Navigating resistance in global health governance: Certification of smallpox eradication in China

ABSTRACT

Certification is an essential stage in disease eradication efforts, encompassing epidemiological, managerial, and political complexities. The certification of smallpox eradication in the People’s Republic of China (PRC, or China) exemplifies the multifaceted nature of the certification. Despite eradicating smallpox in the early 1960s, before the Global Smallpox Eradication Programme (SEP) intensified in 1967, China was one of the last countries certified as smallpox-free by the World Health Organization (WHO) in 1979. The WHO encountered notable resistance during the certification of smallpox eradication in China. This article examines the underlying motivations propelling China’s resistance, the factors that contributed to the shifts in its stance, the challenges navigated by the WHO, and the ultimate achievement of certification despite controversies surrounding its transparency and credibility. Through the case of the certification of smallpox eradication, the article provides a historical context of China’s selective engagement in global health governance, emphasising the critical importance of building a trusting relationship between the WHO and its member states. It offers insights for fostering effective collaboration among diverse stakeholders driven by varied political agendas in addressing shared global health challenges such as the coronavirus disease (COVID-19) pandemic.

KEYWORDS:

• Smallpox eradication
• certification
• China
• World Health Organization
• global health politics

Acknowledgement

The article originated from chapters in my PhD thesis, ‘China in the Worldwide Eradication of Smallpox, 1900-1985: Recovering and Democratizing Histories of International Health’, supported by the Wellcome Trust (Grant number 208142/Z/17/Z). It was rewritten and revised under the Wellcome Trust-funded project ‘Connecting Three Worlds: Socialism, Medicine and Global Health after WWII’ (Grant number 221321/Z/20/Z). I thank the editor, anonymous reviewers, Sanjoy Bhattacharya, Dóra Vargha, Sarah Howard and the colleagues of Connecting Three Worlds for their comments. Previous versions of this paper were presented at the ‘Global Interference? Science and Foreign Policy Interactions in China’ workshop supported by the Lise Meitner Research Group at the Max Plank Institute for the History of Science, and ‘Afterlives of Epidemics: Ends, Legacies and Hauntings’ supported by the Department of Culture Studies and Oriental Languages at the University of Oslo, I thank the organisers for their sponsorship and the participants for their comments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Wellcome Trust: [Grant Number: 208142/Z/17/Z]. It was rewritten and revised under the Wellcome Trust-funded project ‘Connecting Three Worlds: Socialism, Medicine and Global Health after WWII’ [Grant number: 221321/Z/20/Z].