The Complications of Reporting Mpox in China

Wednesday - August 2 2023, 14:49 UTC - 1 year ago

In this newsletter, I want to highlight the difficulty in understanding the exact scale of mpox in China due to the limited public health information shared by the government, the aggregation of data from different sources, and the politically sensitive status of Taiwan. This makes it hard to follow the impact of public health measures and to get an accurate picture of the situation there.

This morning, I published a story on the developing mpox situation there and the government’s response so far. While Beijing did recently issue a guidance on mpox prevention, the country hasn’t taken a very proactive approach to containing the outbreak—a stark contrast from its strict covid policies (which I wrote about extensively last year). Beijing’s omission may be a result of "technology nationalism," says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. But delaying the approval of effective foreign vaccines could stymie prevention and result in more dangerous outcomes, Huang warns—the same thing that happened with covid.

You can read more about the difficulties in containing the mpox spread in China in the story today. But in this newsletter, I want to highlight a different challenge: because of the way Beijing has so far reported mpox data and the way the WHO publishes it, it’s quite difficult to understand the exact scale of mpox in the country. When I started reporting this story, I found that the only available mpox case count China has published is a one-time report tallying cases from June 2 to June 30. No information on weekly developments or cases from before or after June has been made public, even though other Asian countries, including Japan, started to see cases rise back in March.

Honestly, I found this data surprising and alarming. News about mpox in China has been mostly under the radar, but as the WHO overview explains: "In the most recent week of full reporting, 7 countries reported an increase in the weekly number of cases, with the highest increase reported in China." The WHO data shows that from May to July, China reported 315 mpox cases, the most around the world in this time frame.

Sounds quite bad, right? It turns out the reality is a tad more complicated. On the WHO website, the recent mpox data listed under China is the sum of cases reported in China, Taiwan, and Hong Kong. While China has not signaled any interest in using mpox vaccines, Taiwan, which has its own CDC, has already administered over 72,000 shots so far. While China has only issued a one-month report of case counts, Taiwan has a public database showing how many new cases are reported each week, making it easy to see that the outbreak is on the decline there, six months after local transmission started.

So aggregating very different sources of data creates a confusing landscape and makes it hard to follow the impact of public health measures. This is not to say the outbreak in China is insignificant, but that the data on the WHO website can easily mislead observers. It’s important to realize that despite how authoritative they may sound, international organizations like the WHO don’t have a magic source of data that overcomes the limited public health information coming out of China. It can only rely on individual countries to voluntarily report such data. (The WHO didn’t immediately respond to questions about its data aggregation practices; today is a public holiday in Switzerland, where it’s headquartered.) .

Unfortunately, as the status of Taiwan remains one of the mos politically sensitive issues in the region, and as other countries have also had better success containing mpox cases, China is less likely to report more; this makes it harder to get an accurate picture of the situation there.