(Photo: Financial Times)
By Jacob Starr – Contributor
Throughout the Covid-19 pandemic, there have been distinct discrepancies between the fortunes of different countries across the globe in their efforts to mitigate the effects of the virus. This can partly be attributed to difference in resources availability, income levels and standards of living. At least theoretically it is, for obvious reasons, far easier for developed counties to tackle the pandemic. However, a more interesting inconsistency arises when merely comparing more developed counties, which all should, again theoretically, be more financially and medically equipped to impose the necessary public health measures. These extremities between these countries can, albeit extremely broadly, be demonstrated in a comparison between two groups.
Firstly, the Anglo-American group, where governments in London and Washington have performed appallingly throughout the crisis, as the statistics demonstrate. The US and the UK currently have the first and third highest cumulative Covid-19 death figures worldwide, standing at over 117,000 and 41,000 respectively at the time of writing. These figures are put into perspective when compared to those of the second group, East Asian countries. To exemplify this, China (4,634), South Korea (277), Japan (922), Hong Kong (4), Taiwan (7), and Singapore (25) have all, through a variety of successful measures, limited Covid-19 deaths to significantly lower levels, to such an extent that there are undoubtedly differing circumstances in effect.
Whilst there has been significant variation between continental European states, as a generalisation most European nations’ statistics resemble an intermediate level between the Anglo-American world and East Asia. Additionally, Australia and New Zealand are politically and culturally part of the Anglo-America world, but they act as an anomaly, as geographical isolation has enabled their cases to remain relatively low. Therefore, it is necessary to highlight and examine the reason for the extremity between the two aforementioned groups, to understand why the Covid-19 outbreaks in the US and the UK have been so comparatively devastating. Fundamentally, what societal, political and policy factors led to this divergence of fortunes?
Experience of previous pandemics
Originating in southern China, the 2002-04 SARS pandemic affected multiple Asian counties, particularly China, Hong Kong, Taiwan, and Singapore. Though the transmission rate of SARS was lower than Covid-19, the morality rate was significantly greater at around 10% compared to 2%. In response, the lethality of the outbreak prompted the implementation of public health measures in these countries to prevent the spread of the virus.
From April 2003, after a few months of delay, China successfully implemented various local quarantines and wider lockdowns to prevent the spread. As Covid-19 spread through China in January, China did not delay. SARS had prepared them to implement the necessary public health measures effectively and swiftly, resulting in comparatively fewer deaths. Meanwhile, Hong Kong’s experience of more than a third of all SARS deaths led to improvement and expansion of medical facilities and the enforcement of hygiene awareness in the psyche of Hong-Kong’s citizens. This dynamic in Hong Kong and other countries in the region meant they were well-equipped once Covid-19 arrived.
Most significantly, however, was the development of test, track, and trace systems. Taiwan’s difficulties in this area in 2003 prompted them to develop more effective systems for future pandemics. Taiwan’s incredibly effective Covid-19 test, track and trace system has limited their death total to 7, whilst avoiding the need for any lockdown. Similarly, South Korea’s internationally acclaimed testing regime mimics one they were forced to implement during the 2015 MERS outbreak in the country. However, despite these underlying advantages of previous outbreaks, they cannot alone explain the glaring differences in case numbers to the US and the UK, and there instead needs to be inquest into the lack of preparation and early policy errors made by American and British governments.
Early measures and early failings
The difference in Covid-19 deaths between the two groups is consistent with repeated the failings of American and British governments prior to and throughout the outbreak, in comparison to swift action, medical preparation and effective organisational practices implemented by various governments across the world.
The initial failings were embedded long before the pandemic and were perpetuated throughout the crisis, with regards to medical preparations and organisation, symbolised by recent revelations of a British pandemic team of Cabinet ministers being scrapped in July in order to divert efforts to Brexit, and consistent reports from British doctors regarding the lack of PPE at the beginning of the crisis. Meanwhile, the US had insufficient long-term stockpiles of PPE, and failed to effectively order and distribute new PPE to hospitals as American Covid-19 cases increase exponentially. In startling comparison, due to the aforementioned experiences and successful pandemic preparation, many East Asian states have long been prepared through stockpiling and rapid production of medical equipment. Taiwan has sustained massive surpluses of PPE, whilst China developed the organisation capacity to produce a surplus of ventilators. Resultingly, Taiwanese exports of surgical masks to the US have reached over 400,000 and China has delivered thousands of ventilators to Europe and South America.
