COVID-19 and China’s Health Code System

The health code system (健康码) that the Chinese government has developed in response to COVID-19 builds upon long established traditions of population surveillance and control. No region in the world has a longer and more sustained history of gathering population data than China. The various regimes that have ruled this region have used civil registers to monitor their populations since ancient times. They had already developed sophisticated systems of community-based surveillance a thousand years ago.[i] Modern governments have been no less zealous in their pursuit of information for the purposes of governance. Since 1949, the Chinese Communist Party have conducted numerous data gathering projects, using information compiled by work teams to divide citizens into taxonomies of class, ethnicity, and household registration.[ii]

The latest taxonomic project is designed to separate healthy citizens from those infected with COVID-19.[iii] The latter category is further subdivided into four groups; confirmed cases, suspected cases, those with a fever, and those who have had contact with a confirmed case. Each individual is assigned a colour within a traffic light system. A green status indicates a healthy person, an amber status indicates potential contact with an infected person, while a red status indicates a confirmed or suspected infection. Those assigned to the two last categories are required to undergo a period of quarantine, usually for fourteen days, and to submit data such as temperature readings. At the time of writing, it seems that an individual’s colour status is determined largely by antigen rather than antibody testing, meaning that that the health code system monitors active rather than recovered cases. Whether antibody testing might later be incorporated into the system remains unclear, particularly as the issue of reinfection has yet to be resolved. The colour status system is used to regulate an individual’s movements, depending on restrictions in place in a particular region. In its strictest form it can be used to determine whether a person is permitted to leave their residential area or take public transportation.  

The health code system has made extensive use of online platforms such as WeChat and Alipay. Individuals use these to generate their own personal QR codes, which can be scanned to determine their entrance into or exit from a particular area. It helps that QR codes, which are in their infancy in countries such as the UK, have long been used in China for financial and other transactions. In some areas, health code systems have also been integrated with facial recognition software, meaning that individuals merely have to present themselves to be scanned. Though it is technically possible to apply for a non-digital health code, this currently only lasts for a limited period. This, of course, leaves those sections of the population who do not possess smart phones, including many elderly and impoverished people, at a distinct disadvantage. The advantage of using this system, however, is that it allows health authorities to track COVID-19 by monitoring individual interactions within large mobile populations. To give one example, if the status of an individual passenger on a bus changes from green to amber, the colours of all the other passengers also change. Whereas case tracking in most countries currently relies upon knowledge flowing through personalised networks, with individuals informing each other if they suspect that they are infected, the health code system is able to monitor a depersonalised network of fleeting contacts.  

Given its distinctly Orwellian overtones, one might assume that the health code system was imposed on the population by the central government. However, in its initial phase at least, it was actually developed as a local initiative. The first health codes were created on February 7th in the Yuhang District of the city Hangzhou and were designed as a means to cope with high levels of internal migration. Many other regions soon followed suit, creating their own health codes. This localised pattern of development created a number of problems, as it meant that each region that operated its own code system became separated from the outside world by a data wall (数据墙). It soon became apparent that it was necessary to integrate these localised systems, so provinces began to undergo a process of mutual recognition (互认). Data walls were torn down and replaced by an archipelago of data island (数据孤岛). Currently, as long as an individual’s province or city has been recognised by others, then they are free to hop between these data islands, which operate as a system of cooperating information regimes. If an individual’s own geographic area has not been recognised, however, then when they arrive in a new region, they will find that their green status automatically switches to amber, meaning they will then be required to undergo a period of quarantine.  

The mutual recognition system has resulted in considerable problems for those who find themselves in high risk areas. Chief amongst these are the population of Hubei. As the pandemic is widely believed to have started in this province, local residents have reported significant discrimination, being barred from travelling to or residing in other areas. An unwillingness to ratify Hubei green codes is perhaps understandable, as it seems that some with such designations have later been found to be carrying the virus. Understandably, however, residents of Hubei who have a green code feel somewhat aggrieved when they are unable to leave their own province. Recently, the unwillingness of Jiangxi authorities to allow entrance to Hubei citizens led to a clash between protestors and police forces from the two provinces on a bridge on the outskirts of Jiujiang City. Other regions have been more accommodating to migrants from Hubei, particularly manufacturing areas that have found themselves in desperate need of labourers.  

The other group currently seen as a major source of suspicion in China, are the large number of citizens who have returned from overseas. These include students who were studying in foreign universities. Like residents of Hubei, returned migrants and travellers have faced discrimination and vitriolic attacks on social media, yet they are, admittedly, the leading vectors of infection in China today. In response to the problem of returning overseas citizens, some areas have begun to implement an international version of the health code system, although this is still in its infancy. Whether or not digital surveillance becomes a fully international phenomenon remains to be seen. While other nations are unlikely to adopt a system as stringent and invasive as that found in China, many are experimenting with similar forms of digital health monitoring. Researchers at the University of Oxford, for example, are attempting to develop a mobile contact-tracing app for use in the UK.[iv] Other East Asian nations have developed their own digital contact-tracing systems  

It is not hyperbolic to suggest that China’s health code system represents an unprecedented form biological governance. Having witnessed its emergence, alongside the resuscitation of long dormant practices of quarantine and policing, it is unsurprising that many scholars have begun dusting off their copies off Foucault. Invoking biopolitics in the context of COVID-19 seems to have become a kind of intellectual Pavlovian response, with scholars including Bruno Latour and Giorgio Agamben all answering the call.[v] The lukewarm reception that the interventions of these intellectual luminaries has received, reveals, perhaps, that we have a greater appetite for abstract theorising when pathogens are held safely at bay.[vi] When everyone around us starts to develop a dry cough, we seem to favour more sombre evidence-based discussions of the relative efficacy of various policies of biological governance.  

