What can the world learn from the U.S. and China’s vastly different responses to COVID-19?

By Shuyue “Sylvia” Wang

Introduction

The COVID-19 pandemic, which emerged in late 2019 in Wuhan, China, became one of the most significant global health crises of the 21st century. The World Health Organization (WHO) declared the pandemic over in 2023 (Rigby and Satija). By July 2024, more than seven million deaths had been reported worldwide, according to the WHO COVID-19 dashboard. Beyond the health impact, the pandemic inflicted severe economic losses globally. In China, the implementation of the zero-COVID policy in 2022 caused its economy to falter, resulting in a GDP contraction of approximately 3.9 percent (Gong et al.).

As the world's two largest economies, the United States and China faced considerable challenges in their pandemic responses, shaped by their distinct governance structures and cultural contexts. In the United States, responses varied significantly across states, with state and local governments leading the management of the pandemic through public health measures such as mask mandates, social distancing, and resident care. In contrast, with a single-party system, China’s leaders were able to enforce strict pandemic policies quickly, aiming for zero COVID cases across the nation.

This comparative analysis explores the structural, sociopolitical, and cultural factors that influenced the pandemic responses in these two countries. Key factors include governance models, health agency structures, and the influence of cultural and political dynamics. The paper also assesses the strengths and weaknesses of each country’s response, drawing attention to critical lessons learned in areas such as health communication, political leadership, technology use, and the need to address the stigmatization and politicization of public health crises for future pandemic preparedness.

Structure

State-by-State Flexibility vs. Top-Down Control

The United States of America comprises fifty states and the District of Columbia, operating under a system of federalism. The federal government is divided into three branches—executive, legislative, and judicial—with the president serving as the head of the executive branch. While state governments hold most powers, the Constitution grants the federal government limited authority. The decentralization of the U.S. governance structure significantly impacted the country's pandemic response. Responses varied widely across states, with measures depending on local outbreak rates, while coordination from the federal government remained weak (Haffajee and Mellocite). This patchwork approach highlighted the challenges of a fragmented system during a national emergency (Zhao and Guy). Additionally, the U.S.'s two-party political system, dominated by the Democratic and Republican parties, influenced public compliance with COVID-19 measures, state responses, and health messaging.

In contrast, China is a socialist republic governed by a single party, the Chinese Communist Party (CCP). China’s centralized decision-making and top-down approach were evident in its response to COVID-19. The country has twenty-three provinces, five autonomous regions, four direct-controlled municipalities, and two special administrative regions. Each province is subdivided into prefectural-level cities, which are further divided into counties or districts. The central government, or State Council, directs provincial governments, which are responsible for implementing national policy. Unlike the U.S., where cities operate independently of state control, Chinese provinces directly supervise the cities and counties under their jurisdiction. This centralized approach allowed the CCP to enforce its zero-COVID policy, also known as the dynamic zeroing policy, across all regions (Zhao and Guy).

Benefiting from the single-party system, China’s leaders were able to enforce strict pandemic policies quickly. The government’s relationship with cellular service providers also allowed the government to leverage mobile phone data for mass surveillance and contact tracing. For example, China capitalized on its three state-owned telecommunications companies to create the centralized “Telecommunication Big Data Travel Card,” also known as the itinerary code, which tracked users’ movements across provinces and cities within a fourteen-day period using telecom and GPS signals (Yu). In contrast, U.S. cellular providers operating in the private sector limited the government’s access to data, resulting only in state-level collaborations (DeSalvo et al.).

As part of the mass surveillance, emerging digital health technologies from provinces and municipalities evolved. Health code apps in China, such as the Sichuan Health Code and Shanghai Health Code, combine health records, COVID-19 test results, and vaccination data onto one platform, enabling widespread screening and contact tracing. However, these apps raised concerns about privacy and the potential misuse of political power (Cheng et al.; Zhong). Also, the apps contributed to the stigmatization of individuals who tested positive for COVID-19. Erving Goffman describes stigma as "discreditable" when an attribute is not immediately visible to others but can be revealed later (14–15). This concept aligns with how a positive COVID-19 test result is initially invisible but can become known through health code checks. For people in China, a positive COVID test wasn’t just a health matter; the stigma around it often followed them everywhere, thanks to the country’s health code app. One nursing home worker found herself unable to keep her past infection private, as clients could see her history with just a quick scan. Stories like hers reflect the difficult balance between public safety and privacy in a tightly controlled system (Southern Metropolis Daily, “Xinguan quanyu hou de tamen”). As shown in Figure 1, clicking on the button ‘Vaccine & COVID-19 tests’ displays a history of previous COVID-19 test results.

