Plagues of China

China has the world's biggest hepatitis C problem, says WHO
By Julie Zaugg and Yong Xiong

In this picture taken on November 28, 2011, a Chinese parent shows a test result slip confirming his child has hepatitis C, at a hospital in Hefei, east China's Anhui province.

China is facing a hepatitis C epidemic. 

The infectious disease, which can lead to cirrhosis, liver cancer and early death if left untreated, has hit rural areas particularly hard.
In June, China recorded 21,419 new cases of hepatitis C and 14 deaths related to the disease, according to new figures released by China's Center for Disease Control and Prevention. 

For the whole of 2018, the country had 219,375 new cases -- 43% more than in 2010.
China now has the world's largest burden of hepatitis C -- an estimated 8.9 million people, or 0.6% of the overall population -- according to a WHO study released in March. 

Many of them will die from it: China accounts for more then half of the world's annual liver cancer fatalities caused by hepatitis C, according to the study.
The disease is commonly spread by shared needles. 

Consumption of crystal methamphetamine, which has snowballed in recent years in China according to the United Nations Office on Drugs and Crime and can be taken by injection or inhalation, has contributed to the growing number of new infections, according to the WHO.
In Yi Prefecture, a mountainous region in Sichuan province along a major trafficking route with a high proportion of drug users, nearly five times the national average -- 2.8% of the population -- have hepatitis C, according to a study published in 2017 in the British Medical Journal.
Another contributor to China's epidemic is "unsterile medical injections which are often administered for unnecessary reasons," say the WHO report's authors. 

In May this year, 69 dialysis patients were infected in eastern China's Jiangsu province, primarily by unclean equipment and hospital workers' hands, China Central Television reported in May.
To exacerbate the problem, hepatitis C patients in China are not getting the care they need. 

In 2018, just 3.5% of infected people in the country were treated, according to the Polaris Observatory, a non-profit US initiative.
And while the most advanced antiviral treatments for the disease can cure 90% of cases, many patients simply can't afford medication, especially in rural areas. 

Three new hepatitis C drugs were approved by China's Food and Drug Administration in 2017, but they are not covered by China's basic medical insurance, which means patients have to pay for them out of pocket, according the Beijing medicine purchasing database, a government list of medicine purchased by state hospitals.
A 12-week course of Sofosbuvir, one of the treatments not covered by basic insurance, costs 69,600 yuan ($9700 USD).

The paranoia behind China’s treatment of Liu Xiaobo

For the regime, it was safer to turn him into a martyr than allow his ideas to spread 
By Jamil Anderlini

