Both the US and China responded to the 2009 H1N1 pandemic in a decisive and swift manner. However, they handled the crisis with fundamentally different strategies. From the start of the crisis, the US approach was mitigation, focusing on minimising the impact by maximising surge capacity. By contrast, China's response until September 2009 was characterised by an aggressive containment approach that sought to establish barriers against the spread of the disease. In doing so, emphasis was placed on reducing the surge. While the divergent policy responses can be attributed to the differences in the pattern of spread of the virus and policy learning experiences, Chinese leaders had strong political incentives to pursue an excessive approach not informed by science and epidemiology. A comparison of the effectiveness of the two strategies clearly points to the inferiority of the containment strategy in handling the H1N1 pandemic. It is true that decision-makers tend to err on the side of caution when encountering an unpredictable and potentially disastrous novel disease, but that is no justification for allowing risk assessment and risk communication be dominated by worst-case scenarios, or allowing domestic political concerns to prevail over science in decision-making. A comparison between the US and China also suggests the importance of beefing up core surveillance and response capabilities in a coherent and sustainable manner.
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