Fig. 1. Shanghai Health Code screenshot from December 15th, 2022. Screenshot by the author.

How Governance Shapes Public Health Agencies

The governance structures of the U.S. and China extend into the operations and authority of their respective Centers for Disease Control and Prevention (CDC), shaping how each CDC manages the pandemic. The American CDC, a federal agency, reports directly to the federal government and has historically operated with substantial autonomy (Bouey). In contrast, China’s CDC operates under a more complex hierarchical system, with national, provincial, prefectural, and county-level branches. Each CDC branch is managed by its respective provincial or local government and health commission (Xiao et al.). The China CDC at the national level functions primarily as a research institution under the National Health Commission (NHC), with limited authority to manage lower-level branches (Bouey).

These structural differences had significant implications for each country’s pandemic response. While the American CDC has the authority to announce outbreaks and mandate quarantines, China's CDC lacks legal and administrative power. According to Zhong Nanshan, a renowned coronavirus expert, the low status of China’s CDC delayed the announcement that COVID-19 could be transmitted from person to person. Although local CDC branches confirmed person-to-person transmission earlier, they could only report this to local governments and were “unable to do anything else” (Shenzhen News Network). Local governments held discretion over whether to report findings up the chain, resulting in delays in critical epidemic data (Sun et al.). To improve China’s pandemic response, experts have called for elevating the CDC’s status and granting it more administrative power.

In comparison, the U.S. CDC enjoys greater authority and autonomy, though it does not have jurisdiction over state-level decisions. However, during the COVID-19 pandemic, the Trump Administration interfered with the CDC’s policymaking and public communications, undermining its response efforts (Schiff and Mallinson). Moreover, the Supreme Court limited the CDC’s regulatory powers by interpreting the scope of its authority under the Public Health Service Act (National Academies of Sciences, Engineering, and Medicine 15). The court’s ruling striking down the CDC’s nationwide travel mask mandate further weakened its ability to control virus transmission (Huang, “Battle Over CDC’s Power”).

In both the U.S. and China, political administrations—namely, local governments in China and the Trump Administration in the U.S.—hampered the CDCs’ ability to respond effectively to the pandemic (qtd. in Huang, “Battle Over CDC’s Power”). Expanding the regulatory and administrative powers of public health agencies during health emergencies is critical to safeguarding public health, as suggested in a report by the National Academies of Sciences, Engineering, and Medicine 16. The governance structures and challenges faced by public health agencies in the U.S. and China also affect the dissemination of health information and the implementation of policies.

Dissemination of Health Information      

Health messaging played a critical role in responding to the COVID-19 pandemic by ensuring that accurate information was communicated to the public. Both the U.S. and Chinese governments utilized social media platforms (SMPs) to disseminate health information. The pandemic highlighted several challenges, including shortcomings in government communication through SMPs, delays in disseminating accurate information from authorities, and other vital aspects of health messaging.

Health Messaging Through Social Media Platforms

Governments and public health authorities in the U.S. and China leveraged SMPs to quickly disseminate health information to citizens. U.S. health authorities used these platforms to share information on COVID-19 testing, steps to follow when experiencing symptoms, and vaccination availability. Similarly, China’s government and CDCs used major platforms such as WeChat and Sina Weibo to release updated policies, provide daily statistics on new cases and deaths, and promote science literacy to the public (Shao et al.). Additionally, SMPs enabled governments to monitor trending information, allowing them to combat rumors and misinformation (Volkin).

