1. Introduction

The primary issue for the survival of an NGO as an organization is the legitimacy of its legal status[1]. According to the current legal system, NGOs in China can be divided into two categories: one is social organizations and foundations, which are registered with the Ministry of Civil Affairs based on the Regulations on the Registration and Management of Social Organizations (1998) and the Measures for the Administration of Foundations (1988), acquiring legal entity status as social organizations; the other category is private non-enterprise units, which are registered with the Ministry of Civil Affairs according to the Interim Regulations on the Registration and Management of Private Non-enterprise Units (1998), and acquire legal entity, partnership, or individual legal status depending on the circumstances [2].

In the global public health arena, disease prevention and control is a long-term and arduous task, involving the health and safety of countries and regions worldwide and representing a challenge faced by all of humanity. As NGOs participate more in the provision of public services, whether in the fields of healthcare, social security, or the production and provision of public goods, or even in the process of resolving and alleviating social conflicts, they play an increasingly important role [3]. Non-governmental organizations (NGOs), as an indispensable force, play a critical role in disease prevention and control. In the context of globalization, the speed of disease transmission has increased, and the difficulty of prevention and control has escalated, requiring the involvement and collaboration of all parties. NGOs, with their flexibility, innovation, and grassroots proximity, have demonstrated unique value in providing medical assistance, health education, and epidemic prevention and control. Analyzing the participation and effects of NGOs in disease prevention and control helps to comprehensively assess their contributions and roles within the global public health system. This not only provides valuable reference for future disease control efforts but also promotes cooperation and coordination between NGOs, government departments, medical institutions, and other stakeholders. Through strengthening information sharing, resource integration, and complementary advantages, all parties can collaborate effectively. In China, after decades of development, the number of NGOs has continuously increased and they have become a vital component of social governance, playing significant roles in various fields. In particular, NGOs have demonstrated distinct advantages in epidemic prevention and control. Therefore, researching the participation of Chinese NGOs in epidemic prevention and control holds both theoretical and practical significance. This article attempts to examine the participation of Chinese NGO organizations in the practice of epidemic prevention and control against the backdrop of the COVID-19 pandemic, summarizing their advantages, analyzing the dilemmas and challenges they face, and proposing corresponding improvement paths, with the aim of optimizing policies for NGO involvement in social governance.

2. Empirical Analysis of NGO Participation in Disease Prevention and Control in China

2.1. A Bridge for Communication Between the Government and the Public

In the process of epidemic prevention and control, NGOs have become a bridge for effective communication and interaction between the government and the public. For instance, some NGOs help the government publicize epidemic prevention policies, laws, and knowledge, thus ensuring that the government’s policies, laws, and prevention measures are better understood by the public, which helps in the implementation of these laws and policies. Some NGOs also collect the demands and opinions of the public and pass them on to the government in appropriate ways, enabling the government to understand the difficulties and ideas of the public in a timely manner and take corresponding actions. Through this two-way interaction and communication, the burden on the government is alleviated, and conflicts between the government and the public are reduced. This helps the government and the public form a stronger alliance to jointly combat the epidemic. The interaction between the state and NGOs not only does not separate the state from society; on the contrary, it brings them together through cooperation. The state and society are defining their relationship through exchanges, which is the basic operational logic of the protective relationship [4].

2.2. Providing Professional Services

During the epidemic prevention and control process, some NGOs utilize their expertise to provide professional services. For example, some NGOs offer disinfection or infection prevention methods, while others provide ways to improve immunity or offer psychological counseling services for those affected by the epidemic, such as those who are sick or have lost loved ones. In terms of providing professional services, NGOs respond quickly in the event of a disaster and actively participate in medical assistance work. Some NGOs, for instance, dispatch professional medical teams to provide timely medical services and aid to affected populations. Additionally, NGOs set up temporary medical stations to offer basic medical coverage for the affected. These initiatives effectively safeguard the health and safety of disaster-affected populations, demonstrating the responsibility and commitment of medical institutions during public health emergencies. The outbreak of the novel coronavirus in 2020 had a major global impact, with its rapid spread, strong infectiousness, and high mutation rate, leading to a worldwide pandemic. This event became one of the most devastating and far-reaching public health emergencies in recent human history. Community workers, as “guardians” of the community, played a significant role in this epidemic prevention and control process. They formed a community governance model centered around the leadership of community party organizations, with multi-party collaboration from NGOs, enterprises, and residents to jointly combat the epidemic, thereby ensuring public safety [5].

