The Story of Schistosomiasis in Mao’s China and After

The following article is important for two reasons. (1) There has been an academic industry devoted to negating every accomplishment of Mao-era China; the scholarship of that industry, as this article illustrates, does not stand up to scrutiny. (2) More immediately, public health has been made into a football of geopolitics. The US is using the pretext of Covid-19 to target China, and so is casting doubt on present-day China’s public health statistics. It is necessary to critique the public health response of any government, including China’s, but on the basis of correct facts.

I grew up in the subtropical agricultural area of China, where there are lots of beautiful rivers, marshes, and lakes, and with these, a long history of snail fever (schistosomiasis). Archaeological studies found that a female corpse in the area dating back to the Western Han dynasty some 2,100 years ago also had snail fever. It is a serious communicable disease. I still remember that when I was little, I was scared of seeing an old relative with an abnormally huge belly, which was one of the symptoms of the disease. She had been infected at a young age. I was lucky that, by the time I was born, the snail fever which had haunted my people for thousands of years had been largely suppressed.

This was the result of decades of tremendous efforts by the Communist Party, scientists, and other working people in China since the 1950s. In those days, the government set up massive free science education programmes for the many poor, illiterate rural people. The aim was to liberate and mobilize people through the health campaign. The Chinese people succeeded in this. The process involved some unprecedented changes in people’s lifestyles, such as cleaning toilets properly, distinguishing human and animal water use, etc. You can still see some legacies of that campaign today. Many Chinese residents, when traveling abroad, are frustrated to find that it is hard to get hot water to drink. The obsession with hot water came directly from the health campaign a half-century ago, as the government recommended everyone only drink boiled water, to reduce the chance of infection. Equally importantly, China provided free or affordable treatment for the snail fever patients, and trained more than a million ‘barefoot doctors’ who provided affordable basic health care in the countryside.

It was Chairman Mao who led the health campaign in China. When he learned of the news that a county in Jiangxi province had finally got rid of the snail fever in 1958, he wrote the poem “Farewell to the god of plague” to celebrate this achievement. Instead of praising the leadership and the government, Mao said the then 6 hundred million Chinese people were equal to Yao and Shun, the most respected sages from thousands of years ago.

This is why I was quite surprised to read an article titled “The Story of How Mao’s China Falsely Claimed It Eradicated Schistosomiasis”.[2] The claims made by the author Zhou Xun are bold and eye-catching, but they go completely against the basic facts long presented by the scientific community within and outside China. I will briefly discuss some of these claims below.

First of all, the author states that “[I]n 1958, at the height of Mao’s Great Leap Forward, a utopian campaign to industrialise China, the PRC became the first country in the world to declare it had successfully eradicated the disease. But it hadn’t.”

It is a very strange claim that China declared it eradicated the disease in 1958, which even contradicts what the author just mentioned a few lines above, namely, that “The goal was to eradicate schistosomiasis within seven years, by 1962.” As I mentioned above, Chairman Mao wrote a famous poem in 1958 to celebrate the eradication of the disease in ONE county.

In fact, to my knowledge, the Chinese government has never declared the eradication of snail fever in the whole country. Certainly, Chairman Mao had the strong intention of eliminating snail fever, as it was a huge threat to people’s health. There was definitely some naive excitement in the country with the initial plan of eradication in a few years, but that did not change the fact that people kept up the fight against schistosomiasis throughout the Mao era. Scholars can have different assessments as to whether that intention of eradication might have caused problems. For example, a recent well-researched book by Miriam Gross, Farewell to the God of Plague, argues that Chairman Mao’s focus on complete disease elimination, rather than control, undermined the long-term nature of prevention work, since endemic diseases like snail fever are almost impossible to eradicate (Gross 2016, p.102).

Nevertheless, it is clear that the campaign against snail fever in Mao’s China was a huge success. The World Health Organization (WHO) observed in 1985 that in China “Considerable progress in control has been made over the years, and of 348 counties where the infection was known to be endemic, 56 are in the surveillance phase, 191 in the consolidation phase, while 101 are still in the attack phase. Many antischistosomiasis hospitals have been closed or reorganized as morbidity due to S. japonicum infection has decreased. The number of infected persons is currently estimated to be 1 million (one-tenth of the original number) and the snail-infested area has been reduced to one-fifth of its original size.” (WHO 1985, pp.79-80) Four years later, WHO (1989, pp.75) reported that schistosomiasis was declared to have been eradicated in the municipality of Shanghai, in the provinces of Guangdong and Fujian, and in the autonomous region of Guangxi by 1989.