However, there were notable shortcomings in this type of communication. In the U.S., SMPs allowed politicians with differing opinions to express their stances on COVID-19, resulting in mixed messages that contributed to the politicization of health messaging. In early 2020, conflicting statements from government officials confused the public: former Surgeon General Jerome Adams initially declared masks ineffective on Twitter in February 2020, only to later advocate for mask-wearing in April (Madhani). Some politicians heavily politicized the COVID-19 pandemic for partisan gain, creating a polarized social media environment. Michael Caputo, a former top spokesperson for the Department of Health and Human Services (HHS) and a Trump loyalist, spread COVID-19 conspiracy theories on his personal Facebook, claiming that Democrats were using the pandemic to unseat Donald Trump (Huang, “HHS Spokesperson”).

In China, health information dissemination via SMPs follows a one-way communication model, where government officials provide the public with updates without avenues for public feedback or interaction. The lack of interaction between the government and the public often left viral misinformation unaddressed by authorities (Zeng and Li; Shao et al.). Zeng and Li argue that the public’s perception of the government as inaccessible created a "psychological distance" between citizens and officials, discouraging public engagement. This reluctance may also relate to China’s cultural norm of high-power distance (Dathe et al.). High power distance refers to societal acceptance of unequal power distribution, where people in lower hierarchical positions accept the authority of superiors (Hofstede). In China, where the CCP holds centralized power and is trusted by the population, this high-power distance can lead to fear of authority and limited communication between subordinates and superiors (Zhao and Guy; Guang et al.). This hierarchical dynamic may have further impeded the government’s ability to address misinformation effectively (Dai et al.).

Delay in Disseminating Accurate Information

Another challenge faced by both the U.S. and China during the early stages of the pandemic was the delay in disseminating accurate information due to political and systemic issues. In the U.S., President Donald Trump intentionally downplayed the severity of COVID-19, distracting the public from the seriousness of the situation (Brooks). This downplaying fueled public skepticism, with many Americans believing the virus threat was "overblown," reducing their willingness to follow protective measures (qtd. in Brooks). Additionally, the CDC’s guidance on mask-wearing was inconsistent. Initially, the CDC discouraged masks, only to later recommend them in April 2020, a shift some attribute to a mask shortage and the need to prioritize medical workers (Tucker et al.). Experts argue that the CDC could have better communicated the need to reserve medical-grade masks for healthcare workers while promoting cloth masks for the general public (Marquez). This inconsistency eroded public trust, with 73% of respondents in a 2022 survey expressing a lack of confidence in the CDC due to "too many conflicting recommendations" (Vankar). Some attribute the declining trust in the CDC to political interference from the Trump administration. From a broader perspective, the shifting guidance from the CDC reflects the evolving nature of the pandemic and the advancement of science as new data emerges (Chow).

In China, delays in confirming and publicly announcing that COVID-19 could be transmitted person-to-person were attributed to a lack of transparency. Hospitals in Wuhan did not disclose information about infections among patients and healthcare workers to investigation teams sent by the National Health Commission. One expert from the second investigation group mentioned limited access to information and suspected that hospitals were withholding data (Sina News). This delay highlights the need for systemic reforms to improve transparency and coordination between hospitals and public health agencies. Furthermore, the lack of autonomy among local CDC branches in China also contributed to communication delays, as discussed in the previous section (Sina News).

Empowering Public Health Through Effective Messaging

For health messaging to be effective, it must be clear and tailored to diverse audiences, as comprehension directly influences trust and compliance (Williams et al.). Holley Wilkin, an associate professor of communication studies at Georgia State University, notes that health messages do not reach a "monolithic audience"; people respond differently depending on their backgrounds. The complexity of COVID-19 responses requires collaboration among various entities, including different ethnic groups and stakeholders, making it essential for health communication to be both culturally tailored and factually consistent (DeSalvo et al.; Marquez). Communities in China used folk performance arts to engage the public with rhythmic, memorable campaigns promoting preventative measures (China Central Television). Similarly, U.S. communities tailored multilingual health messages to immigrant, Latino, and Black populations to raise awareness about vaccines and protective measures (Brewer et al.).

