中共建政初期的防疫經驗與疾病治理：「治療型國家」的觀點

Abstract

關於1949年後中國早期防疫經驗，部分研究察覺防疫治理的動員特徵，與醫療實作的科學主義；但國家如何藉由防疫經驗，建構早期防疫體制與政權特性，則少有討論。為了補充既有文獻的空白，本文使用醫療史的治療型國家（therapeutic state）理論，解釋中國1949∼1957年的防疫經驗。首先，由於民國時期雜揉式的公衛體制，與公衛資源短缺等問題，使中共建政以戰時防疫經驗為基礎建立防疫體制。其次，這種制度遺緒，使中共建立一套雙軌制度的防疫監控機制，防疫站即為這種制度下的例證。第三，這套防疫監控機制，受限於黨政體系冗長的議價過程，及職能疊床架屋的問題，使專業性的疫情監督系統，受到資源排擠與政治干預。整體而論，這對理解當代中國防疫體制的延續性特徵，尤其是近期中國的傳染病疫情的資源錯置與疾病監管難題，仍具意義。

Some studies on the early-stage epidemic prevention efforts in post-1949 China have observed the characteristic of mobilization in epidemic governance and scientism in healthcare practices. However, little research has explored how the state drew on its epidemic prevention experience to develop an epidemic prevention system and regime nature in the early years. To fill this gap in the literature, this study expounds on China`s experience in epidemic prevention from 1949 to 1957 using the therapeutic state theory of the history of medicine. First, in view of hybrid public health institutions implemented during the Republican era and a shortage of public health resources, among other problems, the Chinese Communist Party (CCP) established an epidemic prevention system based on its experience in wartime epidemic prevention. Second, this study contends that such institutional legacies led the CCP to establish a double-track system combining epidemic prevention and surveillance mechanisms. Third, this epidemic prevention-surveillance system was confined by the prolonged bargaining process of the party-government system and the problem of overlapping functions, which in turn subjected the professional epidemic monitoring system to resource crowding out and political interference. In general, this holds some significance for understanding the continuity of China`s epidemic prevention systems in contemporary times, particularly in regard to misallocation of resources and difficulties with disease monitoring and control confronting China during recent infectious disease outbreaks.