COVID-19: Governance goes back to basics

The COVID-19 crisis poses a public health and economic challenge unseen in recent times. As one commentator has put it: There has been an unprecedented use of the word ‘unprecedented’. This challenge requires an effective governance response across all of society and across all societies around the world, which governments at different levels need to lead.

There are three critical attributes to COVID-19 while considering how governments should respond. First, it is a new virus, and while research is ongoing, its impact remains uncertain. Second, its appearance is sudden and its spread exponential. The logic of exponential growth means that a handful of cases rapidly becomes tens of thousands. Third, as with any virus, it spreads without account for the demarcations of borders and government structures.

These attributes point to three dimensions of an effective government response. First, actions need to draw on all available information and focus on adaptation and adjustment as we learn more. This places a premium on timely, objective information-sharing – both about the biological and epidemiological characteristics of the virus and the effectiveness of different policy interventions in managing its impact. Second, speed is of the essence. The usual pace of governments is too slow. Waiting for further information is an expensive choice. Finally, the relentless spread of the virus requires interventions at many levels – from the local neighbourhood to the nation-state and the whole world. Getting these interventions to happen is more important than who does them.

How effective has the response been? 

It is too early for definitive conclusions, yet learning-as-we-go is critical to improving future outcomes. And this requires some assessment of performance. The unfortunate number of fatalities does provide one hard measure, even if there are questions on comparability and the need, for example, to consider ‘excess deaths’ above the long-run average as the data becomes available. The economic impact of policies also requires consideration, even if direct trade-offs between lives and livelihoods are unpalatable and potentially also illusory.

The range in mortality is wide indeed, with more than three orders of magnitude. At the highest, countries with deaths per million in the hundreds (as of 17 May, 2020) include the UK at 511, Italy at 528, the US at 211. Those with tens of deaths per million include Poland at 26, Israel at 31, Turkey at 49 and Germany at 96. And those lower still include South Korea (5 deaths per million), China (3), Australia (4), Taiwan (0.3) and Vietnam with no reported deaths.

Being definitive about what accounts for the differences is difficult. The differential impact on those with underlying health conditions is important. But several points stand out.

First-hand experience and context of the leadership in each country has mattered greatly. Asian countries with recent experiences of SARS (2003) and MERS (2015) reacted more rapidly and effectively than those in North America and Europe. The UK based its contingency planning on a pandemic with quite different characteristics, learning from the Hong Kong flu epidemic of 1968-69, among others. If we were indeed facing an influenza pandemic now, then could it be that the UK would be the most effective in handling the situation and not, say, Korea?

Looking forward, rather than accept a roll of the dice on whether an epidemic is similar to one recently experienced, governments need to think differently about how to plan for the initial response to a new virus. No plan can be perfect. No leaders can have the experience appropriate to every new challenge. 

What matters is to recognise coldly and rapidly the situation as it is, even through the fog of uncertainty of a new virus. In the case of the UK, an effective and rapid response would have focused more on learning from the current experience with this virus around the world and less on triggering existing action plans. With a virus that spreads globally, that means piercing through perceptions and biases of different cultures and societies in order to find commonalities. In January, the situation in Wuhan and the actions of the Chinese authorities seemed alien to many in the West. Many did not appreciate the scientific expertise and experience of leading Chinese scientists, drawing on lessons from SARS. ‘Following the science’ in the UK sometimes appeared to mean assessing peer-reviewed western research rather than learning pragmatically from what had worked in other cultures.

It is notable that many of those who moved quickly to close their borders were smaller countries such as Israel, New Zealand and the UAE or those with most concern that their health systems could not cope with a sudden surge in cases – as was the case in many African countries. Speed of action stands out – even in places such as Singapore and the UAE, whose very essence is connectivity and openness to trade and people flows.  

Leadership matters  

The virus’s exponential spread means leaders need to act quickly, in the face of uncertainty. The correct course of action may go against deeply-held beliefs on the role of government in society, making the decisions even more difficult. This firmness of purpose needs to be complemented by an openness to learn rapidly from what is working in other countries and to change course as needed. Importantly, all of this needs to be communicated with reassurance and empathy, underpinned by a relentless follow-through on implementation.

