The novel coronavirus, SARS-CoV-2 , that causes the disease COVID-19, has proven the ultimate stress test for governance systems globally. And governments worldwide are failing, showing up for all to see how poorly prepared they were for this examination. Even those governments that are likely to be rated relatively highly by scholars of public policy studying this moment later will not pass the examination unscathed. Such is the virality and lethality of this pathogen that success will be measured in hundreds of lives lost, compared to the tens of thousands of fatalities experienced elsewhere. Yet, the common challenges faced by all governments to fight COVID-19 must not mask the considerable variation in their performance which holds lessons from which we must learn.
Stages in the response
Disease outbreaks, even global pandemics, are scarcely new. The playbook for dealing with them therefore is well understood and has been honed by practices and lessons gleaned from hard-fought battles. A first stage is early clear-eyed recognition of the incoming threat, and, in the case of COVID-19 at least, requires the unpalatable decision to lock down society.
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Ideally this is done with full consideration of how to support the most vulnerable members of society, especially in a country such as India, where so many survive hand-to-mouth. This is a phase aimed at buying time, of flattening the epidemic curve, so that public health facilities are not overwhelmed; and, for using this time, paid for by collective sacrifice, to secure the personal protective equipment (PPE) and medical supplies necessary to save lives.
The second phase of the pandemic response is slowly to ease the burden on the economy by permitting a measured return of business activity so that livelihoods and supply chains can be restored. This stage can only be safely executed if accompanied by a war-footing expansion of testing capacity so that new infections can be identified and isolated at once, allowing contact tracing to be implemented by masses trained to do this crucial and painstaking work in communities across the country. The final stage, which for COVID-19 seems a lifetime away, is a mass vaccination programme and then the full rebuilding of economic and social life. None of this is easy, but, like an examination in a dreaded subject, one’s only hope is early and persistent preparation and, at crunch time, remembering the lessons learned.
What drags systems down
So, why have governments failed to do better? And what separates successful responses from failed ones? Answers lie in three main limitations of contemporary governance systems. First, for all the defensive finger pointing, opportunistic politicking and xenophobic posturing — exemplified best by the peevish current occupant of the White House but hardly unique to him — this is not a crisis that can be tackled without robust and multidimensional international cooperation between nations. From the epidemiologists whose data-driven models inform policy debates about how and when to lift quarantines, to the medical community identifying more effective treatments, to the research scientists racing to find a vaccine, we are watching in real time the benefits of intellectual collaboration that does not stop at national borders. But the nationalistic turn in global politics over the past two decades has reduced investment in and undermined the legitimacy of the very institutions that facilitate international partnership at the very time they are needed most.
Interactive map of confirmed coronavirus cases in India | State-wise tracker for coronavirus cases, deaths and testing rates
Prime Minister Narendra Modi did well to convene the leaders of the South Asian Association for Regional Cooperation (SAARC) nations in mid-March to discuss the possibility of a regional response, but that video-conference call also highlighted that there have been no summit-level meetings of SAARC since 2014, in no small part due to India-Pakistan jingoism that has victimised the regional organisation. Similarly, last week’s outburst by United States President Donald Trump that resulted in his demanding that the U.S. end its funding of the World Health Organization (WHO) not only endangers American lives by cutting off his own administration’s access to vital international data, but also directly affects India which receives significant funding and expertise from WHO (with ~10% of its overall WHO financing in 2019 coming directly from the U.S.).
Second, pandemic response requires a whole-of-government strategy, for which political will and legitimate leadership are vital to convene and maintain.
Textbook examples
Germany and Kerala provide two powerful though different examples of this in action. In Germany, in spite of a high level of federalism that gives its States (Länder) a lot of power, Chancellor Angela Merkel’s ability to mobilise the entire system has allowed Germany to emerge as a success story in Europe. In Kerala, as Patrick Heller described in this daily last week ( The Hindu, Editorial page, April 18, 2020), State Chief Minister Pinarayi Vijayan convened a State response team at the earliest possible moment and has provided the full weight of his office in support of a coordinated public health strategy that has been accepted by the State’s citizens who have learned to trust the government in such situations. Yet these two examples stand out in part for how rare they are. Consider again the cautionary tale of the U.S. where some State Governors have yet to issue stay-at-home orders, and others are rushing to open the economy against the express advice of public health experts, all while the U.S. President urges citizens in States governed by his political opponents to seek “liberation”.
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Third, we are seeing first hand the consequences of starving public health systems of necessary funds and resources. The comparative advantage of the private sector is efficiency; the need of the hour in pandemic response is redundancy, or, more precisely, excess capacity. Most hospitals do not need invasive ventilators normally, just as they do not need vast stocks of PPE and extra intensive care units beds, but these are essential goods right now as we brace ourselves for a flood of sick patients into hospitals. Watching the advanced health-care system of northern Italy buckle under the unimaginable pressures to which it was exposed over the past six weeks should be a cautionary tale for all countries that thought turning health care over to private actors was responsible governance. It is not. Again, consider Kerala, which has consistently ranked at the top of State rankings for health expenditures, and which has, as a result, a well-functioning local public health system capable of implementing the test-isolate-trace protocols critical for fighting COVID-19.
A State in contrast
For a sharp and worrying contrast to Kerala’s success, consider Madhya Pradesh. While State Chief Minister Shivraj Singh Chouhan earlier earned plaudits for his investments in infrastructure, health expenditures are low, with the State ranking dead last in this category as in NITI Aayog’s data. This will undermine the State’s ability to fight the virus, which given the rapid growth of cases and a relatively high case fatality ratio, looks increasingly vulnerable to a debilitating outbreak. But even more worrisome is the abdication of good sense by the political class in the State. Even as the threat of COVID-19 was apparent, and as Kerala had put its State response into action, a soap opera in Madhya Pradesh was in full swing, with defections and the collapse of the Congress State government. Then, while the rest of the country was practising social distancing, Mr. Chouhan was at the centre of incongruous images of large-scale packed celebrations. Now, finally, a full month after its new-old Chief Minister was inaugurated on March 23, Madhya Pradesh finally has a Health Minister. Wish him luck; he is going to need it.
Irfan Nooruddin (@irfannooruddin) is the Director of the South Asia Center at the Atlantic Council and professor in the School of Foreign Service at Georgetown University in Washington DC