Liu Xiaobo, the great Chinese public intellectual and Nobel laureate died last week while serving an 11-year sentence for peacefully disagreeing with one-party rule in his country.
His death last week was a farcical spectacle of cruelty. 
His liver cancer was not discovered or acknowledged by his captors until he had just weeks to live, his medical treatment was little more than a fig leaf and his dying wish to leave China was rejected.
The government arranged a hasty burial at sea so that his grave could never serve as a shrine to the country’s most famous dissident, and his brother was paraded before the media to thank the Communist party and the government for his mistreatment. 
Given its roots as a revolutionary movement, the party understands very well the power of charismatic martyrs like Liu, which is why it takes him and his message so seriously.
Already pervasive levels of state censorship have reached new heights in the past week and the government has lashed out angrily at western media for their coverage of Liu and his untimely death. Beijing’s public argument boils down to this: Liu was convicted in a Chinese court so he is a common criminal, awarding him a Nobel Prize was a “blasphemy” and none of this is the business of anyone outside China.
The real rationale, expressed by some officials in private, is this: People like Liu, with their non-violent idealism, calls for individual freedom and willingness to die for their beliefs, pose a potent threat to one-party rule. 
The current Chinese leadership have read Alexis de Tocqueville’s The Ancien Regime and the French Revolution and also closely studied the periods leading up to the 1917 Russian Revolution, the 1911 Chinese revolution and the fall of the Soviet Union.
Their conclusion is that authoritarian systems are at their most vulnerable when they attempt to liberalise. 
The Chinese Communist party must therefore avoid this at all costs.
Since gradual political reform is off the agenda, individuals like Liu must be ruthlessly suppressed lest their spark sets off the prairie fire that could threaten the stability of Chinese society as a whole. 
The fact that Liu earned his stripes as a dissident during the 1989 Tiananmen Square demonstrations and subsequent massacre makes his case so much more significant.
China’s leadership argues, and many ordinary people believe, that the country’s economic success since then would not have been possible had the party not unleashed the People’s Liberation Army on unarmed demonstrators.
Government officials and Communist party cadres think it was a necessary evil.
They believe that the political chaos that could result from a fresh popular push for democracy would result in misery for hundreds of millions.
Compared with that, they ask, what is the suffering of one stubborn individual?
To understand the ruthless authoritarian paranoia behind Beijing’s treatment of Liu is not to excuse it.
This is how Liu himself put it in 2006: “Although the regime of the post-Mao era is still a dictatorship, it is no longer fanatical but rather a rational dictatorship that has become increasingly adept at calculating its interests.”
In calculating those interests, the regime has decided that it was safer to turn Liu into a martyr than to allow his ideas to spread unchallenged. 
This conclusion is probably correct in the short term.
Thanks to the party’s efforts, the vast majority of Chinese people have never heard of Liu and most of those who have heard of him think he was a hopeless troublemaker. 
His death will not spark a revolution.
But I wonder if the party’s calculation will prove correct over the longer term.
By explicitly rejecting gradual top-down democratisation, it is increasing the likelihood of an eventual bottom-up rejection of authoritarian rule. 
If and when that day comes, the demonstrators will no doubt carry banners featuring Liu’s smiling face and emblazoned with the words he wrote but was forbidden to read at his trial on Christmas Day in 2009: “There is no force that can put an end to the human quest for freedom, and China will in the end become a nation ruled by law, where human rights reign supreme.”

As Liu Xiaobo fades, his hopes for reform in China are dying as well

China’s Nobel peace laureate will be hard to replace, amid ever-tighter control
By Emma Graham-Harrison

Liu Xiaobo and his wife Liu Xia, in a photograph released by friends.
When the Chinese dissident and Nobel peace prize winner Liu Xiaobo succumbs to liver cancer, on a day that now seems both inevitable and imminent, the world will not only lose a moral giant. 

A fierce hope for change, a particular dream of a different China, is also lying on its deathbed in the northern Chinese hospital where Liu’s treatment is being rationed out, by doctors of unknown competence and uncharted loyalties.
Poet, intellectual, champion of peaceful protest, little-known inside China because of censorship but a much-lauded name beyond its borders, Liu embodied the fight he led courageously for nearly three decades.
Always resurgent after jail and harassment, he returned to the fray repeatedly over those years, despite the personal cost. 

“Even though I might be faced with nothing but a series of tragedies, I will still struggle, still show my opposition,” he said in a 1988 interview, before the Tiananmen Square massacre.
That spirit made change seem possible, perhaps even within his lifetime. 

His most recent jail sentence, handed down in 2009, was exceptionally severe, but he was still due to emerge at the end of this decade, with release offering the possibility of new writing, a new challenge to authorities.
His death will be convenient for the party he opposed for so long, allowing him to diminish into myth, and leaving no obvious successor.
There are many other dissidents in China – friends, supporters and even rivals of Liu – who face down the growing might of a wealthy authoritarian state with a courage that is hard for anyone protected by the guarantees of a democracy to fully understand.
But today, China seems more tightly controlled than at almost any time since the death of Mao Zedong. 

Even protests with no overt political agenda, such as feminists opposing sexual harassment, are ruthlessly crushed. 

The international community defers more to Beijing’s wishes than it has perhaps for centuries. 

And there is no substitute for the hope Liu offered through his life, as well as through his intellect, long after others had abandoned the idealism of the 1980s.
“Because of him, Chinese history does not come to a stop,” one of his oldest friends, Liao Yiwu, said after he had been awarded the Nobel prize. 