However, a number of leaders who have the ability to rally and persuade a significant number of people in their nations have not acted or have been slow to do so. In Brazil, President Bolsonaro repeatedly denied the challenges that COVID-19 posed, leading to many deaths and the resignation of two health ministers. In the US, the temptation for President Trump to look for short-term political advantage with his closest supporters has won out, placing more attention on who can be blamed, creating splits and competition. Despite this, the size and federated nature of the country has allowed more effective leaders to create space and work together across many states. In the UK, it took several weeks for Prime Minister Boris Johnson to change from boasts of how he was shaking hands with COVID-19 patients in a hospital to asking everyone to ‘stay at home’ and finally testing positive himself. Other leaders such as Chancellor Merkel in Germany and Prime Minister Ardern in New Zealand have been much more effective in leading through actions, explanations and empathy.

Execution matters

Leadership and direction alone are not enough.

After a slow start, the UK was able to build its testing capacity rapidly. It then struggled to get enough health workers to the right place at the right time to use that capacity. Equally, the ability to procure large volumes of personal protective equipment is essential, but of limited use without the logistics capabilities to get it to the right place at the right time. 

Execution excellence does not appear overnight and performance has varied across countries. Drawing on private sector and military support can help quickly fill gaps within the public sector, but playing to existing strengths helps too. The most successful governments have developed strategies that draw on their pre-existing capabilities and what they are able to actually implement. China and Vietnam, for instance, have been able to draw on organisational structures and technology used for domestic surveillance in order to track infected cases. Germany’s decentralised network of laboratories allowed rapid scaling up of testing in contrast to the UK’s initial reliance on centralised testing that would not draw on capacity in universities outside this structure. Local neighbourhood and community organisations have been especially effective in ensuring enforcement of quarantine conditions. South Korea has drawn on its technology sector to develop contact tracing tools rapidly.

Legitimacy matters   

The restrictions imposed on populations by governments and the constraints that populations have imposed on themselves in the past months have been immense. While democracies and dictatorships have different levels of accepted and expected actions, neither could survive imposing the restricted freedom of the past few months without consent.   

The UK passed wide-ranging, previously unimaginable, lockdown legislation and expanded police powers without a parliamentary vote. Yet public opinion on policy choices remains an important pressure and people choose day by day how to behave.

In Vietnam and China, there was widespread acceptance of the need to stay home, even where implementation was more forceful against individuals who disagreed. The cheering from the Wuhan skyscrapers of ‘Wuhan, jia you!’ (Wuhan, keep going!) was spontaneous. It reflected solidarity and pride, not rebellion at being kept at home.

In the time of COVID-19, legitimacy comes from effectiveness and credibility – a belief that government actions will indeed control the virus. In the US and Brazil, this legitimacy appears currently weak, with splintered views and bickering on every aspect of the pandemic.

Global governance still matters

The pandemic has seen a turn inwards: borders have shut, governments have commandeered medical supplies. National and local governments have shown themselves—maybe inevitably—to be more effective in their responses than the UN and the WHO. Underlying US-China tensions have added to the challenge. It is tempting to blame those overseas, whether it is the US insisting on the ‘Wuhan virus’ or China spreading rumours of a US role in the virus origins.

Yet the virus continues to spread globally. Future new viruses will do the same. The most effective responses will be based on open and shared learning from experiences around the world. The fastest early warning of new threats will come from this same openness and connectivity. Whatever reserve stocks are put in place or domestic capacity is built, global trade in health-related manufactured products is still the most effective way to meet peaks in demand – for instance, meeting China’s needs in January and February, and then the needs of the US and Europe in March and beyond. It is evident that poorer countries with the weakest health systems still need support from richer economies to address health challenges. 

Workarounds can be put in place where global responses prove to be impossible. Taiwan, for example, has one of the most effective responses, based on its SARS experience, despite its exclusion from the WHO. But that is a second- or third-best solution.

The recent World Health Assembly vote to set up an independent enquiry into the origins of the COVID-19 virus is a positive sign of multilateral alignment against a background of a tense US-China relationship. Reinvigorating the multilateral response of organisations such as the WHO is critical. All countries need to be involved, while recognising the limits on formal power of any multilateral organisation and not setting unrealistic expectations. Equally, individual leadership makes a difference to what can be achieved in these organisations. Both structures and leadership need strengthening as the virus continues in our lives.