But Deng’s statement was also an admission of the inherent frailty of performance-based legitimacy: In a top-down, state-dominated political system, the link between performance and legitimacy is dangerously tight. When I was conducting research about the health effects of pollution in China last summer, I was amazed to hear so many people, academics and ordinary Chinese, treat a policy failure (like a food safety crisis) or an economic problem (like rising income inequality) as failures of the “system” (tizhi) itself.

The centralization of power since late 2012-early 2013, when Mr. Xi became the C.C.P.’s general secretary and then president of China, has only highlighted the system’s fragility. Thanks partly to the removal of presidential term limits and his vast, terror-inducing anticorruption campaign, Mr. Xi has become China’s paramount leader. But his extraordinary authority has deeply unsettled officials at all levels, with unwanted effects.

Lower-level officials have strong incentives to jump onto Mr. Xi’s bandwagon, especially when he signals a policy priority clearly and consistently. With pollution control, for example, they have sometimes become overzealous and have overshot. But with issues that have gone on and off the government’s agenda, such as vaccine safety, local officials are more likely to adopt a wait-and-see attitude for fear of making a mistake — paying lip service to directives but essentially shirking their responsibilities. As the independent scholar Deng Yuwen has argued, extremely centralized leadership leads to the paradoxical situation in which strict regulation backed by tough penalties can actually translate into no regulation and little accountability.

A preliminary investigation by the Jinhu government found that vaccine-management personnel at the township’s health center had failed to follow protocols for the use and stockpiling of vaccines. And that the local center for disease prevention and control had then failed to report the problem or take follow-up supervisory measures. The report attributed those oversights to “chaotic management, neglect of duties, and regulatory failure.”

Even as policy paralysis at the local level makes major policy failures and scandals more likely, the social discontent spurred by scandals tends to unnerve the government, which then sometimes overreacts. Within a week or so of last summer’s outburst of public outrage, the word “vaccine” became one of the most restricted words on Chinese social media. This month after the scandal in Jinhu, a video circulated on Weibo and WeChat showing a meeting with local officials and residents from a neighboring district, Hongze. A woman can be heard angrily asking about “unknown disturbance” to her phone line and, singling out the local security chief, saying, “Is this way the government treats us? ”

So how can the Chinese government get out of its legitimacy bind? To limit the chances of being perceived as under-delivering public goods, it should stop over-promising them, and concentrate on the ones that the people think are of the utmost importance to their well-being, such as food and vaccine safety. To improve its performance in delivering those, the government should allow economic and social forces to play a bigger role. For example, it should open the vaccine market to foreign products, while encouraging citizens to participate in oversight and formalizing ways they can report any violations of safety standards. Setting clearer directives but less draconian and less arbitrary-seeming penalties would also reduce fear among lower-level officials, giving them reason to do their fair share of work and mitigating the policy-paralysis problem.

China’s people have no institutional recourse to replace the country’s top leaders: They are stuck with the government whether they are pleased with its performance or not. Still, the party-state is generally unwilling to pursue widely unpopular policies and risk triggering mass discontent. In this sense, even the C.C.P.’s rule is an extension of the “mandate of heaven” of imperial times — and in that lineage lies some reason for optimism about the future of vaccine safety in China, more rational and more effective policymaking overall and maybe even some measure of decentralization within the party itself.

Yanzhong Huang is a senior fellow for global health at the Council on Foreign Relations and a professor at Seton Hall University’s School of Diplomacy and International Relations.

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