“After [the Tiananmen Square crackdown of] 1989, many people chose to forget what had happened, chose to go abroad, chose to divert themselves into doing business, or even to working with the government – but he did not.”
Liu first became known as a rebel in the 1980s, one of the most politically open decades in China’s recent history, when internal debates raged about where the country should head as it recovered from the cultural revolution.
“[Democracy] has not been a western preoccupation because when there has been opening up, we see people flock to a demand for freedom within China,” said Stein Ringen, emeritus professor at the University of Oxford and author of The Perfect Dictatorship: China in the 21st Century. 

“All through the 1980s, things were quite fluid, in part because there wasn’t really agreement in the leadership on what the [political] direction should be.”
Liu rose to international prominence during the Tiananmen Square protests, abandoning a position at Columbia University in the US to join students there. 

Jailed for his role, he took up the fight again after his release. 

He was never free from surveillance once he had raised his head above the parapet, often harassed, repeatedly jailed. 

He did not become an accidental hero. 

“If you want to enter hell, don’t complain of the dark; you can’t blame the world for being unfair if you start on the path of the rebel,” he said, in early writings quoted by translator and friend Geremie Barthe.
The crackdown in Tiananmen Square ushered in an era of international isolation, but censure could not survive the siren call of Chinese markets indefinitely, and Beijing was keen to mend the rift, seal its rapid rise in international standing. 

After China’s accession to the WTO in 2001, and in the run-up to the Beijing Olympics, the door towards reform seemed to open a crack again.
This was the China I came to know as a correspondent with Reuters, where authorities continued to jail dissidents, but lawyers, journalists and activists pushed the boundaries of state control and sometimes won victories too.
I even met Liu briefly then, though such was his reputation I was left virtually mute so remember little from the encounter but exchanging greetings.
Soon after, he would take on the authorities, be jailed, then awarded the Nobel prize, after joining forces with other dissidents to draft Charter 08. 

It was a call for change based on the anti-Soviet Charter 77, drawn up by activists in the former Czechoslovakia, also named for the year it was written, and radical only in the challenge they posed authorities.
“When Charter 08 was signed, there was a yearning for more open dialogue and talk about a peaceful societal transition,” Ai Xiaoming scholar and documentary filmmaker in the southern Chinese city of Guangzhou who signed the charter told the New York Times. 

“But now there is even more strict social control, and the room for civil society has shrunk significantly.”
Liu himself is fading, his final words and thoughts may collected imperfectly in some kind of brief outline, but as he is already reported to be severely ill, they may also be lost entirely.
The foreign support that might have bolstered his friends and buoyed dissidents taking on his legacy has been conspicuous by its absence or muted tone. 

Even Norway, which hosts the Nobel prize committee, has stayed silent on Liu’s illness, influenced by new ties with Beijing.
China’s economic might, and Xi Jinping’s search for absolute control means that Liu’s death brings a curtain down on a period where hope survived, even if it did not always flourish, and ushers in something darker.
“It’s very hard to see any organised opposition now emerging, or any person able to take a real position of authority against the regime,” Ringen said. 

“About these matters I am extremely pessimistic. I see absolutely no room for speaking out.”

German, US doctors visit ill Chinese Nobel winner

AFP

A file picture released by the family of Liu Xiaobo taken on March 14, 2005 shows 2010 Nobel peace laureate Liu Xiaobo, left, and his brother Liu Xiaoxuan.

