Decoding the data of the Chinese mpox outbreak

This story first appeared in China Report, MIT Technology Review's newsletter about technology developments in China.Sign upto receive it in your inbox every Tuesday.

Almost exactly a year after the World Health Organization declared mpox (formerly known as monkeypox) a public health emergency, the hot spot for the outbreak has quietly moved from the US and Europe to Asia. China in particular is experiencing a concerning increase in mpox cases right now.

This morning, I published a story on the developing mpox situation there and the government's response so far. While Beijing did recently issue a guidance on mpox prevention, the country hasn't taken a very proactive approach to containing the outbreak-a stark contrast from its strict covid policies (which I wrote about extensively last year).

It's particularly worrying that the government hasn't talked at all about using mpox vaccines, though there are three options available globally and they have proved to be effective at containing the mpox spread in countries including the United States.

Beijing's omission may be a result of technology nationalism," says Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. But delaying the approval of effective foreign vaccines could stymie prevention and result in more dangerous outcomes, Huang warns-the same thing that happened with covid.

You can read more about the difficulties in containing the mpox spread in China in the story today. But in this newsletter, I want to highlight a different challenge: because of the way Beijing has so far reported mpox data and the way the WHO publishes it, it's quite difficult to understand the exact scale of mpox in the country.

When I started reporting this story, I found that the only available mpox case count China has published is a one-time report tallying cases from June 2 to June 30. No information on weekly developments or cases from before or after June has been made public, even though other Asian countries, including Japan, started to see cases rise back in March.

But when I looked up the WHO dashboard on the global mpox outbreak, with data starting in January 2022, I was surprised to find a consistent stream of new cases being reported by China several times a week, as recently as July 20.

For some time I thought this meant Chinese health authorities or researchers had been quietly reporting more timely data to the WHO while keeping the information inaccessible to the public. After all, something similar has happened before with covid data.

Honestly, I found this data surprising and alarming. News about mpox in China has been mostly under the radar, but as the WHO overview explains: In the most recent week of full reporting, 7 countries reported an increase in the weekly number of cases, with the highest increase reported in China." The WHO data shows that from May to July, China reported 315 mpox cases, the most around the world in this time frame.

Sounds quite bad, right?

It turns out the reality is a tad more complicated. On the WHO website, the recent mpox data listed under China is the sum of cases reported in China, Taiwan, and Hong Kong (which a WHO spokesperson tells me is typical).

The lack of data separation is significant here for a few reasons. First, while case counts have indeed risen in China, we don't know by how much and over what time frame. China reported 106 cases in June alone, and it's safe to assume there were additional cases in May and July. (According to Tarik Jaarevi, a WHO spokesperson, Chinareported eight mpox cases to the WHO in July, but it's unclear on what date those cases were documented or whethertheyrepresent the whole month. China's CDC has not publicly released any information on mpox cases forJuly.) There's little to no information there to help us understand the exact urgency and severity of the outbreak, which can lead to panic and uninformed interventions. What's more, as its handling of covid shows, the Chinese government may be holding onto data to serve its own interests.

Beyond that, this combined data reporting obscures the fact that Taiwan and China, with their different governing bodies, have responded to public health emergencies in very different ways.

While China has not signaled any interest in using mpox vaccines, Taiwan, which has its own CDC, has already administered over 72,000 shots so far. While China has only issued a one-month report of case counts, Taiwan has a public database showing how many new cases are reported each week, making it easy to see that the outbreak is on the decline there, six months after local transmission started.

So aggregating very different sources of data creates a confusing landscape and makes it hard to follow the impact of public health measures.

This means that when the WHO data shows a 550% increase in weekly new cases in China between July 10 and July 17, the jump means little. It doesn't reveal the direction of the mpox outbreak; it only emphasizes the broken, irregular pattern of case reporting from China.

This is not to say the outbreak in China is insignificant, but that the data on the WHO website can easily mislead observers.

It's important to realize that despite how authoritative they may sound, international organizations like the WHO don't have a magic source of data that overcomes the limited public health information coming out of China. It can only rely on individual countries to voluntarily report such data. In general, WHO provides aggregated data for China (including Hong Kong SAR and Taiwan)," Jaarevi wrote in reply to MIT Technology Review's emailed questions. He says WHO has reached out to China for case-specific data so the 106 cases in June can be assigned to the appropriate weeks.

Unfortunately, as the status of Taiwan remains one of the most sensitive security topics to Beijing, even the act of singling out the island's public health data can be seen as a political move. That is larger than any technical obstacle. At a crucial time like this, transparent and timely case counting is one of the most important public health tools against infectious diseases. It's too bad that politics is getting in the way of that.

Do you think WHO should disaggregate the mpox data of China and Taiwan? What are your reasons? Tell me at zeyi@technologyreview.com.

Catch up with China

1. Chinese feminists are rushing out to support the Barbie movie. (But you can't do a Barbenheimer" double feature yet, since Oppenheimer isn't arriving in China until August 30.) (Financial Times $)

2. The US government believes Chinese hackers have inserted malware into the communications, logistics, and supply networks of US military bases. (New York Times $)

3. A former party official in the city of Hangzhou, who oversaw the rise of tech giant Alibaba, was imprisoned for life for taking $25 million in bribes. (Bloomberg $)

4. Volkswagen bought a 5% stake in the Chinese electric vehicle company Xpeng, and the companies will jointly develop two EV models under the Volkswagen brand. (Wall Street Journal $)

5. TikTok's newly launched ad library in Europe shows that Chinese major state media have run over 1,000 ads on the platform, even though TikTok's policy forbids political ads. (Forbes)

6. Shein spent $600,000 on lobbying activities between April 1 and June 30, nearly three times its lobbying spending in the first quarter. (Business of Fashion)

7. China will restrict the export of long-range civilian drones, citing concerns that they might be converted to military use. (Associated Press)

8. A Taiwanese businessman accused of espionage and stealing state secrets was freed after two years in a Chinese jail. (BBC)

Lost in translation

A new AI photo generator app called (Miaoya Camera), developed with support from a Alibaba-owned company, is all the rage in China right now. Users can upload 21 photos with their faces to create personalized portraits that look as if they were created by a professional. It's priced at just 9.9 RMB ($1.38), a tiny fraction of what chain photography studios often charge. (These studios have become a popular business in recent years.)

Experts told Chinese publication Southern Metropolis Daily that the technology Miaoya Camera uses-mostly the open-source model Stable Diffusion and a technique called low-rank adaptation of large language models" to improve the result-is nothing groundbreaking but just well packaged for the user experience. Expectedly, a controversy then arose about the broad data use permissions in the app's user agreement; the app apologized and promised it will use personal data only to generate profile photos.

One more thing

This #Barbie is from Dongbei pic.twitter.com/T6acQ3aDCA

- RADII (@RADII_Media) July 27, 2023

These Barbies and Kens are from Dongbei, the northeastern region of China, where food portions are gigantic and people are often stereotyped as being straightforward and tough. (Sort of like the Texas of China, you know.) But really, these are created by an AI artist, Kim Wang, through Midjourney. I talked to Wang in a story earlier this year about using Midjourney to reimagine Chinese history.

Update: The story has been updated with a statement from the WHO to clarify the mpox data reported by China's CDC and the organization's general data practice regarding Taiwan.