All-of-Government, Whole-of-Society Involvement Needed to Fight Virus Anis Chowdhury and Jomo Kwame Sundaram

The Covid-19 pandemic is now widely considered more threatening than any other recent viral epidemic. Most believe that many more have been infected or even died than officially confirmed.

Despite available information, some national leaders believed that the epidemic would not affect them. Others believed that promoting ‘herd immunity’ would protect populations by exposing them to the virus, triggering human immune systems to produce antibodies.

Flattening the curve?

The principal strategy adopted by most governments is to ‘flatten the curve’, so that countries’ health systems can cope with new infections by tracing, testing, isolating and treating those infected until such time that an approved vaccine or ‘cure’ is available to all.

But this is easier said than done. Vulnerability to infection and capacity to respond depend on many factors including healthcare system preparedness, experience and ability in managing viral outbreaks besides the specific challenges raised by Covid-19.

Government capacity to respond depends crucially on system capacity and capabilities — e.g., authorities’ ability to speedily trace, isolate and treat the infected — and available fiscal resources — e.g., to quickly enhance testing capacity and secure personal protective equipment.

But funding cuts, privatization and other types of rent-seeking in recent decades — in the face of rising costs, not least for medicines — have constrained and undermined most public health systems, albeit on various different pretexts.

Early action without lockdowns

Physical distancing, mask use and other precautionary measures as well as mass testing, tracing, isolation and treatment have checked the epidemic without lockdowns. Such measures have been quite successful so far in much of East Asia, Vietnam and the Indian state of Kerala.

Physical distancing and other precautionary measures, such as wearing masks in public areas, will be critically necessary until a vaccine is affordably available to all. Even the availability of a cure will not obviate the need for prevention offered by a vaccine.

Precautionary measures must be appropriate and affordable. To minimize the risk of infection, authorities can encourage and enable, if not require, changes in social interactions, including work and other public space arrangements, including offices, factories, shops, public transportation and classrooms.

Lockdowns: enforced, extended physical distancing

Since Wuhan, many governments have resorted to various types of ‘stay-in-shelter’ ‘lockdowns’ to enforce physical distancing for protracted periods to try to ‘circuit-break’ transmission. They buy precious time, for complementary interventions, allowing health authorities to check and reverse the spread of infections.

Besides enforcing extended physical distancing through lockdowns, appropriate complementary measures are needed for lockdowns to work. Testing, treating and quarantining the infected need to be complemented by tracing to identify those more likely to be infected.

But it has to be acknowledged that lockdowns are only part of an array of measures available to authorities to deal with the Covid-19 pandemic. Lockdowns are blunt measures of last resort, often due to the failure, inadequacy or delay of precautionary ‘early actions’. And ‘if you only have a hammer, every problem begins to look like a nail’.

A lockdown was deemed necessary to deal with the Covid-19 outbreak in Wuhan, and the surrounding three provinces, after other measures to deal with the novel epidemic seemed ‘too little, too late’. But in most other situations, adequate appropriate early precautionary measures may well have proved enough.

Lockdowns should not be economic knockouts

Depending on context, lockdowns have many other effects as well. Good planning, implementation and enforcement of movement restrictions and provisioning for all adversely affected are crucial, not only for efficacy, but also for transitions before, during and after.

Nonetheless, lockdowns typically incur huge economic costs, distributed unevenly in economies and societies. Governments must therefore be mindful of the costs, including of disruptions, and also of how policies affect various people differently.

The effectiveness of a lockdown has to be judged primarily by its ability to quickly ‘flatten the curve’ and ensure no resurgence of infections. Success should not be measured by duration, enforcement stringency or even by unsustainable declines in new cases.

Most ‘casual’ labourers, petty businesses reliant on daily cash turnover and others in the ‘informal’ economy will find it especially difficult to survive extended lockdowns. Although they need more relief support than most, they are often difficult for governments to reach.

Those living in cramped conditions, e.g., urban slums, cannot realistically be expected to practice consistent physical distancing, but will nonetheless need to be enabled to sustainably practice other precautionary measures within their modest means, e.g., using washable masks.

Governance, mobilization, leadership

To enhance efficacy and minimize disruptions, an ‘all of government’ approach at all levels needs to be developed, involving much more than public health and police enforcement authorities.

Human resource, social protection, transport, education, media, industry, fiscal and other relevant authorities need to be appropriately engaged to develop the various required transitions and to plan for the post-lockdown ‘new normal’.

Another condition for success is ‘whole of society’ mobilization and support. Government transparency and explanations for various measures undertaken are important for public understanding, cooperation, support and legitimacy.

The authorities must also realize how measures will be seen. Singapore’s apparent early success, for example, was not what it seemed as it had overlooked official disincentives for possibly infected migrant workers to cooperate.

Appropriate enhanced public health and other relevant communications and education will often need to be quickly developed to succeed. The efficacy and consequences of a ‘lockdown’ and related measures are contingent on public appreciation of the challenges and the ability of societies to respond appropriately with socio-economic, cultural and behavioural changes.

While the Covid-19 crisis is undoubtedly exceptional and full social mobilization is needed, such special ‘wartime’ measures must not be abused, e.g., by the temptation to bias implementation of measures for political advantage. Success can thus be greatly enabled by legitimate, credible and exemplary leadership, government and otherwise.

(This article was originally published in Inter Press service (IPS) news on April 28, 2020.)