US and German doctors examined China's Nobel Peace Prize laureate Liu Xiaobo on Saturday and concluded he was in a serious condition with late-stage liver cancer, the hospital treating him said.
The foreign doctors visited Liu, 61, at the hospital in the northeastern city of Shenyang following international pressure for China to let him go abroad or allow him to choose his own treatment.
Friends of Liu's fear he is near death since he was transferred from prison to the Shenyang hospital after he was diagnosed with terminal liver cancer more than a month ago.
The First Hospital of China Medical University said Liu was visited by American oncology expert Joseph Herman from the MD Anderson Cancer Center and German doctor Marcus Buchler from Heidelberg University.
The doctors, who were invited by the hospital at Liu's family's request, found that Liu had excess abdominal fluid and was in serious condition, the hospital said on its website.
They suggested that Liu undergo an MRI to evaluate his liver's condition and decide if he should undergo radiotherapy or another type of intervention.
If his liver function improves, they could consider immunotherapy, but for now Liu will continue supportive therapy to alleviate the pain and "elevate his quality of life," the hospital said.
"The American and German specialists have fully endorsed the treatment programme and measures by the group of national experts," it said.
Patrick Poon, a China researcher from Amnesty International, welcomed the decision to allow international experts access to Liu.
But Poon said the decision "shows that China is determined not to fulfil Liu Xiaobo's wish to receive medical care abroad".
Furthermore, the experts are unlikely to be able to speak about Liu's condition, Poon said.
"Reasons like privacy could be cited as the excuse of not disclosing any details."
Beijing has come under fire from human rights groups over its treatment of the activist and for waiting until he became so ill to take him out of prison, but authorities insist he has been afforded top medical care from renowned doctors.
The doctors' visit comes as Xi Jinping is in Hamburg, Germany, for a G20 summit ending Saturday.
Liu was sentenced to 11 years in prison in December 2009 for "subversion" after calling for democratic reform. 

At the Nobel ceremony in Oslo in 2010, he was represented by an empty chair.
A friend of Liu's, who asked to remain anonymous due to the case's sensitivity, told AFP that both his younger and older brothers are set to visit him in hospital for the first time this weekend.
But "Liu's friends are still not able to meet him," Poon said, which "speaks a lot about the restrictions Liu and his family face."

Criminal Nation

Persecuted to the End: China, Let Liu Xiaobo Leave

By Jackie Sheehan

'The struggle for proper protection of citizens’ rights in China will shortly have to go on without Liu Xiaobo, one of its most thoughtful, decent, and eloquent proponents.'

The 11-year sentence imposed on Liu Xiaobo in December 2009 dismayed anyone who had followed his career as a writer and activist over the previous 20 years, not only because it was completely unjustified for a man who had done nothing more than peacefully express his views, but also because its length meant that there was a real risk, given prevailing prison conditions in China, that Liu would not survive it.
In 2010 when Liu received the Nobel Peace Prize, I wrote that the Chinese government would be very anxious that he not die in prison, and that his international fame would be some protection against the worst abuses of his rights.
Seven years on, I doubt both those conclusions, given the utterly cynical way in which the government has waited until Liu is close to death from liver cancer and reportedly beyond treatment before transferring him from prison to the First Hospital of China Medical University in Shenyang.
That his wife, the artist Liu Xia, can now be with him every day is some small mercy for both of them.
Liu Xia has been through her own personal hell of surveillance and isolation since her husband won the Nobel Peace Prize, being confined to her apartment in Beijing and only allowed out under guard. Friends and supporters who managed to get a glimpse of her or speak to her feared for her mental health as years of this relentless persecution took their toll.
That Liu and his family have reportedly said they are satisfied with the treatment he is now receiving means nothing at all; as long as they are still on Chinese soil, they cannot be assumed to be able to speak freely. 
