This article comes from WeChat public account: cultural aspect (ID: whzh_21bcr) , herein as a” cultural aspect “feature articles, author: Gu Xin Institute of Social management, Zhejiang University
[Introduction] The occurrence of the new crown epidemic has exposed many loopholes and shortcomings in China’s disease control system, especially the early warning mechanism for diseases. In response to this phenomenon, a popular statement recently is that the status of the CDC is too low, and the status of the CDC should be improved through re-administration. The author of this article points out that the root of the problem is to properly handle the relationship between the administrative mechanism and the community mechanism. “The question that should really be reflected is not why the CDC does not have administrative power, but why institutions with administrative power do not exercise administrative power better. , Including granting certain technically powerful administrative powers to the CDC. “The author believes that independence is the most valuable feature of a professional institution and a scientific community. The direction of reforming the disease control system in the future is not to create another administrative organization, but it should be de-administrated. It needs to ensure the authenticity and transparency of the public governance system, and let the community governance work to properly handle professional independence. And the political nature of decision-making.
Creating a Qualified “Gatekeeper”:
Three relations in the governance reform of disease control system
The outbreak of the new crown pneumonia epidemic is now beyond expectations of many people. Recall that on January 20, when the state included neo-pneumococcal pneumonia into the list of statutory secondary infectious diseases and started national emergency management according to primary infectious diseases, few people would have expected the situation today. At that time, a foreign research team established an epidemic prediction model based on public case data, which showed that the number of confirmed patients may be as high as 5,000 in the future, and this prediction was scoffed by the domestic epidemic prevention and control experts at the time, saying that this number was only a high prediction interval It’s just that.
I am afraid that rare Zhuge Liang is Guan Yi, a foreign academician of the Royal College of Medicine and a virologist at the University of Hong Kong. On January 23, Wuhan implemented the “cities closure” measure, but Guan Yi said in an interview with Caixin.com, “The epidemic situation is no longer under control in Wuhan. Everyone must be a deserter “, which has caused a sound of irony and criticism in the online world of Mainland China. In fact, in this interview, Guan Yi made a judgment that the epidemic is more serious than SARS and that the scale of infection “may be 10 times the jump of SARS.”
By the end of the atypical pneumonia epidemic on August 16, 2003, a total of 5,327 SARS-diagnosed cases were reported in mainland China, including 349 deaths; however, by February 28, 2020, the author wrote this article At that time, 78,632 confirmed cases of new coronary pneumonia and 2747 deaths were reported in mainland China. However, Guan Yi’s judgment on the infectivity of the new crown virus did not cause a positive response from the Internet public at the time, but was criticized as “nonsense” along with his “destroyer” self-deprecation, and some netizens questioned him as a virologist It is not the professional authority of the epidemicologist to judge the infectivity of the virus.
It can be seen that in public perception, the authoritative judge of whether any kind of disease is contagious or not, from person to person, should be an epidemiologist. Epidemiologist is a non-professional term. In technical terms, it should be an epidemiologist, and an epidemiologist belongs to a subclass of public health scientists.
So, among the epidemiologists in mainland China, (hereinafter referred to as “China”) , why did not the prophets like Guan Yi, What about the alerter, or the whistleblower? In fact, it is not only the lack of early-warners. Even for the changing trend of the epidemic, domestic publishers are scarce. Several research teams abroad have established a variety of models and published a variety of forecasts, and some research teams have never been involved in Chinese research.
However, we rarely see Chinese epidemiologists release predictions, just a handful of mathematical modeling enthusiasts sporadic self-media through media. To this day, countless media, both traditional and new media, are keen to investigate when the inflection point of the epidemic will occur, and they are often questioned by clinical medical experts, such as Academician Zhong Nanshan. A team led by Academician Zhong Nanshan is also engaged in one of the professional work of epidemiologists across the border, that is, to simulate and predict the epidemic situation of new coronary pneumonia through mathematical modeling.
To the point where the epidemic has developed to this day, there have been many reflections and critiques of Zhuge Liang afterwards. Although the current control of the outbreak has beenTo no avail, but this kind of retrospective Zhuge Liang-style reflection is still beneficial to the people, the country, and the nation. Only by reflecting deeply and putting the results of reflection into practice can our country avoid a second mistake in the future.
Among them, one of the focal points of reflection is the epidemiologist, especially the important meeting point of epidemiologists-China’s disease control system. Despite divergent opinions, there is a consensus that is converging. That is, in the face of a “big test” of the national governance system and governance capabilities, the results of the disease control system are beyond par, especially in the early warning field. The disease control and governance system and governance capability are undoubtedly an integral part of the entire Chinese national governance system and governance capability, and are of vital importance for the management of sudden outbreaks. In short, if the epidemic control is likened to a palace group (such as the Forbidden City) , the disease control system should play a good role The role of “gatekeeper”. Now, in the epidemic of new crown pneumonia, the goalkeeper has conceded more goals.