2.3. Providing Assistance

Looking at the development of social assistance systems across countries, it serves as the last line of defense for social stability and the minimum safety net for the livelihood of the poor [6]. During the epidemic prevention and control process, some NGOs mobilize their resources to provide various forms of assistance to the public. For instance, one NGO actively participated in community prevention efforts during the epidemic. This organization went deep into communities, understood the needs of residents, and distributed epidemic prevention materials such as masks and disinfectants to effectively meet the protection needs of the residents. At the same time, the organization also carried out public education activities, combining online and offline methods to spread prevention knowledge and raise residents’ awareness of self-protection. These efforts effectively reduced the infection rate in the community and made a positive contribution to epidemic control. NGOs also provide various free professional services.

2.4. Providing Financial Support

NGO social capital is represented by the relationships, support, understanding, or trust between NGOs, the government, enterprises, citizens, and within NGOs themselves. Epidemic prevention and control requires a significant amount of funding, and the government may face financial constraints. Some NGOs in China have also actively raised funds for epidemic control. Through fundraising activities, they gather money and donate it to specific projects or regions to ease the financial pressure in those areas. NGOs are able to mobilize local and overseas resources that the government may not be able to access, thereby partially compensating for the government’s lack of financial support for vulnerable groups [7].

3. Advantages of NGO Participation in Epidemic Prevention and Control in China

Through an analysis of the participation of Chinese NGOs in epidemic prevention and control, we identify the following advantages:

3.1. Public Welfare Nature

The essence of NGOs is that they are public welfare organizations. They are not profit-driven, which allows them to provide more free services for epidemic prevention and control, and to embody a greater sense of risk awareness in their work. In practice, various NGOs have not only demonstrated advantages in quick response and flexible deployment during epidemic prevention, but also provided extensive support and services in areas such as health education and vaccination. These activities not only enhanced public awareness of diseases but also promoted community health. NGOs, through collaboration with international organizations, government agencies, and communities, have jointly built a diversified disease prevention network, thereby enabling more effective responses to public health challenges. The public welfare nature of NGOs allows them to gain the trust of the government, enabling them to engage more deeply in epidemic prevention and control and better fulfill their roles.

3.2. Professionalism

“Concept and Responsibility” and “The Road to Professionalization” are the essential principles to be upheld within the internal conditions of autonomous growth, and these are more important than “economic foundations” [8]. In China, many NGOs are composed of professionals from specific industries, who possess the relevant expertise. From the perspective of disease prevention, the involvement of NGOs has led to a noticeable decline in the incidence and mortality rates of various target diseases. For example, the incidence of leptospirosis has remained at a low level in recent years, with the highest incidence between 2019 and 2022 being only 0.03 per 100,000 people. Although the specific data for 2023 have not been released, it is expected that the incidence will continue to remain low. Similarly, the incidence rates of diseases such as influenza and Class A and B infectious diseases have also been effectively controlled through the joint efforts of NGOs. Notably, the global challenge of AIDS has seen a significant decline in incidence in China, from 5.10 per 100,000 in 2019 to 3.69 per 100,000 in 2022, reflecting the positive role of NGOs in AIDS prevention and control. The improvement in cure rates is also an important indication of the success of disease prevention efforts, thanks to the close cooperation between NGOs and medical institutions, which has provided patients with more timely and effective treatment.