Even if there is nothing to offer him but palliative care at this stage, only outside China can Liu and those closest to him at least say what they really feel about China and about the ordeal which they have all undergone while he has been in prison. 
Even if Liu was able to write while in prison, it’s very unlikely that he was allowed to bring any papers out with him; Democracy Wall veteran and China Democracy Party founder Qin Yongmin had every scrap of paper, even his copy of his own notice of sentence, confiscated from him when he was released from jail in 2010.
If we are to hear anything more from Liu Xiaobo that we can trust as his authentic testimony, it will have to come from outside China.
Liu’s writings and activism have been part of a broad and long-running campaign in the PRC, taken up in various ways by different generations, to bring the ruling party under the control of the law and establish legal guarantees for the rights which all Chinese citizens have had on paper, in the Constitution, since the early 1950s.
Without such checks and balances, how an individual is treated in China has depended on who they are, and “rights” have actually been privileges, to be granted or withheld at the whim of the leadership.
There could be no better illustration of this than the fact that Bo Xilai, only five years into his prison sentence for corruption and abuse of power on an epic scale, was revealed to be suffering from liver cancer in the same week that Liu Xiaobo’s condition became known. 
Bo’s cancer has been detected at an early stage and should be treatable, and even though the facilities at Qincheng No.1 Prison have been described by a Chinese academic as “excellent”, he has reportedly been moved to a hospital near Dalian.
And clearly, prisoners should be entitled to good-quality medical care and parole in the case of serious illness, regardless of what they have done.
This is not an argument that Bo’s Chongqing torture spree in the service of his self-enriching crackdown on alleged organized crime should disqualify him from enjoying a prisoner’s basic rights. The point is that, because of his former CCP status, Bo has been given the consideration due to a prisoner found to be seriously ill, while Liu Xiaobo has only been admitted to a proper hospital when his cancer was already beyond treatment.
The withholding of medical parole and proper treatment from Liu Xiaobo is part of a pattern in recent years of targeting activists and lawyers in this way. 
In the case of Cao Shunli, she was managing several health problems when detained in September 2013 well enough to be planning to travel abroad to participate in a UN human rights review, but only five months later died after having medicines confiscated from her and being denied treatment in detention. 
The detention centre where she was held asked her family to apply for medical parole for her, clearly fearing that she would otherwise die in detention.
Guangdong anti-torture activist Huang Yan has reported receiving inadequate medical care for her ovarian cancer and diabetes while in prison, and the cancer had reportedly spread to other sites by April 2016. 
Environmental activist Peng Ming foreshadowed his own sudden death in prison with a warning to his family to suspect foul play if he met with an “accident”.
Huang was one of six cases of seriously ill prisoners highlighted by China Human Rights Defenders in an appeal to the UN in May 2016, a month before a CCP government White Paper on “New Progress in the Judicial Protection of Human Rights in China” was released, which included the following statement on detainees’ rights: “Prisons and detention houses should improve medical services for detainees, create medical records for them, staff them with stationed doctors, who make rounds of the cells every day, and transfer those who need to be treated in hospitals outside in a timely manner… We should improve medical facilities, strengthen disease prevention and control, provide timely treatment to sick detainees, and guarantee their rights to life and health in accordance with the law.”
But this was already the law in China, and routinely disregarded when it came to activist prisoners.
So the struggle for proper protection of citizens’ rights in China will shortly have to go on without Liu Xiaobo, one of its most thoughtful, decent, and eloquent proponents.
Perhaps his example can inspire his successors to try to do so without giving in to rancor, hatred, or desire for vengeance, but always with hope that there is nothing about China’s situation which makes citizens’ rights, social justice and freedom an impossible dream.