Foucauldian scholars have never been particularly interested in issues as banal as efficacy, or in questions as naïve as whether or not the disciplinary practices they deconstruct actually helped to improve the health and wellbeing of populations. Yet, as Simon Szreter and Keith Breckenridge have argued, it is often those who have been excluded from the machinations of the biopolitical state that have suffered the worst consequences, being unable to access vital assets such as healthcare and famine relief.[vii] The COVID-19 pandemic has taught us that we must consider the efficacy of strict biological governance not simply critique its disciplinary effects. After all, the most egregious abuses of power during the pandemic have not come from states that have maintained strict control over the bodies of their populations, such as Singapore, South Korea and Taiwan, but have, rather, been perpetrated by figures such as Trump and Bolsonaro, who have chosen to deny their populations the benefits of mass testing and contact tracking.  

One of the most urgent questions we all face today is the extent to which we are willing to overlook the implications of widespread biological surveillance in order to control the pandemic. This issue is particularly fraught in China, where it is not difficult to envision a future in which the big data surveillance technologies currently being innovated might be used against less legitimate targets than COVID-19. For the hundreds of thousands of Uyghurs detained in the concentration camps or monitored in their homes, the draconian surveillance state is already a painful reality. At the same time, we cannot escape the conclusion that population surveillance is a vital necessity in order to overcome this terrible disease. We are living in a world of least worsts. As Alison Bashford noted in her recent reappraisal of the apparatus of quarantine in the context of COVID-19, “disease can’t be controlled in any urgent present by what ought to be.”[viii] So if you are the type of person who feels they ought to decry a biopolitical system in which the state uses big data to monitor both bodies and populations, you should not feel too guilty if you find yourself, in your long hours of state-mandated privacy, hoping that the Chinese health code system might turn out to be a great success.[ix]

Works Cited

[i] Von Glahn, Richard, “Household Registration, Property Rights, and Social Obligations in Imperial China: Principles and Practices,” in Keith Breckenridge and Simon Szreter (eds) Registration and Recognition: Documenting the Person in World History, Oxford University Press, Oxford, 2012.

[ii] On ethnicity, for example, see Mullaney, Thomas, Coming to Terms with the Nation: Ethnic Classification in Modern China. University of California Press, 2010.

[iii] The following description of the health code system is based upon online interviews with residents of Wuhan, supplemented by the following articles 王阳  张守坤, “健康码何时实现全国互通互认,” 法制日报, 30.03.2020; 张兴华, “健康码：让复工复产按下快捷键” 光明日报 22.03.2020; 陈绪厚 何利权, “‘持湖北绿码被确诊’,多地采取行动了,” 澎湃新闻, 01.04.2020

[iv] Big Data Institute, “Controlling coronavirus transmission using a mobile app to trace close proximity contacts,” 31^st March 2020, https://www.bdi.ox.ac.uk/news/controlling-coronavirus-transmission-using-a-mobile-app-to-trace-close-proximity-contacts

[v] Latour, Bruno “Is This a Dress Rehearsal?” Critical Inquiry, 26^th March 2020; Agamben, Giorgio (trans) “The Invention of an Epidemic” European Journal of Psychoanalysis, 26^th February 2020 [vi] For critiques of Latour and Agamben see Clover, Joshua, The Rise and Fall of Biopolitics: A Response to Bruno Latour, Critical Inquiry 29^th March 2020; Berg, Anastasia, “Giorgio Agamben’s Coronavirus Cluelessness” The Chronicle of Higher Education, 23^rd March 2020

[vii] Breckenridge, Keith and Simon Szreter (eds) Registration and Recognition: Documenting the Person in World History, Oxford University Press, Oxford, 2012.

[viii] Bashford, Alison, “Beyond Quarantine Critique,” Somatosphere, 6^th March 2020

[ix] I would like to thank Eddie Schmitt for his (socially distanced) input into this article. Any errors are mine alone.

---

Chris Courtney is an Assistant Professor of Chinese History at the University of Durham. His research focusses on the environmental and social history of Wuhan and Hubei. He is the author of The Nature of Disaster in China: The 1931 Yangzi River Flood, a study of one of the deadliest disasters if its kind in human history. He is currently writing a history of heat in modern China, examining how ordinary people coped with the challenge of living with extreme temperatures in the twentieth and twenty-first centuries.