To get the response to Covid-19 right, our politics must be right
Pandemic response tends to be a topdown technocratic affair. Responsible decisionmakers mobilise the best available science and engineering knowledge to implement social, public health and clinical interventions on a scale that is commensurate with what it takes to manage, control and possibly eliminate the circulation of infectious agents.
But as we have learnt, there is a caveat: for this to work requires the consent and active co-operation of the people.
In authoritarian states, it is possible to herd, cajole and bludgeon people into submission because they lack constitutional rights protection, an independent judiciary (upholding due process and the rule of law), and a free media to report on rights transgressions. In organised autocracies such as the People’s Republic of China, which has a well-oiled chain of command by way of the Communist Party, disease outbreaks can be efficiently contained, in contrast to poorly organised autocracies such as Venezuela, where chaos fuels rapid spread.
But autocratic efficiency comes at a considerable cost to dignity, freedom and rights. In democracies our preferred way of arranging our political lives the people must be persuaded, educated and beseeched to adhere to public health norms by the making of appeals to notions of the common good. As we have seen, in many societies people have given their consent to temporarily suspend some of their freedoms for the common good. As we have also seen, to keep consent, states must be consistently effective in curtailing the spread of disease as variants pop up, each with their unique challenges.
Germany, Denmark, Canada and New Zealand are good examples of democracies that effectively intervened on a national scale during the Covid-19 pandemic. Contrast their performance with those of Brazil, India, Ethiopia and the US all federations that have struggled to be effective. Ethiopia has the additional challenge of a devastating internal war. The US has yet to confront in critical segments of society the anachronistic but enduring belief in limited government, which is an inappropriate manner of constrained authority to have during a pandemic.
The Covid-19 pandemic revealed an additional critical factor that none of the various risk indices recognised as important prior to the outbreak: it is one thing to have public health capacity, quite another to translate capacity into capability. The US, for example, has high levels of refined and sophisticated capacity in the Centers for Disease Control and Prevention, but under Donald Trump experienced a profound failure to mobilise its resources, technology and expertise to practical effect on the ground in collaboration with states and municipal governments. Capacity is about assets. Capability is about mobilising the assets and putting them to work.
How does that happen? It is about leadership, no question. It is also about politics. Politics is nothing but the rules, processes, and adrenaline by which the resources of a country are distributed and applied. In a pandemic, resources should go where the risk to health and life is greatest, not towards who happens to be the best organised or most influential, vectored along party or partisan lines. An epidemic is an existential threat to all people living in a particular territory, and it is in the national interest to defend and protect the entire country. A pandemic is an existential threat to humanity itself, and multilateral institutions should defend and protect our species.
Though our failures to manage pandemics are largely economic, social and political, limited resources are going into research to identify which barriers should be lowered and what incentives put in place for behaviour to conform to pandemic health norms. No parent wants to see their children die, especially when there is a vaccine available. No adult wants to have a life cut short when it doesn’t have to be that way. Except for the so-called antivaxxers a small minority who are not embarrassed to display their private discordance (some say lunacy) in public most people who hesitate simply yearn for more information and greater assurance from those they love and respect, that medical therapies are safe and effective.
We do not therefore have a science, or medical or public health problem, but a social, economic and political one. Both of us have researched and taught, and one of us served in an arm of a state (SA) long enough to know that to get pandemic response right, we need to get our politics right. In the end, pandemic response is not what an elevated group of experts do to people, but how people own and direct their behaviour with the support of their leaders and political institutions.