Liu Xiaobo, China’s Prescient Dissident

By Jiayang Fan

Even a diagnosis of late-stage liver cancer has not liberated Liu Xiaobo, China’s lone Nobel Peace Prize laureate.

China’s lone Nobel Peace Prize laureate, the political dissident Liu Xiaobo, is gravely ill.
In 2008, Liu, a prolific essayist and poet, was working on a manifesto advocating peaceful democratic reform, which became known as Charter 08, when the Chinese government tried him and found him guilty of “inciting subversion of state power.”
Since then, he has been serving an eleven-year sentence at a prison in the remote northeastern province of Liaoning, and his wife, Liu Xia, has been under house arrest in Beijing, despite the lack of any charges against her.
Liu’s diagnosis of late-stage liver cancer came at the end of last month.
The prognosis is grim.
In a video that a friend of the couple’s shared on social media, Liu’s wife says, through tears, that the doctors “can’t do surgery, can’t do radiation therapy, can’t do chemotherapy.”
Yet even this particularly wretched twist of fate has not liberated the man who has devoted his life to fighting for liberty.
Although Liu, who is now sixty-one, has been transferred to a hospital in Shenyang, on medical parole, he has yet to be granted release from his sentence.
Last Thursday, his lawyer said that the authorities are refusing to allow him to travel abroad for medical treatment.
In response to a statement from the United States Embassy calling for the couple to be given “genuine freedom,” the Chinese foreign ministry warned that “no country has a right to interfere and make irresponsible remarks on Chinese internal affairs.”
It added that “China is a country with rule of law, where everybody is equal in front of the law.”
This is a curious remark, given the increasingly repressive regime that Xi Jinping has fostered since taking office, in 2013. 
Civil society and the rule of law were part of what Liu campaigned for more than a decade ago, but, as unlikely as those concepts seemed then, they are less certain now.
After a period of enforced ideological conformity, the government has expanded its security apparatus, increased censorship, tightened its control of nongovernmental organizations, and toughened surveillance laws. 
Rights lawyers and activists have been arrested and jailed, and others have fled abroad.
Liu once had opportunities to do so himself.
A scholar of Chinese literature and philosophy, he taught at Beijing Normal University in the nineteen-eighties, where he became known for his frank reappraisals of China’s past and present, particularly of the brutalities imposed during the decades under Mao.
Liu’s passion and audacity could at times be provoking to both his peers and to the public, but they spoke to a deep investment in his country’s future and his determination to contribute to it.
His intellectual honesty rendered him vulnerable yet dauntless.
In the spring of 1989, Liu was in New York, where he was teaching at Barnard College, when the student protests calling for democracy and accountability began in Tiananmen Square.
He returned to Beijing and stayed in the square for several days, talking to the students about how democratic politics must be “politics without hatred and without enemies.”
When Premier Li Peng imposed martial law, Liu negotiated with the Army to allow demonstrators a safe exit from Tiananmen.
But, at the beginning of June, the Party ordered a crackdown, in which thousands of people were killed. (The state has never permitted an official tally.)
For Liu’s involvement in the events, the Chinese press labelled him a “mad dog” and a “Black Hand” for allegedly manipulating the will of the people, and he was sentenced to two years in prison for “counter-revolutionary propaganda.”
After his release, Liu was offered asylum in the Australian Embassy, but he refused it.
Similar offers came again and again, but a life in which Liu did not feel that he could make a direct impact held no appeal for him.
At a time when other intellectuals, registering the need for self-preservation, turned to writing books less likely to be banned on the mainland, Liu chose to prioritize his principles, in order to be an “authentic” person.
He was barred from publishing and giving public lectures in China, but on foreign Web sites he wrote more than a thousand articles promoting humanitarianism and democracy; he called the Internet “God’s gift to China.”
Liu was awarded the Nobel Peace Prize, in 2010, while he was serving his sentence, in recognition of “his long and non-violent struggle for fundamental human rights in China.”
In an essay titled “Changing the Regime by Changing Society”—which during his trial was cited as evidence of his counter-revolutionary ideals—Liu expressed hope that the Chinese people would awaken to their situation and that their new awareness would forge a sense of solidarity against the state.
But he also warned of a growing moral vacuum in the nation.
He wrote:
China has entered an Age of Cynicism in which people no longer believe in anything...
Even high officials and other Communist Party members no longer believe Party verbiage. 
Fidelity to cherished beliefs has been replaced by loyalty to anything that brings material benefit. Unrelenting inculcation of Chinese Communist Party ideology has produced generations of people whose memories are blank.
It’s impossible to say what access Liu has had to the outside world during his incarceration.
It would certainly pain him to see how little younger people in China care or even know about the events in Tiananmen (the subject is strictly censored in the media) and how the nation’s growing international prominence has obscured its domestic ills—though he predicted as much.
“The Chinese Communists are concentrating on economics, seeking to make themselves part of globalization, and are courting friends internationally precisely by discarding their erstwhile ideology,” he wrote in 2006.
“When the ‘rise’ of a large dictatorial state that commands rapidly increasing economic strength meets with no effective deterrence from outside, but only an attitude of appeasement from the international mainstream, the results will not only be another catastrophe for the Chinese people, but likely also a disaster for the spread of liberal democracy in the world.” 
It perhaps would not surprise him to hear that last week, austerity-stricken Greece, which is courting Chinese investment, blocked a European Union effort to issue a statement condemning China’s human-rights violations.
As the news of Liu’s illness spread surreptitiously throughout China, democracy activists started a petition far narrower in its ambitions than Charter 08.
It asks only for Liu to be freed and to be given whatever medical care might help him now.
He would surely be grateful to his supporters for that gesture, but more than his illness he would regret how correctly he diagnosed Beijing’s recurring authoritarian impulses and his countrymen’s growing indifference to them.
Liu has always been a man of ideas, but that prescience will be of no comfort to anyone.