The University of Chicago Center in Beijing
Culture Plaza 20th Floor
59A Zhongguancun Street
Haidian District, Beijing, 100872
On June 26th, 2018, the University of Chicago Center in Beijing along with the Northwestern Pritzker School of Law and the Health Governance Initiative (HGI) , a Beijing-Based think tank focuses on health law and policy, hosted the “Infectious Disease Law and Policy Forum.” The forum, which brought together 19 experts from different universities; national and international health organizations; NGOs; and media corporations, sought to answer the question of how we can utilize law and policy regarding infectious disease to promote social justice. Jonathan Lio, an organizer of the conference and professor at the University of Chicago, built on this further by saying that he wants to create “[A society] where everyone has equal access to education, prevention, diagnosis, and treatment. Where our most vulnerable are protected and respected while we move towards eradicating infectious disease.”
The conference’s opening remarks were given by conference co-organizers Jonathan Lio; Mingting Chen, Deputy Director of the National Center for Tuberculosis, Chinese Center for Disease Control and Prevention (China CDC); Brian Citro, Assistant Professor at Northwestern Pritzker School of Law; and Ping Jia, Health Governance Initiative’s Executive Director and Adjunct Professor of St. Mary’s Law School. Professor Citro briefly touched on the origins of the forum, the speakers then expressed their hope that the conference would help move towards forming new partnerships between different government organizations, NGOs, medical centers, and businesses, which would help ensure that laws and policies are written, enacted, implemented, and enforced in a way that benefits society and works to eradicate infectious diseases while also treating patients with dignity and respect. Their remarks left the audience anticipating an open, fruitful, frank, and constructive discussion.
The first session of the forum laid groundwork for further discussion by introducing the current state of tuberculosis in China and some of the issues that exist in the status quo with implementing and enforcing infectious disease law. They addressed the scale of the current TB epidemic in China, with over 800,000 cases being reported per year, and emphasized the ease with which it can spread from person to person via the respiratory track. Hui Zhang, Assistant Director at the National Center for Tuberculosis, spoke to the prevalence of MDR and XTR TB and addressed some of the challenges that exist with treating it, such as a severe burden with imbalanced distribution and a lack of effective means of prevention. She concluded by discussing the opportunities and key efforts in the future, such as the UN High level meeting on TB next year, which could help combat the disease. To help the audience better understand how these changes could be implemented, Mingting Chen gave an introduction to the Chinese Legal System which covered health-related laws and how TB is classified and controlled under the “Law on the Prevention and Treatment of Infectious Disease.” Yanzhong Huang, Professor of Seton Hall University and Senior Researcher of Council on Foreign Relations, addressed the Global Health Governance and its challenges. He pointed out that the major sovereignty; sectoral; and accountability challenges that states; IGOs; and non-state actors face when operating within this legal system to address infectious disease issues were discussed. Lastly, solutions such as further co-operation; a multisectoral approach; and increased transparency were proposed to more effectively eradicate the disease in the long term.
After a Q&A that focused on the status-quo issues of infectious disease law enforcement, the next session, which presented the ethical issues that can arise in the implementation of new anti-infectious disease law and policy, moderated by Bo REN, Vice Editor-in-Chief from CAIXIN Media Group, began. First, Renzong Qiu, a professor at the Chinese Academy of Social Sciences, discussed the conditions under which it is ethically justifiable to limit an individual’s freedom to control an epidemic. Professor Qiu argued that 5 factors must be considered: effectiveness, proportionality, necessity, least infringement, and transparency. In his opinion, these conditions could serve as an evaluative framework to construct policies that are ethical while effectively preventing the spread of contagious diseases. These same ethical questions were then considered in the context of the interrelated issues of drug dependence and infectious diseases. Professor Jianhua Li, Former Director of Yunnan Institute for Drug Abuse pointed that given that there are currently at least 14 million illegal users of psychoactive drugs in China and that a significant proportion of drug users are infected with HIV/AIDS, other STDs, and hepatitis B/C, the question of how to formulate policies to best combat these issues is of great significance. He argued that current social issues such as stigmas and policy issues such as compulsory isolation detoxification are inimical to combatting these issues, and instead proposed solutions such as strengthening education to eliminate misunderstandings around these diseases, designing culturally appropriate behavior intervention, and advocating that the government improve laws and policies related to drug use. Finally, Professor Jia Ping from HGI discussed the ethical issues relating to the affordability and accessibility of drugs, stressing the importance of applying the Principle of Justice in the field of medicine. He argued that simply implementing universal healthcare doesn’t necessarily resolve problems of accessibility because it places the burden on low-income taxpayers. Instead, he pushed for changing the drug development and production model in such a way that increases both the affordability and accessibility of drugs, thus allowing them to help more people.
