China’s Mid-January 2020 ‘Patriotic Health Campaign’
On 14 January 2020, six days before the Chinese government announced it had set up an inter-ministerial coordinating body to tackle a new coronavirus, it had already begun a nationwide campaign to clean up markets, combat vectors of disease, and mobilize citizens to adopt behaviours to prevent the spread of infectious diseases. This campaign, which was quickly adopted by provincial governments across China, went unnoticed internationally because it did not mention the coronavirus and was led by the “National Patriotic Health Campaign Commission,” a long-standing body little known outside of China that brings together leaders from government ministries, Communist Party departments and the Central Military Commission. The fact that this body has gone unnoticed shows that we need to understand the Chinese “government” and wider political system, including its many policy making and implementing bodies, if we are to fully understand its response to the coronavirus, inform policy making internationally, and enable crucial collaboration.
It is widely known that on 20 January central Chinese authorities announced a set of steps to counter a novel coronavirus. They publicized a State Council Executive Meeting on it, held the first meeting of a new inter-ministerial coordinating body (literally, “joint mechanism”) set up to tackle it, and issued a public announcement on managing the disease it caused according to class-A measures. It was also on that date that the head of the National Health Commission’s team of medical experts Zhong Nanshan spoke on China Central Television (CCTV) about human-to-human transmission. All these actions were taken by well-known, high-profile government bodies—the State Council and the National Health Commission—the first places international analysts might turn to understand the government’s response.
What we know little about is a campaign launched by another central-level commission six days earlier that set sweeping measures in motion to mobilize government, Party and public in a large-scale preventative effort against seasonal infectious diseases. Though National Health Commission Vice-Head Li Bin mentioned the campaign at a State Council press conference, clearly linking it to the epidemic, it has gone otherwise unnoticed.
On 14 January, the Office of the “National Patriotic Health Campaign Commission” (NPHCC) issued a document, “NHPCC Document No.1, 2020,” addressed to its provincial-level branches. The document launched a “Winter-Spring Patriotic Health Campaign” with the aim of “lowering the risk of environmental transmission of key winter-spring seasonal infectious diseases.” This earlier, little-known step focused on combatting vectors of disease, cleaning up marketplaces, and mobilizing citizens to engage in preventative behaviours.
This research briefing uses publicly available policy documents to explain the campaign and its place in the Chinese response to the coronavirus. It also shows that we need to think about what constitutes “government” when trying to understand how the Chinese authorities responded to the virus. Only by taking a wide view of government in light of what we know about the political system does this earlier element of the central response become apparent. In turn, only then do we notice that some provinces, too, responded quickly to this central call, setting in motion campaigns against infectious diseases before 20 January.
What is a “Patriotic Health Campaign” and Why Have We Overlooked This One?
“Patriotic health work,” according to the State Council in 2014, includes “acting as early as possible to mobilize…and control the occurrence and transmission of diseases at the source.” It involves “Patriotic Health” agencies mobilizing “the masses”—getting the general public to actively participate. In the words of the State Council, it “uses prevention and control by the masses, giving play to the strengths of primary-level Patriotic Health agencies and teams within townships and sub-district offices, urban and rural communities, state agencies, and enterprises and public institutions.” It is meant to “strengthen collaboration between specialist prevention and control and public participation.”
Patriotic health campaigns are a distinctive feature of the Chinese Communist Party’s (CCP) approach to governing. They are thought to have originated before the founding of the People’s Republic of China in 1949 as a way of periodically mobilizing the Party, its governing bodies, and the local population to take measures against disease and promote public health. In the early 1950s a Commission was set up to take charge of organizing and mobilizing Patriotic Health campaigns. The Campaign’s better known iterations include those during the Great Leap Forward to “Eradicate the Four Pests.”
Like other elements of Chinese governance, these campaigns draw on participation by “the masses,” while also attempting to educate them and alter their habits. They work through top-down mobilization, reaching society level by level and organization by organization to generate the most extensive possible participation. Campaigns also use occasions like Spring Festival and the Dragon Boat Festival and their associated traditions to encourage public participation.
But if this 2020 Campaign was linked to the novel coronavirus, why did we not notice it? First, in the official policy document that launched it, the campaign was not discursively linked to a specific virus. Instead, it was framed as a campaign much like any other, against seasonal infectious diseases.
Second, it was not launched by an agency that is well-known outside China or easily recognizable as an important part of the government structure. The Chinese political system features many committees and commissions that are frequently reshuffled or repurposed and are often dually, triply, or otherwise confusingly named. The 14 January 2020 campaign was launched by a little-studied organization with a formidable line-up of Party, government, military, and mass organization members. Unlike other easily recognizable elements of the political system—the State Council, the National Health Commission, or even the CCP Central Committee—it was not the place analysts looked to in order to understand the government’s response.
