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SPF China Observer


No.28 2020/05/03

Can we learn from history in the fight against COVID-19?
Looking back on East Asia during the Bubonic plague epidemic

Tomoko Ako (Professor, Graduate School of Arts and Sciences, The University of Tokyo)

With the spread of COVID-19 in 2020, the world is in a turmoil. Due to this disease, which could infect anyone, our lives have been transformed. How should we understand this situation and find future guidelines? In an attempt to get hints by looking back on history, I opened the book Hygiene and the modern age: Governance, medical care, and society in East Asia during the plague epidemic edited by Takeshi Nagashima, Tomoo Ichikawa, and Wataru Iijima (Hosei University Press, 2017). This book describes the battle with the Bubonic plague in East Asia swayed by imperialism: in the open-port cities of China (Shanghai, Tianjin); Kobe, where foreign settlement had just been abolished; Taiwan and Korea, which had just become Japanese colonies; and Java, under Dutch rule.

The “West” and “China” in opposition over public health

According to the book, “鼠疫,” or “plague” (referring to the Bubonic plague), was for the first time in history confirmed medically in Hong Kong in 1894. In Hong Kong under the British rule that followed non-interventionism, the residential areas of European and Chinese residents were separated. However, with the increase in the Chinese population, introducing a British-style hygienic administration was considered in the Chinese community as well. However, in Hong Kong at that time, it was difficult to comprehensively gain access birth/death registries and have a clear record of the movement of people in and out of the system. Since many Chinese residents were not consulted by practitioners of Western medicine, they could not even be expected to report their illness through a physician. Meanwhile, James Lawson, a medical officer at the Hong Kong Government Office, suggested mobilizing police officers to detect, isolate, and disinfect patients; and involving Western physicians in Donghua Clinic (a voluntary hospital for Chinese residents based on Chinese medicine).

The eighth governor of Hong Kong, John Pope Hennessy, was the first person to appoint a Chinese as a member of the Legislative Council, but his secretary, E. J. Eitel, could speak Cantonese and placed great importance on medical care that respected Chinese customs. It is said that he was critical of enforcing Western-style hygiene measures. As a result, he was at odds with Dr. Philip Bernard Chenery Ayres and others who proposed to hire a “dirt patrol officer” (a staff member who patrolled the city and encouraged residents to make improvements). In 1882, Osbert Chadwick was sent from Britain and the Report on the Sanitary Condition of Hong Kong was produced. The report mentioned that we should not blame unsanitary conditions on the ignorance and irresponsibility of Chinese residents. It referred to the introduction of soil drying methods and flush toilets based on the need to improve the overall urban environment.

 The sanitation committee also played an important role in sanitation administration. It consisted of bureaucratic members such as civil engineers, colonial physicians, population registration directors, police secretaries, health patrol officers, and non-bureaucratic members such as businesspeople, medical physicians, lawyers with medical qualifications, and insurance union secretary generals. However, until 1888, when the second Chinese member joined, there was only one Chinese member, a lawyer named Ho Kai (何啓), who had a medical qualification. In the United Kingdom, a sanitary administration that combined local autonomy and expertise was promoted. However, this had not been achieved in Hong Kong under colonization. Chinese representatives were hardly allowed to participate in the policy-making process.

Hoax and prejudice amplified discrimination and hatred against the “others”

In 1910, 16 years after Yersinia pestis was discovered in Hong Kong, there was a plague-suspected death in the northern ward of the Shanghai International Settlement (the boundary with the Chinese administrative region). Residents were evacuated from buildings, houses, and their surroundings wherever people were suspected of being infected; the houses were fumigated, and people were forced to disinfect or incinerate their household goods and tableware, which had also been removed from the house.

However, the Chinese were not familiar with the spaces and methods of specialized modern medicine, such as forced isolation and door-to-door inspections. Chinese women ran away with their children, fearing Western male physicians and inspectors. When hoaxes, such as “People with yellow skin are forced to be quarantined when they are found by hygiene workers,” and “in isolation hospitals, they are making medicine using the body of isolated people as the ingredients,” began spreading, there was a series of incidents in which inspections were obstructed by Chinese people who surrounded the hygiene staff and physicians who came to carry out inspections.

In response to the backlash from Chinese society, international settlement authorities set up a forum for discussions with Chinese representatives. A public meeting was held, and the Chinese public clinic—a quarantine hospital for Chinese people—was established. Door-to-door inspection was discontinued, and in areas where infection was a concern, a Chinese female physician recommended by both the Chinese public clinic and the Ministry of Health performed the door-to-door inspection.

A newspaper article in Shanghai at the time said, “Upper-class Chinese understand the plague inspection, but lower-class Chinese are unable to understand and are afraid....Ignorant people are confused by hoaxes and are causing a riot....Fearful lower middle-class people got worked up and caused a riot.” The view with a fixed oppositional axis such as “upper class–lower class” and “Western–Chinese” was taken for granted. These reports contributed to prejudice and discrimination. Due to increased fear toward infectious disease, people’s desire to overprotect their “self” became heightened, and even developed hatred toward “others.”

The difference between 100 years ago and today

Looking back on the situation in Hong Kong and Shanghai during the Bubonic plague epidemic in this way, at the root of the hoaxes and discrimination were misunderstandings caused by differences in medical and lifestyle habits, and the presence of a divisive composition that had been rooted in society. After more than 100 years since the plague era, although colonial rule has ended in most areas, these situations do not seem to have changed very much.

