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 appealing to the common good. In many societies, as we have seen, people have given their consent to temporarily suspend some of their freedoms for the common good, but states must be consistently effective in curtailing spread, particularly as new variants arise.
Canada, Denmark, Germany, and New Zealand are good examples of democracies that during the COVID-19 pandemic effectively intervened on a national scale. Contrast their performance with Brazil, Ethiopia, India, and the United States–all federations–that have struggled to be effective. Ethiopia has the additional challenge of a devastating internal war. The United States has yet to confront the anachronistic, but enduring, belief in limited government.
The COVID-19 pandemic revealed an additional critical factor that none of the various risk indices recognized as important prior to the outbreak and it is this: it is one thing to have public health capacity, quite another to translate capacity into capability. The United States, for example, has high levels of refined and sophisticated capacity in the Centers for Disease Control and Prevention, but under Donald Trump there was a profound failure to mobilize its resources, technology, and expertise. Capacity is about assets, and capability is about mobilizing those assets and putting them to work.
How does that happen? It is about leadership, no question. It is also about politics. Politics are nothing but the rules, processes, and adrenalin 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, and not to who happens to be the best organized, or most influential, or vectored along party lines. An epidemic is an existential threat to all human beings living in a particular territory and it is in the national interest to defend and protect the entire country and all its people. A pandemic is an existential threat to humanity itself and multilateral institutions should defend and protect our species.
Although 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 to be put in place for behavior to conform to pandemic health norms. No parent wants to see their children die 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 anti-vaxxers, a small minority, those 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; we have a social, economic, and political one. Both of us have researched, taught, and one of us served in government (South Africa) 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 behavior with the support of their leaders and political institutions.