What is the National Patriotic Health Campaign Commission?
The NPHCC is referred to officially as a “deliberative and coordinating agency of the State Council.” Its component units and members are approved by the State Council and its head is a State Council leader, currently Sun Chunlan. The Commission’s vice-heads and members are ministers, vice-ministers and other leaders from across the Party and government system. At present, first in its line-up of vice-heads is Ma Xiaowei, who is concurrently Head of the National Health Commission. Other vice-heads include the ministers of Ecology and Environment, Housing and Urban-Rural Development, and Agriculture and Rural Affairs, as well as vice-heads of the State Council Secretariat, the CCP Central Propaganda Department, the National Development and Reform Commission, and the Central Military Commission Logistics Department.
The NPHCC’s Office is headed by National Health Commission Vice-Head Yu Xuejun. The Commission’s Office, which sits within the National Health Commission, is in charge of day-to-day affairs, organizing and coordinating implementation by member organizations, supervising decision-making, and drafting policy. Coordination among departments takes place partly via a “contact person” designated by each member organization. When deemed necessary, contact people come together at meetings convened by the NPHCC Office Head.
Xi Jinping’s first administration (2012–2017) changed the NPHCC’s composition, functions, working methods and structures, amending rules that had been in place since 1999. In 2014, the amended rules explicitly listed military leaders among the agencies from which vice-heads and members should come and placed the NPHCC’s planning and policy making under “overall national economic and social development plans.” They placed a greater onus on public participation, redefining existing mobilizing functions to include “coordinating and carrying out major disease prevention and control and public health incident prevention and control by the public.” The NPHCC’s way of working was altered significantly, requiring member ministries and departments to “strengthen coordination and cooperation,” highlighting public communications, public mobilization and public oversight, and focusing on guiding, supervising, and creating institutionalized standards and indicators instead of “exchanging experience, discussing problems…and promoting the work of all localities.” Annual meetings involving all provincial leaders were swapped for “topic-specific meetings” called by the NPHCC Head (or the Vice-Head on her behalf) and attended by members whose work the topic of the meeting pertains to.
In the past decade the Commission has clearly gained a more prominent role. In 2016 it was cited in a five-year plan (2016–2020) on prevention and control against infectious diseases. Its work was cited both in Xi Jinping’s report at the 19th National Party Congress in 2017 and in Hu Jintao’s reports at the 18th and 17th congresses in 2012 and 2007. This contrasts with the period between the end of the Cultural Revolution in the 1970s and 2002, when its work received no mention in any such report. A 2014 State Council guiding policy document, lauded as the first of its kind for Patriotic Health work in 25 years, called for legislating on the Commission’s work, incorporating it into legal systems, and facilitating inter-departmental data sharing. It urged its members to incorporate health work into their agendas, strengthen inter-departmental cooperation, and put the people in place to assume responsibility. It called for stronger funding—via Ministry of Finance special transfers—to facilitate the work of the Commission and its local counterparts and required that Patriotic Health work be part of leading group and cadre assessments.
What Makes the Mid-January Campaign Important and What did it Entail?
Though the 14 January NPHCC document that launched the 2020 Campaign makes no mention of an epidemic or a coronavirus, we know from Vice-Head Li Bin that the National Health Commission considered it part of the authorities’ response. The document’s core goal was to address environmental hygiene in markets.
Based on a careful reading of more than 40 policy documents issued by the NPHCC in recent years, it is clear that this January 2020 campaign differs from the Commission’s regular initiatives in a number of ways.
First, it does not fit neatly into the Commission’s typical calendar. The NPHCC’s work is carried out in rough annual cycles, partly to support international initiatives like Global Handwashing Day, and partly according to its own work rhythm. While it is not unheard of, it is also not typical for the national commission to launch campaigns against winter-spring infectious diseases. Nationwide campaigns against viruses often focus on spring and summer, with these seasons sometimes referred to as “a focal period for health work to protect against disease.”
Second, while the NPHCC does respond to newly arising issues through sporadic campaigns, the policy documents that launch those campaigns usually name the specific viruses or vector-borne diseases that have prompted them. For example, in February 2016, its Office called for a Spring Patriotic Health Campaign to Exterminate Mosquitoes. This campaign document cites clearly the Zika Virus, Dengue, the soon-to-rise temperatures in China, and the particular susceptibility of the country’s southern provinces to mosquitoes. In contrast, the 14 January 2020 document names no virus or disease, it only cites concerns about high levels of trade and travel during the coming Spring Festival as the Campaign’s rationale.