3.3. Independence

The most obvious characteristic of NGOs is their independence from the government, which results in a looser relationship with the government. Unlike semi-governmental organizations, NGOs cannot rely on the government’s administrative system for operation, nor can they directly utilize the administrative system for their activities. However, they can operate through networks established by government-affiliated or semi-governmental organizations. This represents a secondary distribution of government resources, where government-affiliated or semi-governmental organizations are the primary beneficiaries, and NGOs are the secondary beneficiaries [9]. Compared to the government, NGOs possess strong autonomy and an independent status, enabling them to conduct activities independently. This independence allows them to play a more autonomous role in epidemic responses without overly relying on directives from higher authorities. This independence has at least two advantages: first, it allows NGOs to respond more quickly to epidemics; second, it enables them to make independent judgments and take measures they believe to be more effective. NGOs are characterized by their flexibility, broad reach, and proximity to grassroots communities, enabling them to respond swiftly to disease prevention needs and provide more timely and effective services to residents. Therefore, in disease prevention work, the advantages of NGOs should be fully utilized. Their unique organizational structure and operational methods can be leveraged to carry out diverse disease prevention activities, such as organizing health lectures and free medical consultations to enhance community residents’ awareness and ability in disease prevention.

4. Challenges and Dilemmas of China’s NGO Participation in Epidemic Prevention and Control

From a general perspective, especially considering China’s emerging market economy, our NGOs are still in a vulnerable and difficult period of development. [10] It must be acknowledged that while Chinese NGOs have contributed to epidemic prevention and control, some issues and challenges have also emerged during their involvement.

4.1. Insufficient Legal Protection for NGO Participation in Epidemic Prevention and Control

In the late 1990s, the Chinese government amended the “Regulations on the Registration and Administration of Social Organizations” (1989) in response to changes in the social and economic landscape, issuing a revised version in September 1998. Simultaneously, the government introduced the “Regulations on the Registration and Administration of Private Non-Enterprise Units” (1998) and the “Charitable Donations Law” (1999). Moreover, the Ministry of Civil Affairs has issued over 50 regulations regarding the management of social organizations, with even more local-level regulations for grassroots organizations. These laws and regulations form the legal framework for the development of Chinese civil society post-reform and opening-up (refer to Deng Guosheng, 2002). This framework reflects the state’s role as the primary provider of institutional frameworks, attempting to control, constrain, and influence the growth of NGOs as it shifts from a government-led to a more socially-led model. [11] During the COVID-19 epidemic, the legal channels for the participation of social organizations, such as NGOs, in emergency management were obstructed and not smooth. Issues such as unclear rights to information and participation in emergency management, as well as insufficient protection for supervisory and remedial rights against improper actions, were evident. The current “Emergency Response Law” contains only a few advocacy-oriented provisions, and practical implementation is more complex. From the experience of the Omicron variant’s spread, the lack of clear institutional norms in the existing emergency response law has resulted in gaps in cooperation, responsibility, and supervision between the government and social organizations, which has led to problems, such as untransparent operations and subsequent public reports and discussions. Public concerns during the epidemic focused on three main issues: “insufficient oversight from government departments and other social actors,” “lack of transparency and regulatory constraints in social organization activities,” and “legislative lag in providing a regulatory framework for social organizations.” These issues indicate that there is a pressing need for legal regulations to govern the participation of social organizations in epidemic prevention and control. Moreover, the legal status of social organizations in emergency management still lacks sufficient protection. Affirmative and supportive provisions are limited, and their practical implementation is weak, leading to a fragmented approach in which social organizations act independently and without a clear legal framework.

4.2. Uneven Development of NGOs

There are significant imbalances in the development of NGOs, which seriously hinder their role in epidemic prevention and control. On the one hand, regional disparities exist. For example, compared to commercial and integrated communities, older residential areas have a weak foundation for community autonomy. Faced with the rapid increase in epidemic control tasks, administrative departments struggle to take on the comprehensive and fundamental responsibility. Social organizations, due to their smaller numbers, lower professional levels, lack of coordination, and outdated technology, struggle to collaborate effectively, thus impacting the efficiency of community-based epidemic control. On the other hand, there is an imbalance in the types of NGOs. According to the “Special Action Plan for Cultivating and Developing Community Social Organizations (2021-2023),” the proportion of public welfare and self-help organizations within community NGOs is low, and organizations focused on emergency response development are extremely rare. This indicates a severe imbalance in the types of community NGOs. For instance, self-help organizations are the smallest and have developed slowly, failing to reflect or garner attention for the specific needs of the groups they represent. This limitation also affects the ability of other types of social organizations to provide services. During the Omicron variant’s spread, issues such as the difficulties faced by special groups, including the disabled, patients, and elderly, were prominently exposed. This caused a failure in addressing the demand gaps in community services and triggered a “secondary” crisis in people’s livelihoods during the epidemic.