While we are frightened and suffering from the COVID-19 tragedy, there are domestic and international arguments about science and medicine, and about methods of governance and management. We are giving one another suspicious looks, and are in strong opposition with each other. Known as the “lower class” under Western-centric imperialism, China has now become a global superpower that handles big data. For the world to unite in fighting the pandemic, it is vital that nationalism be overcome, and we collectively cease the attacks and defenses concerning the identification of the source of the virus, the political bargaining regarding the World Health Organization (WHO), and conflicting interests regarding vaccine development, and actively share important information and expertise. However, all countries tend to lean toward prioritizing their own national interest. In addition, many of the problems surrounding the infectious disease cannot be solved in the context of a binary confrontation such as “West vs. Non-West” and “pro-China vs. anti-China.” Why is it that the focus tends to concentrate on such oppositions?

What is the difference between 100 years ago and the present? Clearly, medical science has developed greatly, and specialists’ technical expertise has risen significantly. Sanitation should be much better. As globalization progresses, various collaborations such as the cross-national provision of technology and information, financial cooperation, etc., are accelerating. And yet, especially in the early phase, the mechanism of international cooperation on COVID-19 did not work well. Why was this so?

Primarily, the fact that important information and data were not shared quickly and efficiently caused a significant damage. As already reported by many media outlets, Chinese physicians reported in early January that the death toll from an unknown form of pneumonia was on the rise. How many victims could have been saved if their warnings had quickly spread throughout China and around the world?

Moreover, although China has a great deal of power in the world, it is a non-democratic nation and operates on its own logic even if it causes various problems. As such, communication with democratic nations frequently fails. Even in societies that were under colonial rule 100 years ago, there was a difference in the way information was transmitted. For example, in Shanghai, publicity on infectious diseases was mainly done in English-language papers, and almost no articles were published in Chinese newspapers such as Shenbao. As such, important information was not transmitted to Chinese residents who could not read English. However, even though the tools for communication have become so diverse today, communication is not going well.

Moreover, China, an authoritarian nation that puts forward its own culture and ideas, has a kind of “heterogeneous” existence. Because of that, it is likely that problems arise due to stereotypes. For example, when the COVID-19 infection was spreading rapidly mainly in Wuhan, and many people were dying every day, did those of use outside China look at the situation in Wuhan and think, “This may happen to us someday”? Did not many of us think, “Things in China are hard” and perceived the situation as mainly affecting the “Other”? Watching Chinese people receive food without having direct contact with the delivery people, or eating one by one in isolation in restaurants, separated by booths, did we not think, “Is it necessary to do that much?” Perhaps some of us laughed at the sight of people from the residents’ associations forcibly driving back people who were trying to leave their homes even though they were subject to the quarantine, or police mobilizing and blocking the city. While both Japan and Western countries perceived China’s problems as those of the “Other,” we lost the time to prepare measures against the infectious disease.

Some events may be amplified by the development of information technology. Discrimination and hoaxes have always existed, but with social media, untrue or misleading statements from officials and from the news media, and emotional analysis without reason can instantly reach the other side of the globe, and affect many people. One-dimensional images are created and disseminated, without sufficient time to verify the accuracy of the information and the acquisition route of the data. The spread of a single point of view, at a time when a compound vision is needed, may contribute to violent discrimination.

There is also a problem in that “national logic” has been prioritized above all. While globalization is advancing, nationalism is emerging and people are expressing their hostility toward other nations more prominently. Will President Trump, who repeats the term “Chinese virus” without giving enough scientific evidence, actively seek to cooperate with China in the fight against COVID-19? Awaiting General Secretary Xi Jinping’s visit to Japan and the Olympics, the Japanese government may have postponed an important decision regarding coronavirus.


In Hong Kong during the Bubonic plague epidemic, there were various communication problems between European and Chinese communities. However, the “cadets,”[1] who spoke Cantonese and had a deep understanding of Chinese society, acted as intermediaries, and a hospital like the Donghua clinic for Chinese residents, which was based on Chinese medicine and operated by the Chinese elites, played a certain role as an intermediate organization. In Shanghai as well, to improve the effectiveness of public health by involving Chinese residents, who formed most of the population, repeated discussions took place in an attempt to secure procedures to coordinate various interests and opinions rather than a one-sided enforcement that would cause a resident backlash. In times when there is a lot to lose by pushing the national logic forward, various private channels should be activated. Communication should be done carefully and swiftly so that information, experience, and expertise can be effectively shared. By doing so, ideas will be born one after another, important information will be transmitted, many trial and error will occur in a short amount of time, research and development will proceed, and new treatments will be tested.

During the plague era, anti-Western sentiment was rising rapidly in China. The Boxer Rebellion in northern China, which occurred in 1900, was an extension of that trend. Even in the global situation surrounding COVID-19, if we do not make the effort for careful communication, a backlash may occur in various places, which may cause an uproar and conflict. Again, it will be important to create an environment in which the vitality of the private sector that overcomes the oppositional structure between nations can be brought to the forefront.

(Dated May 1, 2020)

1 In 1861, a system was developed in which young British university graduates—called “the cadets”—were to master Cantonese so they can be trained as personnel with the ability to communicate with lower-ranking Chinese officials and residents.


Nagashima, T., Ichikawa, T., and Iijima, W. (Eds.). (2017). Hygiene and the modern age: Governance, medical care, and society in East Asia during the plague epidemic. Tokyo: Hosei University Press.

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