Third, the 2020 January document urges localities to “recognize the importance and urgency” of this campaign. Past policy documents launching spring and summer campaigns against diseases, viruses and vectors of disease tend to include other, more light-hearted activities to promote health and fitness such as skipping, dance, tai chi and football. The 14 January 2020 document does not do this.
What it does do, however, is set out in clear, simple, and detailed terms the content of the Campaign that provincial-level Patriotic Health Commission branches are expected to act on. It contains five sets of measures. They include the following:
1. Environmental hygiene measures with a focus on markets
Local Patriotic Health Campaign Commissions (PHCCs) are to "use the capacity of the Patriotic Health Campaign"; to mobilize all kinds of departments and work units and take corrective action to clean up places where crowds gather, like markets, airports, stations, and commercial centres, as well as alleys, in-city-villages, belts where rural areas meets urban, building and demolition sites, and old residential areas. It calls for treating markets as a priority, collaborating with government departments and organizing for specialists to take corrective measures in and around marketplaces. This includes cleaning up stalls, cleaning and disinfecting facilities such as public toilets and water pools and addressing rubbish disposal. It also requires commissions to draw on the traditional custom of "sweeping the dust" to mobilize the public to carry out "a big clean."
2. Control measures against vectors of disease
These measures too are detailed and clear. They include cleaning residential estates, rubbish transfer stations, and building sites, and eliminating the breeding grounds for vectors like rats and mice, cockroaches, mosquitoes, and flies. The focus is rats and mice. It demands a tightening up of control measures against vectors in all types of markets, better measures in markets to control against rats, mice and flies, and action to ensure market drainage systems are working sufficiently. In markets where there are signs of rats and mice, professionals are to be called in; and the public is to be mobilized to clean up rubbish sheds, basements, garages, wells, restrooms, and receptacles that easily collect water.
3. Public health communications
The document calls for local PHCCs to use newspapers, TV, public transport adverts, and WeChat, Weibo and TikTok for health communications. It demands that commissions organize public communications boards at the entrances to markets to help sellers, personnel working in markets, and consumers "to grasp health information and the key ways to protect against winter and spring infectious diseases, teach people to often wash their hands and ventilate frequently, and caution people to keep an eye on their health and promptly seek medical assistance if they find they have symptoms."
4. Marketplace regulation
These measures use an existing initiative as an inroad to ensure marketplace regulation. The document calls on local PHCCs to assess whether markets in their jurisdiction meet Healthy City Development Initiative standards (which include requirements such as the provision of hygiene management and cleaning personnel and the maintenance of good environmental hygiene and well-regulated transport in the areas around markets). It prompts local commissions to ensure that existing market management measures are being fully implemented, urging them to establish a clear picture of how well markets in their area are currently being managed and to formulate plans and measures for taking corrective action for each market in their jurisdiction.
5. Organization and implementation
Measures to ensure implementation begin with an explicit statement on the importance and urgency of this campaign, urging quick action to make arrangements based on local circumstances. The document states that this Winter-Spring Patriotic Health Campaign requires strong leadership and clearly set out priorities, objectives and divisions of labour. It calls for using “public opinion guidance” and public oversight to promptly spot weaknesses, urge implementation, and ensure responsibility is taken and measures are implemented. It calls for getting all social strata and urban and rural populations involved in a mass patriotic health campaign, to carry out prevention and control by the public. Finally, it states that all provincial commissions should report on this work to the NPHCC before the end of March, and that when deemed necessary, the national commission will make on-site visits.
In the days that followed this document’s release, around the country a number of provincial-level PHCC branches moved quickly to launch local campaigns through similar documents. On 15 January, on China’s southeast coast, Fujian Province PHCC Office issued Fujian PHCC Document No.1. In the northwest, on 17 January, Gansu Province PHCC Office issued Gansu PHCC Document No.1. On 19 January Shanghai’s provincial-level PHCC Office issued its own instructions—in a format accessible for visually impaired people—while also forwarding the national commission’s own Document No.1, to reinforce the message of importance. Provincial-level authorities in Zhejiang and Tianjin later reported that their work on these campaigns had begun on 15 and 16 January. Sichuan’s campaign document came on 20 January and Hunan’s on 21st. While some provinces didn’t publish their documents on health commission or provincial government websites, authorities under them, such as Pingyin County in Shandong, Lianyungang in Jiangsu, and Ningguo City in Anhui, which issued campaign documents on 20 and 21 January, cited provincial level documents, telling us that other provinces too began their campaigns earlier in January.