4.3. Limited Emergency Response Capability of NGOs

The effective operation of NGOs’ emergency response capabilities played a key role in maintaining stability in the post-epidemic era and ensuring the normal functioning of cities. However, with the recent large-scale outbreaks of COVID-19, some Chinese NGOs have revealed issues such as insufficient business capabilities and low public credibility. These problems manifest in several ways: slow response to needs, low work efficiency, slow and imprecise distribution of funds and materials, and some volunteers lacking the necessary expertise and competence. On the other hand, the lack of sufficient emergency resource support for social organizations has hindered the improvement and deployment of their emergency response capabilities. For example, during the pandemic, the emergency policies directed at social organizations were mostly mobilization-based services. Meanwhile, the difficulties caused by the epidemic to the survival and development of social organizations received insufficient attention, and the support policies for social organizations were either significantly lacking or set at too low standards, severely limiting the emergency response capabilities and enthusiasm of social organizations.

4.4. Inadequate Collaborative Mechanism Among NGOs

On one hand, NGOs’ involvement in grassroots services tends to be episodic and temporary, with limited proactive cooperation and interlinking development. In fact, apart from social organizations that collaborate with the government through service purchases, other social organizations have not developed smooth coordination with government departments, social media, and other organizations. This results in low levels of government-society cooperation, lack of flexibility in cooperative mechanisms, and inadequate communication and interaction between organizations. On this basis, due to the localized and departmentalized nature of the emergency management system, information and resources are confined within certain regions, causing NGOs to face fragmented regional cooperation during the epidemic response. On the other hand, some grassroots governments lack experience in managing social organizations, leading to trust and communication issues between them. The heavy burden of epidemic control work has caused local governments to operate beyond their capacity, which in turn made it difficult to address issues that could have been resolved through collaboration with social organizations, due to lack of trust and concerns about delegation. This has resulted in decreased efficiency and chaos. Such uncoordinated, poorly planned, and inefficient emergency response actions have hindered effective epidemic relief efforts. For example, during the Omicron outbreak this spring, civil affairs departments focused primarily on social security matters, neglecting the post-epidemic issues, and failed to prepare adequate emergency plans.

5. Path Optimization of NGO Participation in Pandemic Prevention and Control

5.1. Optimizing Emergency Legislation to Enhance Rule of Law Protection

Standardizing the entities involved in pandemic response and improving the rule of law mechanism are powerful measures to promote the involvement of social organizations in pandemic control and regulate the behavior of practice entities. Overall, it is necessary to accelerate the legislation for social organizations, safeguard their rights, regulate the entities involved in pandemic prevention, and clarify the shared governance responsibility of social organizations and the government in social affairs. More importantly, the government must change its mindset, providing NGOs with adequate space and trust, understanding their current developmental stage, and recognizing the time constraints on the effectiveness of social services. [12] Specifically, this includes clearly defined principles in laws and regulations, participation mechanisms, management systems, and training mechanisms, as well as the development of targeted systems for NGO participation in pandemic prevention based on regional circumstances. This will help form a system that promotes the development of social organizations and supports their involvement in emergency management, guiding their healthy and orderly development. Additionally, regions should encourage the active participation of social organizations in grassroots emergency management cooperation with local governments, enterprises, public institutions, and other regional social organizations based on the improvement of the “three-network collaboration” and “five-network collaboration.” Thus, establishing a sound legal system for NGOs and streamlining management structures to ensure the independence, autonomy, and social function of NGOs, while limiting illegal associations and activities, has become an important part of advancing democratic and legal governance in China. [13]