In addition to disseminating essential health information, effective health messaging should emphasize collective responsibility in overcoming a health crisis. China’s central government framed anti-epidemic efforts as the "people’s fight," emphasizing that every citizen had a role to play (China's State Council Information Office). In contrast, the U.S. government took a more individualistic approach, presenting COVID-19 protection measures as a personal responsibility rather than a collective effort, which failed to convey the importance of collective action in defeating the pandemic (Tomori et al.; qtd. in Brooks). Despite this, many U.S. citizens stepped in to fill the gap, promoting preventative behaviors through social media campaigns advocating vaccines and mask-wearing (Basch et al.; de Vere Hunt et al.).

Challenges in public health messaging persist, particularly as the public expects clear guidance from health agencies amid an unpredictable pandemic. As Sandra Albrecht, an assistant professor of epidemiology at Columbia University, explains, public health information—such as risk levels post-vaccination—is often complex and not easily reduced to binary terms (Chow).

As health information was disseminated, the next critical step was ensuring that policies were effectively implemented on the ground. Clear and consistent public messaging laid the foundation for successful implementation; however, inconsistent or conflicting messages often undermined adherence to health measures. The transition from communication to action required that both the U.S. and China address challenges unique to their governance structures. In the U.S., localized implementation of policies reflected the complexities of a federalist system, where state and local governments held considerable authority in health responses. Meanwhile, in China, centralized directives faced regional adaptations and, at times, overzealous enforcement by local authorities. As the focus shifted from informing the public to enforcing policies, each country encountered a distinct set of obstacles, demonstrating that effective health responses rely not only on accurate messaging but also on the ability to translate those messages into cohesive, localized action.

Implementation

Both the American and Chinese governments faced a gap between policy-making and implementation (Zhao and Guy). Therefore, how localities implemented policies was critical for pandemic control. Both countries exhibited significant variation in the scope and stringency of policy implementation, with conflicting policies between local and upper-level governments often arising from political division and regional discrimination.

In the U.S., the response to COVID-19 was largely localized and fragmented, lacking cohesive national guidance from the federal government. This decentralized approach, a feature of American federalism, meant that state governments were better positioned to respond to outbreaks, as only they could enforce measures like shelter-in-place orders (Shaw). The Federalist structure clarified the roles of states and local governments (cities, counties, etc.), which were the first responders in implementing aggressive measures such as mandatory vaccinations, business closures, and stay-at-home orders (Berman 6). Meanwhile, the federal government’s role was to oversee the national response, coordinate leadership, and support states and local governments with scientific research, treatments, and supplies (Berman 7). Haffajee and Mello recommended that federal leadership provide unified guidance by establishing a playbook, setting up mitigation strategies, and creating a timeline to align decision-making across the country. However, responses varied widely among states during early 2020. For instance, while California enforced proactive statewide lockdowns, North Dakota did not recommend or mandate similar measures (Haffajee and Mello). This inconsistency highlighted the need for federal leadership to provide unified guidance for state-level responses. As shown in Figure 2 (McCarthy), the patchwork of state-level responses highlighted the need for unified federal guidance.

Fig. 2. COVID-19 stay-at-home orders across U.S. states as of April 2020 (McCarthy). 

The political landscape in the U.S. further complicated the COVID-19 response. The partisan divide resulted in differences in the speed and duration of preventive measures implemented by Republican and Democratic governors (Neelon et al.). This divide extended to individuals, affecting voluntary compliance with social distancing and masking (Clinton et al.).

Lockdowns and Labels: The Cost of China’s Risk-Based COVID Response

In contrast, China’s response was characterized by its “dynamic zeroing” national strategy, which aimed to achieve zero domestic COVID-19 infections. The variation in implementation across the country stemmed from the government’s classification of regions into high-, medium-, and low-risk categories, allowing localities to enforce measures based on their specific situations (Lyu et al.). The State Council provided different mitigation strategies for each risk level, enabling local governments to manage region-specific outbreaks more effectively, especially after the severe outbreaks of 2020 (Cheng et al.). However, the varying lockdown measures under this risk-based classification system led to regional discrimination. Travelers from high- or medium-risk areas were also subject to strict restrictions and verbal attacks; some were even accused of maliciously spreading the virus (Zhang).

