reports only clusters of cases rather than widespread community transmission. China has been widely criticised for its role and responsibilities during the pandemic because of censorship, transparency, and human rights concerns. But the rest of the world can still learn from China's successes in bringing its outbreak under control.
China's response shows the importance of domestic research and public health capacity. Huge investments have left China much better prepared for COVID-19 than for severe acute respiratory syndrome (SARS). When SARS broke out in 2002, China was unprepared initially, especially as the pathogen was unknown. When COVID-19 emerged in December, 2019, Chinese scientists were quickly able to identify the virus and shared genomic sequencing data internationally on Jan 11, 2020. By the end of January, doctors from mainland China and Hong Kong had characterised the clinical features of patients with COVID-19, person-to-person transmission, genomic characteristics, and epidemiology, warning the world about the threat of COVID-19 with research papers published in The Lancet. China has also been at the forefront of vaccine research, with promising results of early trials of a recombinant adenovirus type-5-vectored COVID-19 vaccine developed in China published in The Lancet in May and July. Such research was done incredibly fast and rigorously through close cooperation within China at a time of national emergency. For other countries, particularly low-income and middle-income countries, China's experience shows the importance of investing in national health and research systems to enhance laboratory capacity as well as workforce. They are fundamental to a quick and effective national response to health emergencies and to global health security.
A second lesson is that a robust foundation of research cannot guarantee effective control without strong top-level political commitment to use science to tackle the outbreak decisively. Governments and their leaders must respect science, understand its value, and act on it in a way that is best for society. China's National Health Commission sent three groups of national infectious disease experts to Wuhan at the beginning of the outbreak to investigate the risks and transmission of COVID-19, and their recommendations informed the decision to lockdown Wuhan on Jan 23. When Chen Wang, president of the Chinese Academy of Medical Sciences, and colleagues saw the need for Fangcang shelter hospitals, the government was quick to respond.
Third, achieving rapid and effective implementation of control measures for COVID-19 requires broad community engagement. Community solidarity has been unprecedented during the COVID-19 outbreak in China. Control measures that could sacrifice individual freedom, like mandatory mask-wearing in public areas, were accepted readily by the public. Millions of China's community workers have “built the first line of defense against COVID-19”, according to Xinhua News Agency, in their work to provide essential health checks and support for people with fever, severe diseases, pregnant women, and those quarantined at home. There are tensions between freedom and security that each country has to reckon with, and some of China's approaches to surveillance, for example, would not be acceptable elsewhere. But China's experiences show the importance of community solidarity and what it can achieve.
So, there are lessons for health to learn from China. But how will Chinese and global health communities work together in the future? China's Foreign Minister Wang Yi has said that globalisation needs to be more inclusive and beneficial to all, that multilateralism must be safeguarded and promoted even more firmly, and that global governance needs to be reformed and improved where it is most lacking. The health community is waiting to see if China will become a multilateral leader in global health, what role it wants in international global health security, and whether it will aspire to fill the vacuum in global health left by the USA.
China is facing legitimate questions in many areas of its domestic and foreign policy, but when it comes to COVID-19, scapegoating China for the pandemic is not a constructive response. “Now is the time for global leaders to decide: will we succumb to chaos, division and inequality? Or will we right the wrongs of the past and move forward together, for the good of all?”, as UN Secretary-General António Guterres asked in his 2020 Nelson Mandela Annual Lecture. Tackling a global health emergency like a pandemic requires open collaboration. The lack of global solidarity to address COVID-19 amid geopolitical instability is a threat to us all.
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