The next session, moderated by Wei Zhou, Professor of Sichuan University School of Law and Director of Center for the Study of Human Rights Law, further discussed the ethics of anti-infectious disease law and policy, focusing on how to best protect and ensure the rights and dignity of patients. Vincent Johnson, a law professor at St. Mary’s University, discussed the issue of tort liability under American law, focusing on liability for harm caused by the actual transmission of infectious diseases. Given that Chinese tort law is neither as well-developed or complex as American tort law, Johnson argued that when developing laws to protect against the transmission of diseases, American tort law could serve as a useful example. He examined liability in the different instances of intentional battery, recklessness, negligence, and fraud. Professor Johnson concluded by emphasizing the ability of tort law to deter the spread of infectious diseases and compensate victims. Next, the discussion turned to the importance of the legal protection of the dignity of patients. Jiayou Shi, a professor at the Renmin University of China Law School, argued that patients should have the right to informed consent and the ability to make decisions themselves. He also pointed out that the doctors should avoid giving their patients false hope and ensure them end-of-life care, including the right to refuse further care. Lastly, the session turned to a specific example of the Chinese legal system failing to adequately protect and compensate a patient. Dr. Xiangdong Peng, a researcher of Beijing Yi'an Research Center for Health and Immunization, discussed a 1995 case, “Yaoyao” (a pseudonym), a one-year-old child, became the first recorded case of vaccine-associated paralytic poliomyelitis (VAPP) after being administered an oral polio vaccine (OPV). This case revealed that reasonable legal compensation for the risks and damages associated with vaccines and VAPP are unobtainable within the current legal framework. The presentation ended by echoing the demands of parents affected by VAPP, urging that legal changes be implemented such earlier treatment of risk and long-term treatment, rehabilitation, and social security.
Continuing with the theme of protecting the rights and dignity of patients, the final two sessions of the forum emphasized the importance of taking a rights-based approach to combatting both HBV and TB. They argued that this rights-based approach provides a legal framework that respects the dignity and autonomy of patients, establishes the legal rights of those infected, establishes the obligations of the government/NGOs, and guarantees patients meaningful participation in the medical process. Brian Citro, an assistant clinical professor at Northwestern Pritzker School of Law, discussed three parts of a rights-based approach, which include protects individual entitlements, ensures individual freedoms and protects preventative rights. Abhaya Moturu and Nesha Abiraj, from Northwestern Pritzker School of Law, concluded by presenting several recommendations for achieving health equity, from legal and policy reform to approving new vaccines and decreasing the price of medication. Citro built on the work presented by Moturu and Abiraj by arguing that a rights-based approach can also help combat the global TB epidemic. He concluded by recommending the development and implementation of rights-based policy which would prohibit discrimination, remove stigmatizing terms from legislation, ensure the privacy of people with TB, and help community organizations better participate in the legislative process as a way more effectively combat and one day eradicate the disease. Ms. Minyan Li (Alee) provided a reflection on the protection of TB patients’ rights and the regulations on AIDS prevention and treatment, which is thought to be of comparative utility to China’s legislation in TB. James Yang from UNDP commented on the session based on its work in China.
The forum concluded with a six-person panel that discussed future opportunities for partnership building to better combat infectious diseases in China. Facilitated by Professor Ping Jia, the panelists including Shitong Huan from the Bill and Melinda Gates Foundation, were asked to provide their own recommendations for how to better fight infectious diseases in the future. These included further government action to empower local and social forces, increased multi-sectoral and multi-national collaboration, empowering individuals to be leaders, and refining legal language to be more precise. The panel concluded by emphasizing that countries need to focus less on national borders and issues of sovereignty and instead move towards collaboration at all levels if they are to ever accomplish their goal of eliminating all infectious diseases.
The University of Chicago Center in Beijing is proud to have hosted the wonderful speakers and provided them with a space to convene and share their interdisciplinary and multi-faceted expertise. The forum was certainly energizing and contributed to the Center’s goal of fostering discussion and deliberation amongst scholars from all over the world. It served as a stepping stone towards future collaborations, conversations, and actions. The Center looks forward to hosting similar forums that can further help promote the creation of a more just and healthy society.