This surplus in medical equipment has only been achieved though containment of the virus, demonstrating the necessity for effective test, track, and trace systems. World-class Taiwanese and South Korean testing regimes, resulting in relatively low cases validate this fundamental necessity of pandemic mitigation. American testing has been comparatively inadequate, given the failure to implement widespread testing throughout February and March. There was no aggressive testing, isolation, contact tracing, or quarantine in the US for six weeks after the virus hit. Even by May, testing did not meet Harvard University’s estimate of 900,000 tests per day as a minimum requirement of controlling the virus.
The UK was initially testing and tracing effectively, yet organisational failures undermined these efforts when delays in the ordering of testing kits forced the British government to deliberately stall testing efforts on 12th March, despite explicit World Health Organisation advise to the contrary. By mid-March, five weeks after the first British cases on 31st January, the UK was testing under 2,000 people per day. These testing debacles illustrate that it is the timing of measures relative to the emergence of first cases that enables a pandemic to be effectively controlled. Where South Korea and Taiwan acted swiftly, the US and the UK disastrously stubbled out of the starting blocks.
Furthermore, experts have suggested that restrictions in the UK came too late. The Premier League was only suspend on 13th March, while pubs only closed on 20th March. By this point, Covid-19 was widespread in the population. The British government only recently enforced 14-day quarantine for those coming into the country. Taiwan and Singapore introduced this measure on 19th and 23rd March, respectively.
As the crisis progressed, the public message surfaced as another desperate failure, amidst Trump’s overexaggerating of his government success against the pandemic and understating the severity of the outbreak. In similarly incompetent fashion, Johnson’s stubbornness throughout the Cummings fiasco accompanied the start of a period in which the message regarding the easing of restrictions has been vague and ambiguous. Contrastingly, after troubling start with testing, Japan has kept deaths relatively low by providing a clear message to the public, emphasising the need for hygiene measures and the avoidance of large gatherings to it citizens. This has allowed a collective public effort to facilitate gradually loosening restrictions in recent weeks.
A deeper problem – A political and cultural dynamic
As a collective, these systemic, organisational, and political failures imposed severe consequences upon public health. The pattern refutes coincidence and illuminates upon fundamental troubles of the Anglo-American political climate. It is consistent with an entrenched, aggressive form of neoliberal ideology throughout Anglo-American society that uniquely glorifies individualism, privatisation, and deliberate limitations on state control, all of which prove futile during a pandemic. When compared to more collectivist cultures in some countries with limited Covid-19 cases, our individualist culture limits our ability and willingness to produce a collective organised effort.
This political ideology has coincided with stagnating living standards and consistently increasing inequality on both sides of the Atlantic. When our political system cannot be trusted to improve our material conditions, our trust in its ability to manage crisis similarly diminishes, leading to a breakdown in public trust and coordination at the exact point it is most required. Oppositely, where living standards have improved over recent decades, as in China or South Korea, the ability of the political system to improve citizens material conditions translates into public trust in the government’s ability to handle the pandemic, and therefore a stronger willingness to cooperation with the collective effort.
In the US, mass privatisation and decentralisation of the healthcare system has created organisational difficulties with the distribution of medical equipment and supplies throughout the pandemic, while a long-term lack of NHS funding has made it more susceptible to the current public health crisis. These are not just individual decisions by recent governments to reduce spending, they are ideologically ingrained in economic ideas of limited government involvement and the admiration of the free market, that make our society more vulnerable to Covid-19.
Most significant is the persistence of this form of politics, culture, and ideology to limit the organisational capacity of the state. This is demonstrated through its inability to successfully organise the required measures on a national scale, exemplified by the difficulties in implementing vital test, tract, and trace systems. However, it is further limited through an ideological unwillingness to organise. The intense micromanagement of society and the economy being required to fight the pandemic is inconsistent with the ideologies of either the American or British political regimes.
What does this all mean?
The problem arises from the perils and promises of liberal democratic society. The Covid-19 pandemic proves a difficult balance between individualism and the need for collect organisation. Perhaps a more collectivised, locally organised, and participatory form of democracy, whereby decisions are made democratically within communities and workplaces, rather than the top-down competitive elitism we currently have, is required to produce a society able to manage post-Covid-19 crises, such as the climate crisis or escalating inequality.
Of course, the short analysis in this piece is too simplistic, as each country’s experience and success with Covid-19 is dependent on a unique variety of complex medical, societal, political, and demographic challenges. However, it was fundamentally the measures taken early on that made the difference. Moreover, it is the political culture of a society that directly determines the nature of how and when these measures are implemented, and therefore how successful they are. The specific difficulties experienced in the US and the UK can be characterised by a flawed attempt to implement a collective effort during a crisis, after glorifying individualism for half a century.