How did the People’s Republic of China under Mao’s rule respond to a pandemic arriving from abroad? Xiaoping Fang’s new book on the El Tor cholera pandemic (1961–5) provides a compelling answer. Much like Fang’s essential book on China’s barefoot doctors which draws on copious archival records and oral histories, China and the Cholera Pandemic paints a well-documented and dynamic picture of how the pandemic evolved within China’s social, political, and economic fabric as the country was recovering from the Great Leap Forward.Footnote 1 Focussing on Zhejiang – the most impacted province, with over 10 000 cases (p. 20) – Fang argues that the government’s efforts to contain the pandemic through an ‘emergency disciplinary state’, as Fang calls it, would shape Mao’s style of governance in the following years.
In the introduction, Fang lays out the book’s three major themes: mobility, social divisions and border drawing, and data and social structure. The first theme, mobility, is the focus of the first two chapters. In Chapter 1, Fang presents his hypothesis that El Tor cholera entered and spread from China via migration routes to and from Southeast Asia. Specifically, the repatriation of Indonesian Chinese to the PRC and the Chinese migratory flux to Hong Kong then the Philippines matched the timeline for when those places recorded cholera outbreaks. Chapter 2 then shifts the focus to Zhejiang province and the various population flows resulting from tightened government control in the form of a household registration system that consolidated the rural/urban divide. By braiding together multiple environmental and social factors – ranging from land and water transportation networks, festivities, seafood-eating habits, agricultural cycles, and intensified population gathering during ‘Shuangqiang, or the quick harvesting and planting of rice crops’(p. 3) – Fang presents an ecosystem that set the scene for Zhejiang’s cholera outbreak in July 1962.
In order to explore social divisions and border drawing in Zhejiang before and during the pandemic, in Chapter 3 Fang focuses on three important societal divides: rural/urban, male/female, and military/civilian. Cholera had a greater impact in rural areas owing to the poor water-management infrastructure there; women participated in agricultural production, making their infection rate equal to men’s; and the superior nutrition and limited contact with civilians on military bases explains the lower caseload among soldiers. Chapter 4 describes the multi-layered borders and quarantine measures used to control the movement of people: natural boundaries, administrative categorisation, and manmade frontiers in the form of quarantine zones established within the province. Fang also notes that some people at the time questioned the usefulness of isolating individuals, as the El Tor vibrio was already well established within Zhejiang’s ecosystem.
The theme of data and social structure is explored in detail with regard to three policies: comprehensive inoculation (Chapter 5), the case identification system (Chapter 6), and confidential reporting (Chapter 7). Fang underlines the PRC’s comprehensive inoculation campaign despite the controversy surrounding its efficacy; however, it is helpful to note that the Nationalist regime in Taiwan, which was a member of the WHO epidemiological intelligence network, also conducted mass inoculations vaccination during the same pandemic. Chapter 6 illustrates how governmental organisations ‘saw’ cholera through stool samples, as cholera produces similar symptoms to other diseases.Footnote 2 In this way, Fang shows how the PRC government used the collection of epidemic-related numbers to improve its knowledge of its population. Through cholera case reporting, which established a flow of information between medical institutions and administrative units, public health in China became closely intertwined with administrative control. Chapter 7 details how the different levels of government kept the outbreak a secret without sacrificing popular awareness: officials promoted their campaigns as preventive even though the cholera outbreak was clearly ongoing; they only partially copied information from materials issued by the central government; and the government media outlet People’s Daily was slow to mention the outbreak in China and mainly focused on foreign countries. This last chapter should be of great use to historians struggling to assess historical materials from the PRC. In the conclusion, Fang clarifies the core concept of the ‘emergency disciplinary state’ and discusses similarities to how the PRC has responded to the COVID-19 pandemic.
Fang’s core argument is that the PRC’s emergency disciplinary state was established in reaction to the El Tor cholera pandemic. However, the book can also be read as an account of the resistance, confrontations, and negotiations that occurred between various strands of power in moving towards that style of governance, which was not without its blind spots: public health staff encountered difficulties and even violence when attempting to check inoculation certificates of officers in the People’s Liberation Army (Chapter 4); overseas Chinese were exempted from vaccination certificate checks because the PRC needed their remittances and skills (Chapter 4); and the Zhejiang government adapted its 1963 vaccination campaign to avoid peak farming season due to the passive participation of local cadres and farmworkers the previous year (Chapter 6). There was therefore some flexibility in the PRC’s seemingly strict approach to epidemic control.
It is unfortunate that Fang does not analyse the sources cited in the text more often, as the rare occasions where he weighs in on conflicting information encountered in the archives (pp. 41–3) are enlightening. Chapter 2 also includes some passages in which the causal relationship between environmental and social factors and the public health situation are not clearly established by historical sources or by the author himself (pp. 74–5, 100).
Fang’s account of this much-overlooked public health crisis draws on abundant historical materials. The book is a must-read for historians and students interested in the PRC’s health policies, as well as for those curious about crisis governance in the PRC at the national, provincial, and county levels during transitional years between the Great Leap Forward and the Cultural Revolution.