5.2. Strengthening NGO Organizational Cultivation for Balanced Development

To address the imbalance in the development of social organizations, a multifaceted approach should be taken to increase government support, enhance emergency management capabilities, and gradually form a long-term mechanism for government-social organization cooperation. On one hand, policies should encourage, support, and guide the establishment and development of social organizations, particularly those involved in public health services. This includes improving the policies for the foundational cultivation of social organizations by enhancing targeted support, strengthening talent development, and providing incubation platforms to address the initial challenges of establishing and operating social organizations. On the other hand, a model of “government funding support, professional team management, multi-party cooperation, and societal benefits” should be developed to specifically enhance the emergency management capabilities of social organizations. Furthermore, the policy framework for government procurement of social organization services should be optimized by giving preference to social organizations engaged in public health services, building a demand expression mechanism with three-party participation, and improving the government’s public service evaluation system. These steps will lower the threshold for social organizations to participate in pandemic control, improve the alignment between service procurement and pandemic prevention needs, and enhance the efficiency and quality of social organizations’ services in pandemic control. [14]

5.3. Enhancing NGO Emergency Management Capabilities

NGOs need to enhance their empowerment in emergency governance. The emergency capabilities of social organizations in the face of the COVID-19 pandemic include prevention and early warning, organizational integration, technical expertise, and coordination, which are core to their role in pandemic prevention. Therefore, it is essential to innovate training methods by actively collaborating with civil affairs departments, universities, and emergency-related institutions to conduct multi-level, cross-disciplinary emergency training, forming a combined model of internal and external training, theory and practice. Moreover, market research should be emphasized to analyze the needs for pandemic prevention and the market saturation of social services, aligning the organization’s professional advantages with the demand for differentiated services. On the other hand, the application of “intellect” and “technology” should be finely tuned to ensure reasonable and orderly distribution of the number and types of social organizations and tasks in pandemic prevention within regions, increasing governance resilience. This includes leveraging the professional advantages of social organizations, creating diversified channels for experts and think tanks, and improving the breadth and depth of expert involvement in social organization emergency decision-making. Additionally, a mechanism should be established for the application and analysis of technical governance in pandemic prevention, studying its applicability and effectiveness in different emergency management scenarios. To enhance the role of environmental protection NGOs in ecological conservation, it is necessary to improve the cooperation mechanisms between these NGOs and the government, adopt voluntary registration systems, enhance the organizations’ internal capacity, increase financing abilities, cultivate specialized talent, innovate management systems, update management philosophies, and perfect the supervision systems of environmental NGOs.

5.4. Constructing Joint Prevention and Control to Improve Pandemic Prevention Efficiency

On one hand, improving the cohesion of social organization networks and ensuring the authority of leading departments are key to enhancing cross-organization and cross-departmental coordination and efficiency. At the same time, it is important to strengthen the management of core organizations and members, reinforcing collaborative management among core members, and incentivizing cooperation in core departments to improve pandemic prevention performance. For example, responsibilities and work mechanisms of core organizations, departments, and members should be clearly defined, reducing gaps and overlaps in responsibilities and minimizing conflicts. On the other hand, the emphasis should be on multi-departmental joint governance. This includes strengthening communication with emergency management departments and focusing on people’s livelihoods during pandemic prevention. The social disorder and functional disruptions caused by the new wave of COVID-19 require the establishment of a cross-department, cross-organization collaboration system to guarantee people’s livelihoods and social assistance. A social assistance system, catering to both normal and emergency scenarios, should be developed to ensure basic production and living needs and support pandemic prevention efforts. Moreover, social organizations should play a full role in joint prevention and control operations, including emergency preparedness, response, risk management, and recovery. This approach should be institutionalized. Based on the response to the Omicron variant, social organizations should guide emerging community groups, such as “team leaders” and “self-help groups,” in both theoretical and practical aspects to ensure professional planning and detailed division of tasks for daily community pandemic prevention, such as building security, disinfection, group buying of supplies, and parcel collection.

6. Conclusion

Although this study has made significant progress in revealing the role of non-governmental organizations (NGOs) in disease prevention and control, some limitations still exist. The data sample in this study is relatively small, which may not fully reflect the extensive practices and contributions of NGOs in disease prevention. Future research can further expand the sample size to include more types of NGOs and cover a broader geographical area, thereby improving the representativeness and accuracy of the study. [15]