The road to modernization of China’s disease control system governance system and governance capabilities seems to be a long one. Nevertheless, we must not falter. When the state and the nation are paying a heavy price for the control of the new crown pneumonia epidemic, we need to postpone Zhuge Liang’s reflection on the public governance of the Chinese disease control system. It is still urgent. This reflection involves many dimensions and countless historical events, which cannot be discussed in this article. Due to space limitations, this article can only focus on three major relationships, and the treatment of these three relationships runs through all aspects of the improvement of the disease control governance system and the improvement of governance capabilities.
I. The relationship between capacity building and governance reform
The disease control system is in a crisis of trust. The call to rebuild the disease control system and pay more attention to the construction of the public health system has been heard. Appealers are not limited to public health experts, and there is no shortage of outside the medical and health community. Heavyweight celebrities. In fact, the call for attention to public health did not appear after the outbreak of the new crown pneumonia epidemic, but for the old talk for many years. For example, on May 18, 2014, Zeng Guang, the chief expert of epidemiology of the Chinese Center for Disease Control and Prevention, called on the “China Public Health Emergency Management Top-Level Design Seminar” that the next wave of medical reform should be public health reform. In this way, in the field of public health, China can realize the transformation from national disaster relief to national defense disaster. Today when the country fights against the “epidemic”, looking back at the call of Academician Zeng Guang about six years ago, we can still feel the hardship of the country against the “epidemic” without sacrificing the results of the national defense epidemic.
In health care, public health is not importantFor example. Among the sounds of reflection on the CDC, there is a particularly prominent point that the reason why the CDC is not effective is because of its low status, and the suggestion to change this pattern is to make the CDC an administrative agency, or Have at least some administrative power. Even Academician Zhong Nanshan, who is not a public health scholar but a non-epidemiologist, has screamed for this. However, this proposal does not take into account the basic fact that the CDC does not equal the CDC.
In fact, there are agencies with administrative responsibilities in the disease control system, that is, the disease control departments in the health and health committees, which are at the bureau, department, and departmental levels among the health administrative departments at all levels. If there is some kind of administrative failure in the CDC administrative department in the treatment of the new crown pneumonia epidemic, then the question that should really be reflected is not why the CDC does not have administrative power, but why the institutions with administrative power do not exercise their administration better. Powers, including the granting of certain technically administrative powers to the CDC.
Academician Zeng Guang believes that the CDC is a technical support organization for decision-making and is equivalent to an “intelligence department.” This positioning is very precise. Intelligence work is not the same as decision-making. Decision-making must depend on accurate intelligence. The accuracy of intelligence depends on professionalism, and professionalism reflects the governance of the community. The core lies in independence and autonomy, not administrativeity.
Three, the relationship between professional independence and decision-making politics
Individuality is the most valuable feature, whether it is a professional institution or a scientific community. The advice of some people of insight is to build the disease control system as an independent system. This means having professional people do professional things, including speaking professional words. This is not the same as the proposal to make the CDC an administrative agency.
However, professional independence often has a complex tension with the political nature of decision-making, which requires constant weighing by all parties. Many public health professionals and a considerable number of enthusiastic “eating people” highly value the independence of the United States CDC and its public health disposal power, but conflicts between professional judgment and political considerations are inevitable.
A recent example, when the U.S. government decided to withdraw an American passenger stranded on a Diamond Princess cruise ship back to the United States, the decision itself was not what the CDC could do, and there were 14 people in the process of specific disposal. Passengers are experiencing symptoms, and the U.S. CDC and the State Department have had a fierce debate over whether they should be allowed to board the plane: Based on professional judgment of the risk of spreading the disease, the CDC believes that these passengers should be hospitalized in Japan, and State Department officials are based on political considerations Insist on bringing them back to the United States, and finally political considerationsDefeated professional judgment.
The tension between professional independence and the political nature of decision-making should not in itself be tense. This is a matter of course, because professional judgment and political considerations are not the same thing at all, and providing professional technical support for public policy and public policy decision-making are not the same thing at all. Most public policies must take into account a large number of political, economic, and social factors. This is a matter of good reason. The opinion that only by strengthening the administrative position of professionals and professional institutions can they play a greater role is essentially ignoring the multidimensional nature of public policy decisions. The fundamental way to rebuild the CDC is not re-administration, but de-administration.