Prevention and control against infectious diseases and vectors thereof have long been part of the NPHCC’s remit. Given this function of the NPHCC, and steps taken over the past decade to strengthen its role and standing more generally, opting to use this commission and its local counterparts—their existing channels and structures and dense organizational networks—may have enabled the Chinese government to mobilize in certain ways with relative speed and efficiency against an emerging epidemic. In the 2016–2020 plan cited above on prevention and control of infectious diseases, the role set out for the NPHCC was that of “vigorously carrying out campaigns in every locality, strengthening environmental hygiene corrective measures and effectively preventing against sudden emergencies caused by vectors of disease…transmitting to humans.” It seems that the Campaign described above was attempting to do just that. The nationwide campaign’s focus on cleaning up markets around the country could not be clearer, suggesting the Chinese authorities were particularly concerned about market hygiene and vectors in the early stage of their epidemic response. Overlooking agencies and steps like this, particularly due to a limited notion of who in a system has the authority to take meaningful policy actions and how, could lead us to misunderstand the response in question. Going forward, if we are to understand the responses of other countries—whether that be to inform our own policy or to enable collaboration and exchange—an approach informed by social science may help to avoid missing such important parts of the picture.
- The National Patriotic Health Campaign Commission launched a health campaign to protect against infectious diseases on 14 January, six days before it is commonly thought the Chinese central response began
- A number of provincial-level commissions had begun their own health campaigns before the 20 January
- This nationwide campaign focused on cleaning up markets and controlling against vectors of disease, and it sought to mobilize the public to engage in preventative behaviours like handwashing and ensuring good ventilation
- The National Patriotic Health Campaign Commission has so far been overlooked in analysis of the Chinese authorities’ response to Covid-19
- The actions of the national and local commissions in mid-January are discernible through publicly available official policy documents
The research underpinning this report was made possible by a British Academy Postdoctoral Fellowship, for which the author is extremely grateful.
About the author
Dr Holly Snape is a British Academy Postdoctoral Fellow at the University of Glasgow.
 The “State Council Joint Covid-19 Epidemic Prevention and Control Work Response Mechanism” (or the “State Council Joint Mechanism”) was set up to facilitate a government-wide response. It is said to have 32 member agencies (mostly government ministries) which also lead or belong to task forces established under it (such as a medical materials task force, a logistics task force, and a research task force).
 The Law of the People’s Republic of China on the Prevention and Treatment of Infectious Diseases divides infectious diseases into three classes (A, B and C), lists the diseases that belong to each class, and sets out measures based on this classification. The government decided the novel coronavirus disease belonged to Class B but demanded Class A prevention and control measures.
 See State Council Information Office “SCIO Press Conference: Introducing the Situation Regarding Novel Coronavirus Pneumonia Prevention and Control Work” 22 January 2020.
 A typical example is an otherwise excellent report by the Institut Montaigne (2020: 11) which argues that “In China as a whole, the virus was recognized as an infectious disease only on January 20, a full 43 days after the first detection. Almost no prevention and containment measures were taken before that time.”
 See 全爱卫办发1号.
 The name was settled on later, with the “Patriotic” part said to originate with a campaign in response to U.S. germ warfare during the Korean War.
 See Shapiro, Judith. Mao’s war against nature: Politics and the environment in revolutionary China. Cambridge University Press, 2001: 86–89.
 See 全爱卫发〔2014〕1号.
 See全爱卫发第3号 for the old version of the rules and 全爱卫发〔2014〕1号 for the new one.
 See全爱卫发〔2014〕1号: 1. Military leaders have in fact long been members of the commission, but this change reflects the importance placed on their inclusion.
 See全爱卫发〔2014〕1号: 2.1.
 See全爱卫发〔2014〕1号: 2.2.
 See全爱卫发〔2014〕1号: 3.1.
 See全爱卫发〔2014〕1号: 3.2.
 See全爱卫发第3号: 3.3.
 See全爱卫发第3号: 5.2.
 See全爱卫发〔2014〕1号: 5.2.
 See 国家卫生计生委关于印发突发急性传染病防治“十三五”规划（2016-2020年）的通知
 National Party Congress reports, typically produced once every five years, are among the most important overarching policy documents in the Chinese political system.
 See《国务院关于进一步加强新时期爱国卫生工作的意见》 (国发〔2014〕66号).
 See State Council Information Office “SCIO Press Conference: Introducing the Situation Regarding Novel Coronavirus Pneumonia Prevention and Control Work” 22 January 2020.
 See 全爱卫办发〔2016〕1号.
 The document uses “鼠” throughout.
 See 国家卫生计生委关于印发突发急性传染病防治“十三五”规划（2016-2020年）的通知.