Since there was no declaration of nationwide eradication of the snail fever, it is utterly strange to see the author’s “discovery” in her interview that “[W]e simply made up the figures.” The author seems to imply that the Chinese government wanted to cover up the fact that China still had snail fever problems so that it made up numbers. China did not hide the fact of widespread snail fever problems. Could some local officials make up numbers at some point? Possibly. Does it change the magnitude of the trend of snail fever infections over a long and well researched period? Quite unlikely.

The author further claims that “China’s official narrative remains that the disease was eradicated but has returned – something it blames on political opponents who sabotaged the campaign.” I am not sure which official narrative the author is referring to, but it is an accepted fact in both official reports and academic research that snail fever made a return in the post-Mao era. The size of snail-infested area decreased from 14321 million square meters in the 1950s to 2750 million square meters in 1980; but in the post-Mao period, very little progress took place, and the size of the snail-infested area increased to more than 3600 million square meters in 2017 (Yuan 1999, Zhou et al 2004, Cao et al 2019). Gross (2016, pp. 246-7) suggests that market reforms and decollectivization of the communes dramatically diminished the funding, personnel, and political support for rural health. Many scientists have also pointed out that the Maoist mass science model which mobilized the mass to kill the snails is incompatible with the market economy (Zhou et al 2004, Yuan 1999, Guo 2006). They also emphasize the fact of the lack of funding to local antischistosomiasis agencies, and rising medical costs, following the market reforms (Zhou et al 2004, Yuan 1999, Guo 2006).

The way that the author presents the Chinese sources is also highly misleading, to say the least. The author cites the official guidelines on prevention and control of snail fever during the 13th five-year plan in China to argue that China has changed the goal from eradication to control.[3] As I mentioned above, the fight against snail fever has not worked so well in the post-Mao era. In the 1980s China had already changed its anti-snail fever strategy due to the changing political economy and the advice from scholars and the WHO (Guo 2006). That does not imply, however, that the Chinese government has given up on eradication as a goal. There is a list of goals/criteria, from basic control of the disease, to the interruption of the transmission, to achieving the status of eradication. Eradication status in a county can be declared after 5 years without a new infection after reaching the interruption of transmission.[4] The document that the author cites clearly states that by 2020, among all the infected counties, 340 of them need to reach the status of eradication, 97 of them need to achieve interruption of transmission, and the remaining 16 counties need to control the disease. It is indeed a mystery to me how the author can misinterpret the document to such a degree.

I probably do not need to discuss the author’s claims any further. Since the last century, there has always been a market for authors to tell and retell the so-called horrors, lies, and failures in the former socialist societies. This has been the case in China itself and outside China, mainly to dispel any possible imagination of a socialist society, but also, increasingly, to feed into some beloved sinophobia propaganda. Socialists always love to read any critical studies on those societies, but unfortunately, “research” like Zhou Xun’s adds nothing to our knowledge about the great revolutions and reforms in the past century.

References

Cao, Chunli, Lijuan Zhang, Ziping Bao, Simin Dai, Shan Lv, Jing Xu, Shizhu Li, Xiaonong Zhou (2019), “Endemic situation of schistosomiasis in People’s Republic of China from 2010 to 2017”, Chinese Journal of Schistosomiasis Control, 31(5).

Gross, M. (2016). Farewell to the God of Plague: Chairman Mao’s Campaign to Deworm China. University of California Press.

Guo, Jiagang. (2006), “The history and current status of China’s schistosomiasis control”, Chinese Journal of Preventive Medicine, 40 (4).

World Health Organization. (1985), “The control of schistosomiasis: report of a WHO expert committee [meeting held in Geneva from 8 to 13 November 1984]”, World Health Organization. https://apps.who.int/iris/handle/10665/39529

World Health Organization. (1989), “The control of schistosomiasis: second report of the WHO Expert Committee [‎meeting held in Geneva from 8-15 November 1991]‎”, World Health Organization. https://apps.who.int/iris/handle/10665/37115

Yuan, Hongchang (1999), “Achievements and experiences of China’s schistosomiasis control”, Chinese Journal of Epidemiology, 20(1).

Zhou, Xiaonong, T. Wang, L, Wang, J. Guo, Q. Yu, J. Xu, R. Wang, Z. Chen, T. Jia, (2004). The current status of schistosomiasis epidemics in China. Chinese Journal of Epidemiology, 25 (7).

[1] Associate Professor of Economics, John Jay College, City University of New York, and Howard University. Part of the essay was based on a talk given in a recent Science for the People webinar.

[2] https://science.thewire.in/health/mao-zedong-china-eradicated-schistosomiasis-covid-19/

[3] The guideline (in Chinese) can be found here: http://www.nhc.gov.cn/jkfpwlz/zcwj1g/201902/43f6003afefe4f389f641c6cff178665.shtml

[4] The details (in Chinese) can be found here: http://www.nhc.gov.cn/zwgkzt/pjbkz1/200804/19030.shtml

The Article Was First Published in RupeIndia