We both spent hundreds of hours in the Situation Room trying to prevent crises or dealing with them when prevention failed. Often, the issues we dealt with involved whole-of-government approaches here in the United States or working with our allies abroad. This experience got us interested in the key differences between countries that have managed the coronavirus outbreak well and those that have not.
Fundamentally, we define success in managing the outbreak as limiting the number of cases and deaths per capita; failure is the opposite. Examples of success include South Korea, Taiwan and New Zealand; all have rates of fewer than 300 cases per million people and no more than five deaths per million. Examples of failure include Spain, Italy and France, which have more than 2,200 cases per million people and death rates above 280 per million.
At least six factors are responsible for this difference. Understanding them is essential as our government and others struggle to deal with covid-19 and consider how to better prepare for future pandemics.
It is important to note what is not responsible for the differential in country performance. This is critical because the Chinese are aggressively arguing that authoritarian governments have dealt with the crisis better than democracies. Outcomes in South Korea, Taiwan and New Zealand show that Beijing’s self-serving argument is specious.
So, what are the factors? We think three were determined before the coronavirus outbreak and three after.
Quality of health. Countries that have successfully managed the outbreak tend to be healthier than those that have not. Researchers think obesity and heart disease are among the greatest risk factors for covid-19 mortality. The obesity rate in South Korea is 5 percent, compared with 37 percent in the United States. About 10.8 percent of American adults have diabetes, compared with 6.9 percent in South Korea and 6.2 percent in New Zealand. In short, successful countries have fewer preexisting conditions known to make it more difficult to fight off the virus.
Quality of the public health system. The strength of a country’s public health system on Day One is a huge determinant of how well it can handle a pandemic. Countries that plan for and invest in preparedness fare better than those that do not. South Korea and Taiwan were prepared, largely because of their experiences with severe acute respiratory syndrome. For example, Taiwan created a National Health Command Center in the aftermath of SARS; in January, this entity activated a Central Epidemic Command Center to coordinate Taiwan’s response to covid-19.
Culture and social cohesion. These intangibles matter. Societies that elevate the good of the whole over the preferences of individuals tend to have a greater degree of social cohesion and compliance with rules designed to protect the public in a health crisis. Public health guidance is rarely ignored in South Korea, Taiwan or Singapore. New Zealand’s social cohesion stems from its small size, relative isolation, and strong senses of identity and history.
Critical decision-making. One lesson from pandemic “war game” exercises is the importance of acting early and decisively to slow the spread of infection. The adage “He who hesitates is lost” could not be more apt. Leaders who delay decisions because they have imperfect information or believe their country might be spared the worst end up wasting precious time; ultimately, more cases and more deaths result. Contrast that with the decisive early action that South Korea, Taiwan and New Zealand took to lock down their countries to stop the spread of the coronavirus.
Considering the entire country. Countries that have applied policies nationwide or thought through the implications that regional policies could have for the entire country have done better than those that have not done so. Germany was the only country in Europe with uniform practices nationwide from the start; it has among the fewest cases and deaths per capita in Europe. Italy, on the other hand, shut down its northern region but initially allowed citizens to travel, inadvertently spreading infections.
Leadership. This is by far the most important factor; it can affect all the others. New Zealand Prime Minister Jacinda Ardern has been praised for her empathy and clear, fact-based communications. Both have engendered public trust to comply with a national shutdown. South Korean President Moon Jae-in’s party recently won a landslide victory in parliamentary elections due in part to public perceptions of his competence in handling the covid-19 crisis and in rapidly providing emergency economic relief to citizens. Leaders who act decisively and early, demonstrate competence in making tough decisions, communicate the facts clearly and consistently, and show empathy for those affected navigate crises far better than those who do not.
The virus that causes covid-19 is a formidable foe. But many countries have shown that it can be beaten. We should learn from experience and follow their lead.