Regional discrimination was particularly evident in the case of the Hubei people. Findings by Fan et al. indicate that individuals residing in or associated with epicenters, such as Hubei Province (where Wuhan is located), faced increased stigmatization and discrimination in daily life and the workplace. Fan et al. further observed that discrimination against people from Hubei intensified during the Chinese New Year, a time of significant travel that accelerated the virus's spread. Residents of Hubei were already burdened with the stigma of being labeled “virus carriers.” In response, local authorities, concerned that the holiday could trigger new outbreaks, enforced strict COVID-19 measures specifically targeting people from Hubei, exacerbating existing stigmatization. Private information about Wuhan residents, including their ID numbers, phone numbers, and home addresses, was made public, and individuals from Hubei were denied entry into some hotels, regardless of their health status (Southern Metropolis Daily, “Chao Qi Qian Wuhan Fan Xiang Zhe”; Yang). Increased discrimination against people from Hubei can be attributed to heightened fears of infection during the holiday period, as seen in prior studies (Zhang et al.).

When Central Directives Clash with Local Realities

A common challenge for both countries was the disparity between upper-level policies and lower-level implementation. In the U.S., the one-size-fits-all approach taken by some states did not suit every region. For example, California was one of the first states to implement statewide lockdowns and business closures, but rural counties pushed back, arguing that the state’s policies did not account for their local economic potential. Despite these concerns, the Governor of California insisted on unified state control (Ho). In addition, conflicting policies emerged within states as some governors prohibited localities from enforcing mask mandates, while certain local officials defied these prohibitions and required masks. These conflicts reflect varying levels of adherence to the CDC’s recommendation for continued masking (Kim and Romero). In China, the conflict between central policies and local implementation resulted in overly stringent measures as local officials sought to avoid responsibility for potential outbreaks in their jurisdictions. When the central government eased COVID-19 policies in 2022, many local governments continued to enforce excessive anti-epidemic measures out of fear of penalties, resulting in a one-size-fits-all approach that failed to account for local conditions (Qiang et al.). For instance, Zhengzhou City imposed a full lockdown rather than targeted epidemic controls (State Council Joint Prevention and Control Mechanism).

Conclusion

The COVID-19 pandemic highlighted critical lessons in public health communication, decision-making, and policy enforcement, underscoring the unique strengths and challenges of governance structures in both the U.S. and China. In the U.S., decentralization enabled local adaptation but led to fragmented, inconsistent responses across states, while political interference complicated clear health messaging. China’s centralized model facilitated swift, coordinated actions, but its hierarchical system and limited transparency delayed essential information sharing.

Clear, consistent health messaging proved essential for fostering public trust and compliance. The U.S. struggled with conflicting announcements from the CDC, undermining public confidence in health guidelines and slowing the uptake of preventive measures. China, while generally unified in messaging, faced limitations in transparency and interactivity, especially on social media platforms where a one-way communication model stifled public engagement. For both countries, enhancing open and interactive communication channels is vital for managing future crises effectively.

The pandemic also illustrated the value of tailoring policy to local needs. While the U.S. federal structure allowed states to adapt responses to their unique contexts, a lack of federal coordination highlighted the need for cohesive, unified protocols. Similarly, in China, greater flexibility and autonomy at local CDC branches could improve responsiveness, particularly in the timely dissemination of local outbreak information.

Political and social factors deeply influenced pandemic responses in both countries. In the U.S., the politicization of COVID-19 further polarized public opinion and complicated compliance with health measures. In China, high-power distance created a psychological barrier between the public and authorities, leading to a lack of interaction and leaving misinformation unaddressed. Social stigma arises as a human cost of using health codes in mass surveillance. For future public health challenges, both countries could benefit from fostering public trust through depoliticized, transparent information-sharing frameworks that empower individuals and communities.

Ultimately, the U.S. and China’s COVID-19 responses reveal that no single approach is universally effective. The U.S. leveraged flexibility at the state-level, though at the expense of nationwide consistency. China’s centralized strategy enabled rapid action, though sometimes with limited regard for individual freedoms. A balanced approach, one that prioritizes timely, transparent communication, respects individual agency, and adapts to local needs, could offer a model for future pandemic responses that both protect public health and honor individual rights.

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