In the direction of de-administrative management, dealing with the tension that often occurs between professional independence and the political nature of decision-making is actually not as difficult as the sky above, nor is it a mysterious and profound “art of decision-making.” The core lies in two points: authenticity and transparency.
The essence of the production of scientific knowledge and the provision of professional judgment is authenticity. As the saying goes, the truth is spoken, but in many cases speaking the truth may cause doubt or disadvantage, so the bottom line is not to tell the truth. Academician Zhong Nanshan is admired as a scholar, and a big factor is that he dares to tell the truth. The fact that this fact cannot be denied is a sad reality. In fact, there are countless reports that professionals dare to tell the truth and are considered heroes.
For example, there are reports detailing that on February 3, Zhang Xiaochun, a professor of imaging at Wuhan University’s Zhongnan Hospital, issued a circle of friends and publicly questioned the reliability of nucleic acid testing for the diagnosis of new coronary pneumonia. She suggested CT imaging as the main basis for diagnosis. The report said that Professor Zhang liked to watch CCTV’s variety show “Is it Real?” “, Like the words of the host Huang Xi,” Never accidentally verify, just speak boldly. ” After processing this sentence, she became, “Never look forward and look back, just speak up.” In Professor Zhang’s opinion, the truth is the most precious quality.
If there are positive reports, naturally there will be negative opinions. Many people are enthusiastic about digging for who tells the truth, and treat the scarcity of truth as relevant. Moral issues, put them on the shelf of morals and even the law. These moral torture or legal inquiries are not unhelpful, but in my opinion, it is more necessary to explore why the truth-telling incentive mechanism does not exist from the perspective of organizational culture and governance systems.
Actuality does not mean accuracy. Zhuge Liang is a professional in military strategy and tactics, but he is not the immortal portrayed in The Romance of the Three Kingdoms, and his professional judgments abound.. The point is that any professional judgment must be open and transparent. As far as the public governance of sudden outbreaks is concerned, the importance of openness and transparency is no longer necessary, but its institutionalization has not been implemented for a long time. Even after we have experienced the profound lessons of SARS, we still have not learned from them. Eating a glutton is not the basis for a long-term wisdom, it is not the moral courage of the relevant person, nor the level of risk judgment of the relevant person, but the lack of relevant institutional construction.
Specifically, any outbreak report should have been open and transparent, and all relevant personnel participating in the outbreak investigation should also be notified by real name. The scope and hierarchy of openness and transparency are of course not necessarily uniform, but even if it is disclosed to the whole society, it is not without benefits. If openness and transparency are institutionalized, the professional judgment of each professional or each professional team will be placed in the scientific / professional community or even (in some specific Under the circumstances) social inspection, the probability of its authenticity will greatly increase. It’s not hard to imagine that if professional judgments only revolve in an internal circle, and professional judges are always mysterious, then these judges cater to power Whether it is a professional authority or an external force) .
Of course, in the case of openness and transparency, professionals may also be cautious, for fear of saying something that does not seem to be effective after the fact. However, this problem can be alleviated through research and norms in the scientific / professional community. In fact, there is a so-called “worst-case scenario” in the field of crisis emergency management, including in the public governance academics of sudden outbreaks. A famous American jurist, “Span class =” text-remarks “label =” Remarks “> (Cass R. Sunstein) ‘s monograph” The Worst Case “has been translated into Chinese. How to “plan for the worst” has become a specialized knowledge. If epidemiologists’ reports on the epidemic, especially their judgment of risks and the choice of response measures, do not reflect this knowledge, in the case of openness and transparency, they will be questioned by the industry and knowledgeable Social criticism.
All of this, telling the truth, being open and transparent, and building capacity, can’t be solved by moral skepticism and eager appeals. The key lies in the system. It is obvious that we lack such a system. Regarding the work of the staff of the disease control system of Wuhan City, Hubei Province, the National Centers for Disease Control and the health administrative departments in various places, especially in the early stage, what they did, there is no openness and transparency, even at the national level. Approved to go to WuhanThe full list of members of the home group is currently in the fog.
Many historical facts have not been recorded on the official websites of CDCs and health administration departments at all levels, and they are only excavated by various media as detectives. All these are the shortcomings of open and transparent institutionalization in showing the public governance system. Only by working on the institutional and organizational construction of the public governance system to make community governance work and solve the problems of how administrative governance can strengthen community governance and complement each other, the disease control system and its internal components In order to become a qualified gatekeeper for epidemic control in healthy China, the organization of disease control centers must be established.
This article comes from WeChat public account: cultural aspect (ID: whzh_21bcr) , author: Gu Xin Institute of Social management, Zhejiang University